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EXHIFIT iBn 17;?43 ���'� )`✓��
CITY Of TIGARD MAR 1? 1975
CMTIFICATE OF OCCUPANCY AND RELEASE OF RESTRIMION CITY OF tIGARU
The City of Tigard hereby certifies that the oc:upancy of
the following described structure or premises with respect to which
a restriction of occupancy was, on .lune _7_____
rccarled in Book 978 , Page 686 , Deed Record of Washington
County, Oregon, is hereby iuthorized and approved.
DESCRIPTION OF PROPERTY:
5ummerfield lot #155
As recorded in Hook 34, Page 5, Plat
records of Washington County, Oregon
OWNER: Mr. A Mrs. M.R. Helser
BUILDING PERMIT NU1,15F.E:
BUILDING ADDAFSS: 10b20 5.W. Highland Drive
This is to certify the said structure meets with the require-
ments of the Building Cale of the rity of Tigard and ',ue h')uve
referenced restriction is hereby released and terminated.
IN WITNESS WHEREOF, the undersigned authorized officer of the
City of Tigard has caused this certificate and release of restriction
to be executed this ,((o day of , 192.
Title: C,f
STATE OF OREGON
SS.
County of Washington )
On this _ 2L day of February , lye, personally
appeared before me the above named Doris _Hertiq__, who-e
signature appear:, hereon and who acknowledg— to me that he e,:ecuted
the st;me t. his offical capacity on behalf of the City of Tigard.
Notary Pulflic of Oregon
My Commission expires:
/ C
rU+A la r+roei.. :...1.......-.._10./ al..:�..1WR A M.
ROOCA VION."EN, M Morn,
book i nn lit F,,Aft h.........._ ...._....................;t,7.1�.....
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City of Tigard
i NSFIEuriON REQU ESJ
for
i%�PECT'ION TIME'
DATE
OY!N FIS N A M F. : ..__Z-0,C - ---------
AU0RE3S: / d&aO -S,ti-_/�
TE "' ' ,'tr r':..ier[j , v1suai 71 ,
RESULT' Ari 4 ' <, Oisapproved I'-s ~. :r,� U
�.+ ,. �...,. ...«. .. .�.�r-�rr�....w .�...• ...w. .. . ..., ..� ..-.. -. .mow
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,f Et:TOR CSAO"E
LNA 114M49 _.
ALL SPACES b2UST BE ENDORSED PRIOR TO
ISSU.,VGE OF BUILDING PERMIT
PLANNING DEPT.
By Date
PUBLIC WORKS DEPT.. _ _�y
By �� —Date
BUILDING DEPT.
TUALATIN RURAL
FIRE DEPT. By Date
APPROVED FOR C^ T3TRi;CTION
CITY OF TIGARD
PERMIT # ADDRESS
BY TITLE---------DATE--.-
13
ot,
I
I
City of Tigard
INSPECTION REOUEST
for
�-, i Cie
INSPECTION TIME : 2;-Z-L,,-7?", PERMIT NO.: —_.—
DATE: DATE I SUED:....,L...L
OWNERS NAME;��T�C �
ADDRESS .
CONTRACTOR :
i
TEST:Air❑, Water ❑ , Visual ❑ , Laboratory ❑
RESULT: Approved )( , Disapproved ❑ Pending ❑
SKETCH: s, ;
7
INSPECTOR DATE
EOTE: Attach supplemental toot date karat-10
i
I
I
I
City of Tigard I
INSPECTION REQUEST
I
for
INSPECTION TIME: ='r PERMIT NO. :-
DATE: .
O. :DATE: DATE ISSUED : / / I
OWNERS NAME ,
ADDRESS:
CONTRACTOR :
TEST : Air ❑, Water❑ , Visual Laboratory ❑
RESULT: ApprovDisapproved ❑ , Pending []
S KETCh:
I
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I
I
INSPECTOR DATE i
[OTE: Attach sapplsmental test data berets] I
J
PLUMBING PERMIT APPLICATION
Jurisdiction of
No. Type of Fixture Fee Permit No. 7q-113= P
Permit fee �3n —*I" 30�
Water Closets (Toiletsj Permit Issued
Bath Tubs &A0 Approved by _
Lavatory Wash Basin 0_9 Building Perrdt
Shower Receipt No. _1,.) :71 (r773-
-Tinks. Dishwashing
Sinks Kitchen -
Sinks, Oj:SLinary Loc tion of Building
P �
Sin
ks, Bar_ �- .0 �✓/� SD _
Sinks Slcp_ _
_ _Automatic DishwaiEer
Dis oral
LaundryTrays Nae & Address of Owner
Drains, Floor_ �
_
Drains Area
Rain Drains
Automatic, Waas'aer Il Name Add u%mer v' _
oun ains,
Fountains, Soda _ /�' z
Hot Water Tank — --✓
Water_ Service (Size 977
Urinals Bui Old or e Alter Repair or
Catc77 asins - and s .a
Lawn Sprinkler_ System —
Swimming Pool _ Other
_Sprinkler System__�
This permit becomes null and void if work or construction authorized is not
commenced within 60 days, or if construction or work is suspended or abandoned
for a period of 120 days at any time after work is commenced.
