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C- CITY Y U TiGARD
Y
OREGON
' Owner:....Tualetin Development..Co.
................ No........74728_...
- -
� , Iuilding Ac1rl►ess......... 10035 S.W.,,C•en•tury...0e,k. Drive"............. F ► j
x.
Certificate is herchy given this......28.th_day of.. ...Ja.nu.ar.y........., 19...7.5..
that said building may be occupied and
that it complies with all requirements of l
the Building Code for the City of Tigard,
as approved by the Tigard City Council.
f...:3`...`.......... ........................................
Building Inspr
ecto
-iii�.:.:%"��'-i��--'��-_' _i��: '�::�i°—i_��`�_ �•>� '• 3
G'•ou Ht •. ��
City of Tigard
INSPECTION REQUEST
for
l
INSPECTION TIME : PERMIT NO. : _._..
DATE: Y.L- DATE ISSUED: _ .L
OWNERS NAME :
ADDRESS :
CONTRACTOR : /. T
TEST. Air ❑, Water ❑ , Visual 0 , Laboratory ❑
RESULT: Approved , Disapproved ❑ , Pending 0
SKETCH:
I
I �
I
)I]NilDECTOR DATE
IOTE : Attach supplementai test data hereto
1
I
City of Tigard
�
INSPECTION N REG UEST
for
PERMIT N 0.:
INSPECTION _-----
I
DATE',. �% ��-�—�- DATE ISSUED:--1-1--
C'.
OWNERS NAME : — l<
ADDRESS . J
ICONTRACTOR :— —
TEST: Air O ,
Water ❑ , Visual C3 , Labo atory ❑
RESULT: Approved ,
Disapproved , pending ❑
SKETCH:
v
--'-" D ATE
INSPECTOR
i COTE . Attach supplemental tett dein he�et]
ALL SPACES ML16T BE ENDORSED
PRIOR TO APPROVAL O T�E PLANS
r=.� --- . rte_ j I
PUBLIC' WORKS DEPT. BY4 'DATE
PLANNING DEPT. ---
BUILDING ?T. -' - - - -- -- -
CC„JidTY M-AL TH r.._�T. �.v.
CITY r. _
TIG;.r0 WA-,:"t 0' L - — ------- 1 A
U S A C Y_-_
N. W. NATURAL GAS BYD
T. R. F. D.
r
1
.. S
4
t
City of Tigard
INSPECTION REQUEST
for
INSPECTION TIME : PERMIT NO. :
DATE: A7J-7:E- DATE ISSUED-.—Lj
OWNERS NAME :
ADDRESS *. .
CONTRACTOR
TEST*. Air 0, Water El Visual r-1 , LabaJatory ❑
RESULT' Approved 0 Disapproved Pending L]
SKETCH* ti�1)
INSPECTOR DATE
OTE Attach suppiemontal t*st data herst-10
ALL SPACES MUST BE ENDORSED
PRIOR TO APPROVAL OF THff PLANS
PUBLIC WORKS 05:13T.
PLANNING r1Z-13T. 13Y.._______----__
[3UiL0!N,-, CE'PT. BY.--,-- DAT 47
COIJ.'-.'-.Y H:-,ALTIq DEPT. 15Y.-
CITY AD'A1NISMA7011 ;D
TICARD WATEP 0)".
