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OF
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CITY OF TIGiARD c �
}'Y
OREGON
ESI; No
y3. C)wner:.....-Nx.•... . -Mrs M.R. Helser .Permit o.74l132.........
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i
. �
Building � f �' i bland Drive
g .�d hcss.....1Q6.40...a..W.....Ii -q.......
20th November 74
('s{� Certificate i3 hereby !given thi..... �1..-....... '
y b --------.._.day of. .... ........... . ......... 1�
that said building may be occupied and
that it complies with all requirements of ( V
the Building Code for the City of Tigard -i'
<ls approved by the Tigard City Council. '`
cr,` C.
sac '
Building Inspector 'r
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EXHIBIT "B" 9098
CITY OF TIGARD
C19MFICATE OF OCCUPANCY AND RELEASE OF RESTRICTION
The City of Tigard hezeby certifies that the occupancy of
the following described structure or premises with respect to which
a restriction of occupancy was, on September 4 , 197},
recorded in Rook '`41 , rage 253 , Deed Record of War>hington
County, Oregon, is hereby authorized and approved.
DESCRIfPION OF PROPERTY:
Summerfield - lot 156
As recoreded in Book 34, pages 5, Plat records of Washington
County, Oregon
OWNER: Mi... F. Mrs. M.R. Helser
BUILDING PERMIT 104MM: 74-132
BUILDING ADDRESS: 10640 S.W. Highland Drive
This is to certify the said structure meets with the require-
ments of the Building Code of the City of Tigard and the above
referenced restriction is hereby released and terminated.
Ifo WI'1'NE,`;S WHEREOF, the undersigned authorized officer of the
City of Tigard has caused this certificate and r^lease of restriction
to be executed this , day of
Title: CITY RLCOROLR
;STATE OF OREGON )ss.
County of Washington )
On this 20th day of hove fiber , 1974 , personally
appeared before me the above named Doris fiarti.g , whose
signature appears hereon and who acknowledged to me that he executed
the same in his offical capt.rity on behalf of the
City of Tigard.
LI k
Notary Flublic of Oregon
My Commission expires:
fibd la own.-' l ,...c r .... .�1...al,L-AB Y.PM
pqn '"MM
o�
BJU x.001 ►�t,i 784
"00
9098
� t o
F
ou i r
• r
0
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•Ta
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l
City of Tigard
INSPECTION REQUEST
for f
I
INSPECTION TIME :,atiY• ,-,,
PERMIT NO. :
DATE: !O ,;81 71 DATE ISSUED:_._!_..t... I
OWNERS NAME : 7• o �=
ADDRESS : -s'LJ 41404N4wn 00,604e
CONTRACTOR :��'�` "E(a __
i TEST: Air O, Water [] , Visual ❑ , Laboratory ❑
I RESULT. Approved 0 , Disapprover Pending ❑
SKETCH:
I
I
I
INSPECTOR Y DATE
I4
CNOtE : Attach supplemental fest data heref]
I
ALL SPACES MUST BE ENDORSED PRIOR TO
ISSUANCE OF BUILDING PERMIT f
PLANNING DEPT.
PUBLIC WORKS DEPT.
By
BUILDING DEPT,
DJ
TUALATIN RURAL
FIRE DEPT. Py
APPROVED FOR C:,:.
CITY OF TiG!L:D
PERMIT #
BY TITLE DATE
4
3
b f!
City of Tigard
c' i SPECTION REQUEST
for
INSPECTION TIME: A- PERMIT PERMIT NO. : --
DATE: DATE ISSOEV :_LL
OWNERS NAME :
ADDRESS:CONTRACTOR : L�_✓�Tt''`/ �'�.�1��2�'c I
TEST : Air ❑, Water❑ , Visual, Laboratory ❑
RESULT: Approved Disapproved 0 , Pending ❑
SKETCH: IAJ),Y PKe 7—/&A/
t�
w
INSPECTOR DATE
[—NOTE: Attach supPlemOntal test data lareta]
City of Tigard
INSPECTION REQUEST
for
INSPECTION TIME: PERMIT NO. :—
DATE: �? 1.'2,:;(,2V DATE ISSUED :
OWNER-34 NAME :
ADDRESS:
CONTRACTOR
TEST : Air ❑, Water[] , visual , Laboratory ❑
RESULT: Approved 10 Disapproved A , Pending ❑
SKETCH: �,' - �. •�
-7?5
INSPECTOR DATE
�NOTQ: Attach 9 _,oplemental test data beret]
i
i
City of Tigard.
