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EXHIBIT "B"
CIT'i OF TIGARD
CERTIr'ICATE OF OCCUPANCY AND RELEASE OF RESTRICTION
The (ity of Tigard hereby certlfie , that the occupancy of
the following described structure or .remibes wi.ta reRpect to which
a restriction of occupancy was, on
recorded in Book '/0 -� , Page -7 U , Deed Record of Washington
County, Oregon, is hereby s.i;,horized and approved.
DESCRIPTION OF PROPTRTYi
/w T .�•c.rn,��� �Z D �«�3c�i vtsivtJ
/95
IC4=Ce-7 5 c%,r
voo—. t '09e5 (7e-u>.rY
OWNER: ea G.o 2,n.� [iti'yL c.c�;>s>L��c n% C°:+_ c. (-13� . 0_elk)
BUILDING PERMIT NUMBER:
BUILDING AUDRE:;S: /O2�"� v_sem �°t� %v,2Y J�+ `L�e ✓�
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 WITEREOF, the undersigned authorized officer of the
City of Tigard has cauied thi> certificate and release of restriction
to be ex:cuted this day of , 192v.
Title: , a
STATE OF OREGON
ss.
County of Washington ) c{
On this i� day of , 1personally r°
appeared befr,re me the above named , whose
signature appears hereon and who acknowledged to met t he executed �
the same in leis offical capacity on behalf of the City of Tigard.
v ary blit �P €g )
My CCiasi wr expires:
eooK X96 r�:cE 61
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City of Tigard
INSPECTION REQUEST
for
INSPECTION TIME :. PERMIT NO. : ---
DATE: -2—�
O. :DATE: .2—LZL,-'�L DATE ISSUED:_.L- Z-
OWNERS NAME :
ADDRESS :
CONTRACTOR :
TEST* Air 0, Water [:1 , Visual [3 , Labcratory ❑
RESULT*. Approved`- , Disapproved ❑ , Pending [j
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SKETCH' 43
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I —jWSPECTOR DATE
ICOTE : Attach suppiemental test data hereta]
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ALL SPACES MUST BE ENDORSED PRIOR TO -
ISSUANCE OF BUILDIlTG PERMIT
PLANNING DEPT.
By ---
PUBLIC WORKS DEPT.
BUILDING DEPT. By D
T`JAI ATIN RITRAL By
MEE LEPT �y - --- - Dw�o __--
APFROV=D FOF
CITY G-
PERMIT ADDRESS
BY- --- _--.TITLE DA E
7
♦•,14y�1 �..".•• .r .:� f t1�`+'' i 'rr�,:. .. '. /�''4•(�?�.1. M' lN .r �.. ^sJ ".t
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City of Tigard
I
INSPECTION REQUEST
for
IINSPECTION TIME : PERMIT `�
N 0. . __.._--
DATE:.. Z&2— DATE ISSUED:w.L._!
OWNERS NAME; __ T, _.
CONTRACTOR :
TEST' Air ❑, Water p , Visual ❑ , Laboratory []
RESULT: Approved ❑ Disapproved Cl Pending 0
/" INSPECTOR ►,,'TE
[NOTE ' Attach supplementol test data heretC
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City of Tigard
INSPECTION REQUEST
for
INSPECTION TIME: PERMIT ►l0. : �___
DATE: DATE ISSUED :__1_/_-_ i
OWNERS NAME :
ADDRESS:
CONTRACTOR : ,!LW1
TEST : Air 0, Water[] , Vieual"0�I-aboratory
RESULT: Approved, Disapproved ❑ Pending p
SKETCH: -�
INSPECTOR DATE
_NOTE: Attach tupplemente! test data bereto] V
PLUMB1NC PERMIT APPLICATION
Jurisdiction of
Type of Fixture Fee Permit No. ? - �
No. TYP Permit fee � _�
water Closets Toilets ! Permit)
i Hath Tubs Auproved by it
Lavatoryas as Building Permit !'
i Shower Receipt No. ini�2
fin n a Di shras ling
Sinks Itchen
Sin s Ordinary ��— Location of Building
its ---
Sinks Slo� _-- -Z
u oma--c shwawa—sTer— _ - - ` I-� --
-DiUosEfl — _ _ _
i Laundry Trays__. _ Name h Address of Owner /c< r< <,t j—
Drains Floor
-brains rea .—•- �' '' ---
rair, e r aerator _ —
Rain mains � .
Automatic asher _ Name Address of Plumber
ountains
r
ountains• oda r
at Ater an _ --
Water Service Size ) — Buildin Old or New Alter Re air or_
Urinals -
atcCi- as ns - ar _-- ns a --
awn S rin er S �stem
_.Swi.mmin Pog o1 OFer --- - - --
ST)rin ler S stem _--- —
This permit becomes null and void if %irk or construction authorized is not
form
comenced 60
days 'atrif any timetafteron or work is k Is commenced.
ended or abandoned
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 sam
to be true and correct. All Provisions of laws and ordinances governing ithis to
of work will be complied with whether spAcified herein or not, g"` g
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.