GENERAL TELLPHONE E3%1. D.,
U S A BY
• N. W. NATURAL GAS By-
P. G. E.
T. R. F. D
or
I
City of Tigard
INSPECTION REQUEST
for
'NSPECTION TIME : PERMIT NO. :
DATE ISSUED:__--L
OWNERS NAME : —L ,--' C'
ADDRESS : .x 'r
CONTRACTOR :
TEST; Air 0 , Water ❑ , Visual ❑ , Laboratory [3
RESULT: Approved ❑ Disapproved Pending ❑
SKETCH:
I
INSPECTOR DATE
NOTF '
1
A�
f•
City of Tigard
INSPECTION REQUEST �
for
INSPECTION TIME: `� PERMIT NO. _ I
DATE: DATE ISSUED :--
OWNERS
SSUED :__OWNERS NAME : T O• '
ADDRESS: Lor
CONTRACTOR : 1 06_z:?�
TEST : Air pl Woter[l Visualy< Laboratory p
RESULT: Approved Disapproved 0 1 Pending p
SKETCH:
INSPECTOR
DATE
CNOTF Attach suPWenlental test data beret a]
City of Tigard
INSPECTION RE® UEST
for
INSPECTION TIME : cl);I�°tltllPERMIT NO. : —
DATE: DATE ISSUED:—LL—
OWNERS NAME : UC ,�� �— �- vw 69 JILL L
J
ADDRESS :
CONTRACTOR :
TEST: Air ❑, Water ❑ , Visual. Laborotory ❑
RESULT: Approved ( , Disapproved C , Pending ❑
SKETCH:
-e–',77
INSPECTOR DATE
COTE : Attach supplemental tett data hereto
PLUMBING PERMIT APPLICATION
Jurisdiction of
No. Type of Fixture Fee Permit No. -2A. _ P
Permit fee
-_� Water Closets (Toilets) Permit Issued
Bath Tubs Approved by _
' Lavatoryy(Wash Basin Building Perm
Shower Receipt No. q g a`i
DishwasHing
Sink�itchen
Sinks. Ordinary Location of Building
_ Sinks Bar_
Sinks, Sloesi
_Automatic L- shwas er
Disposal
Laundry Trays Name & .Address of Owner ,
Drains, Floor _ �� ��', %" •�� �/� ��
Drains,Area
DrainsRefrigerator
Rain Drains
Automatic Washer >' Name � Address of P umberl.- J, ,•
Fountains, Drinking ;, , it /f 'i'
Fountains, Soda
Hot Water Tank
Water Service Size= _
Urinals Buildin Old or New) (Alter, Repair or
Catch-Basins - Yard TH—stallI
Lawn Sprinkler System
Swimming Pool Oder
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 $1,000 bond.
I hereby certify that I have read and examined this application and know the same
to be true and correct. All provisions of laws and ordinances governing this typE
of work will be complied with whether specified herein or not, the g-^acting of a
permit does not presume to give authority to violate or cancel the rrovisions
of any other state or local law regulating construction or, the performance of
construction.
'-' �I
Signatu e-of Applicant
:�!kms,.
EXHIBIT "B"
4060 CITY OF TIGARD
CERTIFICATE 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 March 19, , 19 71
recorded in Book __2§.7 , Page 43 `, Deed Record of Washington
County, Oregon, is hereby authorized and approved.
DESCRIPTION OF FROPk: M
Summerfield - lot 1
As recorded in Book 32, Page 50, Plat records
of Washington County, Oregon
OWNER: Eileen U. Edwards
BUILDING PERMIT NUMBER: 7,1 2A_-,
BUILDING ADDRESS: 10035 S.W. Century Oak 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.
IN WITNESS WHEREOF, the undersigned authorized officer of the'
City of Tigard has caused this certificate and release of restriction
to be executed this day of -A'-�==— , 19
Title:
l�
STATE OF OREGON
)S6.
County of Washington )`
On this -C' day of 'r, 1
personally
appeared before me the above named _ �1 /�KT , whose
signature appears hereon and who ackno ledged to me that he executed
the same in his offical capacity on behalf of the City of Tigard.
Public regon
My Co ssigrf expires:
` P1,M IM mead. .g.f.V.....«1��«M�.J� �•�1�('.�
• � ' ooA 994 N ..._................
a .. �:°•�;
AGE 51 ; .
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ATT 1
E OF
C°un►y `ORESN
of , 49—Q e- n
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and Ele
i
`'eyonc Rona Ond ssen, Di
that t for saidf -Offlc; ^dttor of
rpceiV he within cOtlnt. ° Re Reror �.
No. �► and recor►hst"t, I td° hhe►rby of COW
of said ded i^ b,pk of wNh�er►i fy
rowI l `_-_..._...._. ticords was -
Witness my
ndR anGERndd
R4fo affixed
ecOrds
4 EN
EA8C;Jo,U Oirect.,
of
090v
i
I
City of Tigard
INSPECTION REQUEST
for
INSPECTION TIME: 0 PERMIT NO. : f
DATE: DATE ISSUED :—
OWNERS
SSUED : _OWNERS NAME : -.7.-&-C,. _
ADDRESS: 07 _L_,16 mewII�/rlt,i�
CONTRACTOR : -X
TEST : Air p, Woterp , VisuaiX, Laboratory p I
RESULT: Approved, Disapproved p Pending p
SKETCH.
I
f
i
i � f
INSPECTOR DATE f
COTE: Attach tupplernental test data heretaa
I
EXHIBIT "A"
CITY OF TIGARD
Residential Structure Occupany Rootriction
KNOW ALL MEN BY THESE PRESENTS, that occupancy cf reoidontial
ntructure (a) on the following described lands prior Lo the recording
of an occupancy pornit releasing the roetriction in the Deed Rocordo
of Washington County, Oregon, is prohibitod by the ordinance of
the City of Tigard, Orogon: (The City will ioouo a raloaco
as noon as a (incl inopoction dotornines that the construction
is satisfactorily conploted)
DESCRIPTION OF PROPERTY:
e'er �� �.-� `r.�ca c.� �a� ? d�ar `=a G �t'\ •-a�
G
ADDZES5 OF PR0PCRTY:
NATE OF OWNER: V--- ,\�- <. y-, "k
ADDRESS OF OWNER:
--�•� tea,� �,� o � ����.,.� �'-�'-\�a�
IN WITNESS WHEREOF, the undersigned hoo caused this
restriction to be executed this �—\ day of
OWNER:
ano
APPROVED: Title
B y.