i INSPECTION REOUEST
I for r
_ I INSPECTION TIME : ,S `" PERMIT NO.: L
L
DATE; DATE ISSUED:
r I OWNERS NAME: SDC
ADDRESS :
CON 'RACTOR :-7--=-
I
VC
TEST: Air[], Water p , Visual$ , Laboratory ❑
RESULT: Approved in
Disapproved 13 , Pending U
I SKETCH:
I
I
I
I
I
I �
Icoo ,< 21
I INSPECTOR DATE
INOTE: Attach fupplamantal teat data hast]
1
J
I
I
City of Tigard I
INSPECTION REQUEST
I
for
INSPECTION MIME. _
PERMIT NO. :— i
DATE: / / DATE ISSUED :_1—_L_—
OWNERS NAME : —
ADDRESS:CONTRACTOR : ----- ---- — I
TEST : Air ❑, Water❑ , Visual ❑ , Laboratory p I
RESvLT: Approved.)�L Disapproved ❑ , Pending p
SKETCH. I
� l
I
F t
t'INSPEGTOR DATE
[OIE: Attach supplemental tett doto heretai
PLUMBING PERMIT APPLICATION
Jurisdiction of
No. Type of Fixture Fee Permit No. 7 q-1 e1J--P
Permit fee 2 —;G
Water Closets Toilets �i`�' Permit Issi,e
-- - Bath Tubs Approved by —
Lavato Wash Basin _ Building Permi
Shower—�— Receipt No. ,�y�/
Sin �Dishwashing�
Sinks,.---Kitchen
Kitchen—
Sinks Ordinary Location of Building
--- inkst Bar_____`_ ___
S i nk s Sl ep G -_------
_Automatic Dishwaaslier—
Disposal _ � �,
_ Laund_ry_ Trays — Name,,& Address of Owner _—
Drains, Floor_
I)rain_s, Area
Drains Reiter erator -
Rain Drains •�
I Automatic Washer Name & Address of Plumber
ountains_,__ r_ n in
Fountains, Soda —
Hot Water Tank U-1'.-e-jw __—
Water Service Size
_ Urinals _ — _ Buildin Old or New Alter, Repair or
_ CaT . -TF - �laraT — —
_ Lawn Sprinkler SystemSwimming Pool Other
_SLrink] -r 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 $1,000 boil
I hereby certify that I have read and examined this application and know the s
to be true and correct. All provisions of laws and ordinances governing this t
of work will be complied with whether, specified herein or not, the -ranting of
permit does not presume to give authority to violate or cancel the provisions
of any otter state or local law regulating construction or the performance of
construction.
I
n ' Signature of Applicant
No
City of Tigard
INSPECTION REQUEST
for
%
I INSPECTION TIME : PERMIT NO.: .
I DATE: DATE ISSUED:�l1
OWNERS NAME : 770 - C
ADDRESS :
CONTRACTOR : I
f
TEST: Air❑, Water ❑ , Visual ❑ , Laboratory ❑
RESULT: Approved , Disapproved ❑ Pending ❑
KE
3 TCH:
I
I
I
I
I 1NSP CTOR DATE
ICOTE: Attach ►upplemental tett date herat:01
1
wR iIw w �w w w w ISI
& !T" of
BUILDING PERMIT APPLICATION TIGARD DATE__? 7`7� N-o -
THE UNDERSIGNED HEREBY APPLIES FOR APERMIT FOR THE WORK HEREIN INDICATED
OR AS SHOWN AND APPROVED IN THE ACCOMPANYING PLANS AND SPECIFICATIONS. oWN t /5-E_
OWNER ADDRESS /LAGs"�1 L. .al BUILDER PHONE
/ ENGINEER
BUILC/DER l-✓y`F/" ARCHITECT _ DESIGNER
STRUCTURE NEW — ❑REMODEL ❑ADDITION El REPAIR ❑RENEWAL ❑FIRE DAMAGE_ ❑DEMOL.ITION
RESIDENCE ❑COMM ❑EDUCATIONAL ❑GOV'T ❑RELIGIOUS❑PATIO ❑CARPORT— ❑GARAGE ❑STORAGE❑SLAB ❑FENCE
❑BOND ❑MOVING ❑CONDITIONAL USE ❑DESIGN REVIEW ❑COUNCIL APPROVED [:]SIGNS
OCCUPANCY __.LPND USE ZONE � !—BLDG.TYPE FIRE ZONE_� PLAN CHECK BY� JS'" HEAT__ __
--
UCC. LOAD_. FLOOF_i_LOAD HEIGHT NO.STORIES AREA VALUE .c'/
BUILDING DEPARTMENT SET BACKS FRONT REAR LEFT SIDE — RIGHT SIDE —
Permit / 1 —`"
----- THIS PERMIT IS ISSUED SUBJECT TO THE REGULATIONS CONTAINED IN THE BUILDING CODE, ZONING
Plan Check REGULATIONS AND ALL APPLICABLE CODES . ND ORDINANCES, AND IT IS HEREBY AGREED THAT THE
-- - -- WORK WII.L BE DONE IN ACCORDANCE WITH THE PLANS AND SPECIFICATIONS AND IN COMPLIANCE WITH
Recording ALL APPLICABLE CODES AND ORDINANCES. THE ISSUANCE OF THIS PERMIT DOES NOTWAIVE
RESTRICTIVE COVENANTS. CONTRACTOR AND SUB CONTRACTORS TO HAVE CURRENT CITY BUSINESS
1%State LICENSE. SEPARATE PERMITS REQUIRED FOR SEWER, PLUMBING AND HEATING.