All plumbing firms must be licensed by the City of Tigard and post a $-.,000 boric
I hereby certify that I have read and examined this application and knoo the san
to be true and correct. All provisions of laves and ordinances governing this t}
of work will be complied with whether specified herein or not, the granting of t
permit does not presume to give authority to violate or cancel the provisions
of any other state or local law regulating construction or the performance of
construction. i
Cj 0
IX 30
L� ✓ �� Signature of Applicant
: 863
EXIiIBIT "A"
CITY OF TIGARD
Residential Structure Occupancy Restriction
KNOW ALL MCN BY THESE PRESENTS, That occupancy of residential
structure (a) on the following desc-lbed lands prior to the recording
of an occupancy permit releasing the restriction in the Deec. Records
of Wushington County, Oregon, is prohibited by the ordinance of the
City of Tigard, Oregon:
DESCRIPTION OF PROFERTY:
., .. �1CA Lit tk �
\"4mc oX-cry cMjV,- \MCI S
ADDRESS OF PROPERTY:
NAME OF r)WNER: 1 It r-,
ADDRE i r' OWNER: � 4 If I III A
IN WITNESS WHEREOF, the undersigned has caused this restriction
to be exce,ited this �U, i. day of
VNER t
--Name
AFPROVED: By:
Tale
Byt ti 2.e —
BAICfng official
City of Tigard
STATE OF OREGON /
County of Washington ) �a•l , 197,* .
F rsonally appeared before me the above named
-, acknowledged the foregoing instrument t� be —
voluntary act and deed.
Note y Public f r,Oregon
�a"d�++•^ �e... „;. My Comm!scion Expires t
THUM53LN, p„�
Buoy 978 1,ILMS
Sl ATE OF OREGONCI � es
County of Washington
!, RogerThomson, Director of Records
and Elections and EK-OfticlaRe he i"t ce t fy
Con
veyances for said county, dwrlyrq was
that the within Instrument of
rec,ved and recorded In bcwk Of records
Wltneu my hand and 8"1 Offbw.
ROGR THOMSStN, Director Of
Record 6 SlWIOM
D"suhr
Jua► 7 12 '' t
EXHIB.'T "A"
CITY OF TICARD
Residential "tructure Occupancy Restriction
KNOW ALL MCN BY THESE PRESENTS, That occupancy of residential
structure (s) on the following described lands prior to the recording
of an occupancy permit releasing the restriction in the Deec. Records
of Washington County, Oregon, is prohibited by the ordinance of the
City of Tigard, Oregcn:
DESCRIPTION OF PROPERM 1
t' tk
`_-7 L„) ♦"1.-� r r� C �\ L C .1.4.1
: Fcc � c�5 C:3 Wagl�;��c� } cr�
Com.,„�
ADDRESS OF PROPERTY:
NAML OF OWNER
ADDRF.53 OF )WNM Z , t ` ,�.4 1
IN WITNESS WHEREOF, the undersigned has caused this restriction
to be executed this �y �� day of T��c��� 197y•
OWNER:
APPROVEDt By:
T:tle
By:
i”
BcYi ding Official
City of Tigard
STATE OF OREGON ) ss.
County of Washington ) �� ,y �9?y,
yireona.11y appeared before me the above named �,
and acknowledged the foregoing instr i�r_,z#o be
voluntary act end deed.
i3'f2l—o— e 92 1 Ila—
No y Public for Oregon
My Comm'soion Expires. _
CITY OF TIGARD
12420 S. W. Main Sfrraf
TIGARD, OREGON 91223
APPLICATION FOR BUILDING PERMIT
flow Construction Demolish ❑ Addition ❑ Remodel C1 ?love LJ
ZONING DA'L'E ISSUED BUILDING PERMIT
DATE RECEIVED J--9- )`f HUILOING FEC $—;�_}_U _ No. �
PLAN CHECK $� 7_I ----- 7<17<1- .?—
13Y__ $ VALUATION
TOTAL/ $ %J RECEIPT No.-Lo-q0
TWO SETS OF PLANS AND PLOT PLANS MUST BE FURNISHED 'ITTH APPLICATION
LOT # -1 j t MAP #--- -- - -- CENSUS TRACT Y_ -- JOB #4j�[�_
Architect or Fnginee
r;������ __\��Y�r�{�,1�s•,1C_-�?LZy- __
--- Phone
Owner
Address_\ Z.�'+� l��l. t� 1 _r ,Phoneme
Address—
BUILDING USE S±ngle Res. OX Multi Res. ❑ Comm. ❑ Industrial❑
r'x_CUPANCY GROUP Z _- No. of Stories 1-_ Total Height_,_ Area of Lot
Type of Construction I II ITI IVC Floor Area B-
Set Backs: Front __ Back_] L.Side� � _ R.siee�'.�"
Private Sewer Pipe Size _ Sewer^y,,t1cI 1A_t Septic Tank ❑
water Service Pipe Size Storm Sewer o Ditch ❑ DryweII❑
Street and Curb Requirements e15 rcr.'A � _-
Driveway Width_,— F,�_ l_k -------------No. of Parking Spares_ Z
SEPARATE PERMITS REQUIRED FOR SEWER AND PLUMBING
SPECIAL INFORMATION
ADDRESS ASSIGNED
FIELD CHECK BY DATE
PERMIT APPROVED BYL5�� '--
Tt is understood that all work will conform with applicable codes and or.ainances
of the State of Oregon and the City of Tigard, Oregon, and that the building will
not be occupied until a Certificate of Occupancy has been issued by the City of
Tigard Building Inspector. � �
gn u a App it catSt ___