Btiilding[]ftr�c a
City of Tigard
STATE OF OREGON
County of Weehington 3 °fl' V- , 4 It)J 9
P eonally appoarod before me the above named
and acknowledged the foregoing 00
instrument to be �voluntary/ act and de d.
Itou Public r/O saon
Fly 0o caio0J.on Expiroo:
� �s • ��;Etiv�o
Ii�AR �8 ►y�c,
EXHIBIT "A"
C,ISV
CITY OF TIGARD
Residential Structure Occupony Restriction
KNOW ALL MEN BY THESE PRESENTS, that occupancy of residential
structure (e) on the following described Lands prior to the recording
of an occupancy par.nit releasing the restriction in the Deed Records
of Washington County, Oregon, is prohibitod by the ordinance of
the City of Tigard, Oregon: (The City will isoue a release
as soon as a fincl inspection determines that the construction
is satisfactorily completed)
DESCRIPTION OF PROPERTY:
. b� ��� A 'sT� ..Can �__ca.,_, � '�.1 � c M•.ts C�
ADDRESS OF PROPERTY = ,io`�
NAME OF OWNER: — = dam
ADDRESS OF OWNER;
--7 Acs a G r Q •-�c.� '\�:a
IN WITNESS WHEREOF, the undersigned hoo cojueed this
restriction to be executed this day of
OWNER:
/,Nama
APPROVED: Title
By: 1_
Bu,11ding U f c a
City of Tigard
STATE (IF OREGON
County of Washington °s' c�, ,� 19
P'.jsor,elly appeared before me the above named /CQ
.4�.eW ,L- _ and acknowledgnd the foregoing /
instrument to be Vii.. voluntary act and dead.
ata_ / rr+ i.•,.�--��
No a y Public f r Oregon
My Commisoion Expires:
1nr1Dch1.
nled 1-r�cnol. l.4. 1_.9... 147�af
POOLP THUM85EN.Diner el Il^b.mtd 0.4 Elarnonx
Py._......»..................»................... .Jtw!.r. . D..y •.
967 43
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CITY OF TIGARD
11410 S. W. Main StrMt
TIGARD, OREGON 97117
APPLICATION FOR BUILDING PERMIT
New Construction ® Demolish ❑ Addition El Remodel Move
ZONING DATE ISSUED BUILDING PERMIT
BUILDING FEE $ 9/-6d No.
DATE RECEIVED - PLAN CHECK $ Or-7J 7
BY y.00 A?-116W106 Fct VALUATION
-----'—'�" OTHER $ RECEIPT No. �" (�
�OT�L $ • 92 /%, srp7c
d
11WO SETS OF PLANS AND PLOT PLANS MUST BE FURNISHED WITH APPLICATION
JOB
LOT M Q\ MAP N o7S/-/tJG�O CENSUS TRACT GCS _
Architect or Engineer
Phone
Address --
Owner
—Address Phone
—
Builder_ ------
Phone
—f
BUILDING USE Single Res. ® Multi Res. ❑ Comm. ❑ IndustrialE
OCCUPANCY GROUP "S _ No. of Stories_ Total Height Area of Lot
Type of Construction -
V Floor Area B -- 1 \S S 2`
Set Backs: Front \o' ,m Back las` L.Side g` O R.Side
Private Sewer Pipe Size %.3h%� Sewery.,— ,�'c.,Septic Tank ❑
Water Service Pipe Size_ �' y�_ Storm Sewer Ditch ❑ Drywe1 ❑
Street and Curb Requirements 65
Driveway Width 1K No. of Parking Spaces
SEPARATE PERMITS REQUIRED FOR SEWER AND PLUMBING
SPECIAL INFORMATION
ADDRESS ASSIGNED_/ 03S �w L` T✓ �� D'2i�-e --
FIELD CHECK BY DATE
PEPJ4IT APPROVED BJ_<5;,A—�
it is understood that all work will conform with applicable codes and ordinanc:
of he
notbeoccupied untilnaaCertificate of occupancy nd the Cit, of Tigard, rhas ndlat t
beenissuedby the City otCity o'
Tigard Building Inspector.
Signature or pip—C-11, b