Total l
By
_J C41PPI_ICAN1 OR AGEN1 T
Apprcved Receipt No
ADDRESS ---------- pr/pNF
DATE INSP TYPE INSPECTION REMARKS PLUMBING DATE
._Cfyjtractor'&�444,�,J�11
Permit No. 1�
Rough in
Fixture
Fint.1
HEATING
Contract
Permit No.
Gas or Oil
Rough-in
Final
SEWER
Final
DRIVEWAY
Final
Storm Drainage
(Rain Drain) Final
Sidewalk
Curb&Street Final
AppjoactL__'
FILDG, DEPT. FINAL TEMPORARY CERTIFICATE OCCUPANCY Final
CERTIFICATE OCCUPANCY
Landscaping
Zoning Final
1407'2
EXHIBIT "A"
CITY OF TIGAI3D
Residuntial Str4„ture Occupancy Restriction
KNOW ALL 142N BY UMSE PRESENTS, That occupancy of residential
structure (c) on the following described lands prior to the reco)d;ng
of an occupancy permit releasing the restriction in the Duc,. RQcords
of Washington County, Oregon, is prohibiter: by the ordinance of the
City of 'iirard, Oregon:
DESCRIPTION 0: PROPERTY: Summerfield - Lot A50—
AG recorded in Book s Pe. e _ 5�, Plat records of Washington
County, Oregon.
ADDRESS OF PROPERM(n&t/b e; L-) JA, 1._
DIAME OF WIER: ["la �+ M.5 t�►Y�c `�7.��c--�--
ADDIU',)S OF OWNr .l f 1J• L 1 2,ti T_1t fit:c
--r--'4
IN W:F;99SS MMIREOF, the undersigned has caused this restriction
Th
to be executed this day of 19 7„,
OY,�IER i
�`ti.�ti. fi or,ent,t'o ;sm Inn.
Nane
AI'PROVFD:
i:'ale
By:
Building Official ?y
City of Turd 7-/7 7y �°2
fthdIw twcetd........................._19 ......at........ P.D
,3Q��� RO+;�H TNUt.1GCT.H, bin,+nt nl A��otd� ti rlornoni
STATE OF OREGON )
County of Washin;�`on ) 9
sonally appeared bef,re me the above named
r RM acknowledLed the foregoing instrument to bo
voluntary act and Ot-.d,
tion y Public 'or Orcgon
r n� 984 f%%283
STATE OF OREGON
County of Washington
nrd ElecRum Ond Ex Officlen olReW of Records
"ayonces for said county, da�r o/ Con•
received a�IrIthin Instrument Of wNting erwos
recorded in book of rrcord,
No.
of said COSY
Witness my hand and seal offixed.
ROGER THOMSSEN, Director of
Records 6 EkWlkny
'lU
L o►ar+h
JuL 17 12 24 PM'74
,W
EMLBIT "A"
CITY OF T.IGARD
Residential Structure Occupancy Restriction.
KNOW ALL MLN BY MMSE PRESE.'MM, That occupancy of residential
structure (s) on the following described )ands prior to the recording
of an occupancy permit rcicasirqr,1 the restriction in the Deec Records
of Wachington County, Oregon, is prohibited by the ordinance of the
City of TiCard, Oregon:
DESCRIPTION 07 PROPERTY: Summerfield - Lotj�
As recorded in $odt Page , plat records of 1s1ashirgton
County, Oregon.
ADDRESS OF PROPYRTY;JO&V0_6,-Lj, kA Wlri.'A If r__
NAML OF OWNER: r"l c_ 1� ? M_R 1A
ADDn-SS OF OWIdU: I Z.i i2 g, 1;��
IN WITNESS MTEREOF, the underaiLmed has caused this restriction
Tk_
to be executed this ' defy of
OW'MR
i.-Ain i:mrF ^rent �„aa 7�r/
APPROVE
Title
By;
lWilding Official
City of TiGard
STATE OF OREGON ) Gay
County of W&GhInSton ) z9 .
eraons2ly appeared before we the above named
and acknowledged the foregoing instru to be
voluntary act and deed,
Tiota •y I iblic for 0 g n
1.Y CVu.,U n11Vil ..Aoi Vti�
� A w
i
i t
14=
�X1iIHIT "/."
i CITY OF T IMAD
Residential Structure Occu;.ancy Rcstrictioa
KNOW ALL Ir\dN BY TI SE PRESE21�, That occupancy of residential
structure (.$) on the following described lands prior to the recording
of an occupancy p 1 pcnnit reicasinS the restriction in the Dees Rocorda
of Washington County, Oregon, is proh:'bited by the ordinance of the
E City of Tirard, OrcEon:
DESCRIPTION 0? PROPERTY: :;wnnerfield - Lot
Ara recorded in Book r, Pa„o , Plat records of Washington '
County, Oregon.
i
ADDREM OF PROPERTY tJQG,��b �'� L J• la. t, r.1-,r�. 1 .__ /S
NA X' OF 01;'101 (�'1:
ADDIia5 OF Cklim: TAi
}
q IN WITNESS WHEREOF, thu undersigned has caused this rectrietion
fm to bo executed thio day of � �- 192Y.
r y
Tt/nIntA_ tt.I'•yh �t7r,r:nt.t;'o ,.ttt"• Ire../
APMA ova:
iiL'lo i•
D : ill t >fe' / ���c;,7—
N .
f y 4
uilding Official
/Jity of Tigard rn.e 10 W-40
Ir �,ryttr.11 T110MRR[N.Mr+.M.1 Rsast�.1r[twetcra
STt z OF OREGON ) •e. �� X �. ����'..... ...........a.�
Coun>wy . Washington ) 19 .
Psonally appeared before ma the above navA _
and acknowlcdGm•i tho forcroing instrument to bo
{yy3 voluntary act, and deed.
F.:� 984 IALt283
-1 C i iri✓-r-J
CITY OF TIGARD
12420 S. W, Main Strut
TIGARD, OREGON 97227
APPLICATION FOR BUILDING PERMIT
New Construction ® Demolish Addition Remodel Move F]
ZONING DATE ISSUED_-��j`�� BUILDINC, PERMIT
DATE RECEIVED [ I /rr BUILDING FEE $y �[,7 No.
BY PLAN CHECK $ ' '�
OTHER/Irc..{,/ $ VALUATION
TOTAL/ RECEIPT No.__OyV
TWO SETS OF PLANS AND PLOT PLANS MUST BE FURNISH3D 44TH APPLICATION
LOT #, (a _ MAP # CENSUS TRACT JOB # - ,-
Architect or Engineer
Address / ` c I 'T' • Phone - 1
Ow ne r_t.-Ar'_-'--tn"-
Address L
Builder "{"Q, C
Address Phone
BUILDING USE Single Res. IA/ Multi Res. CI Comm. Tndust.rial�.-]
OCCUPANCY. GROUP No. of Stories Total height Area of Lot
Type of Const-.ruction I II III IV ® Floor Area
Set Backs: Front-,r; Back 1��(o � L.Side-j C" e� ((i����
Private Sewer Pipe Size._ Sewer •+ - Septic Tank U
water Service Pipe Size_ 3 " Storm Sewer Ditch ❑ Drywell E
S'-reet and Curb Requirementsr-,i
Driveway1
width �� No. of Parking Spaces T,
SEPARATE PERMITS REQUIRED FOR SEWER AND PLUMBING
SPECIAL INFORMATION
ADDRESS ASS:i,.VED—�-(`i
FIFLD CHECK By _-_DATE01j')
PER141T APPROVEDit is understood that all work will conform with applicable codes and ordinances
of the State cf Oregon and the City of Tigard, Oregon, and that the building will
not be occuPied until a Certificate of Occupancy has been iSSu,.•d by the City of
Tigard Bu!lding Inspector. -
y,
5i nature of�17ant -- - ._.__...
t