1 Si ature`of Applicant
City of Tigard
INSPECTION REQUEST'
for
INSPECTION TIME : PERMIT NO. ,
DATE: -Y L4J'2q DATE ISSUED:—Y—/—
OWNERS NAME : 9 , ..
A D D R S S :�G ��
CONTRACTOR : '
TEST: Air p , Water Visual O , Laboratory 0
RESULT: Approved , Di5appraved ❑ , Pending []
SKETCH:
INSPECTOR GATE
iNOTE: Alfach fuootemenfal tier dire h•.•rnl
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City of Tigard
INSPECTION REQUEST
for
INSPECTION TIME : PERMIT NO.: —
DATE: —Vl,.2((1V DATE ISSUED: LL_
OWNERS NAME :
ADDRESS : � p/�
CONTRACTOR :-�X O 01—
TEST: Air ❑, Water p , Visual f� , Laboratory ❑
RESULT: Approved ❑ , Diiapprovsd�e , Pending []
SKETCH: --_3 p yJ �_ a 3_ 7
J
INSPECTOR DATE
[NOTE Attach qupplemental feet data heret0
So '.L
CITY OF TIGARD MECHANICAL PERMIT
DATE /4/_2y PERMIT NO. '7,� _ -_ �1 RECEIPT NO.
BY FEE --
1. Permit shall be obtained prior to commencement of installation.
2. Permit shall be obtained for all appliances which are to become
afixture to the building.
3. Relocation, replacements, alterations, or changes to burners and
duct work require permits.
4. All work to he concealed must be inspected before cover up.
New Installation W. Replace ❑ Relocation ❑ Addition ❑ Alteration ❑
CONTR. -'7�•.a�4,aT1� �_��Ce� OWNER_ /� .�_
ADDRESS WORK ADD:ZESS `l� SSS' �• /,,J i.-s s.";;,t/�r
s
(.:-4- A'-U �it APPLICANT �1.�F1!?��' 1��__/11 y �''- %,✓c'
,• TELEPHONE NO.
FURNACE - MANUF/ :ZURER x '�' K- �t� TELT:HONE NO.
HEAT Input rating (Btu Per`` --Hour) /� ��i Vent Size � _ Flue Size
FUEL OIL u GAS X ELECT O OTHER'-----
TOTAL
THER --__—TOTAL SQ. FT. Tor Floor mac)L7 _ Main Floor Basement
GENERAL
ITEM NO. FEE I :ITEM NO. FEE
For Issuance of Permit3.00X Boilers Over 50 Hp
New - Under 100,000 Btu _ 4.00 • _Air Handling 10,000 CFM
New - Over 100.000 Btu i Air-Handling Over 10,000 CFM
Floor rn'ce _ _ Evaporative Cooler
Wall - Floor - Suspended �.0Z Vent Fan - �
Ins�lV'en s .• VenSystem' 0
Re��pPa-i---r- - Heat & Coolin .00 Hood
Boilers Un er H 4.00 Domestic of c�nerato_r 0 .
Boilers to H _ .50 Comm-.—Incinerator 20.0
Bo ers 15 to 30 H 10.00 Tier o Istea
Boilers to 50
INSPECTOR'S COMMENTS
APPROVED BY _ DATE ISSUED BY DATE
Signature of Applicant `��
City of Tigard
INSPECTION REQUEST
for
fLUr t'- �� 'ry .
INSPECTION TIM �:21:11 'PERMIT NO. : ------
DATE : _- ' 1 DATE ISSUED*
OWNERS NAME - -l•-0—'(L'--- -
ADDRESS ' � - _- 1:2. c���mt�+r's'+ 1E_L PCONTRACTOR :
I TESL . A r J , Water r., Vi9uol Loh ,ratory L
RESULT. Approve Disapproved Disapproved J , Pending LJ
SKETCH:
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I INSPECTOR DATE
I [OTE: Attach supplemental feet data heret-
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City ot Tigard
INSPECTION REQUEST �
for
N$PECTION TIME: �•'e-L PERMIT NO. :--
DATE:
O. : _DATE: /.V DATE ISSUED :--/
)WNERS NAME :
ADDRESS: AgA
:ONTRACTOR : x.r c--
I
fEST : Air D, Water[] , Visual , Laboratory p i
3ESULT: Approved Disapproved O , Pending I
;KETCH:
I
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INSPECTOR DATE I
UTE: Attach supplemental tett data beretaa i
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CITY OF TIGARD
12410 S. N. Main Street
TIGARD, OREGON 97217
APPLICATION FOR BUILDING PERMIT
New Construction Demolish ❑ Addition ❑ Remodel ❑ Move❑
NING DATE ISSUED -")I- / S-"7 BUILDING PERMIT
5A7'I: RECEIVED �
BUILDING FEE $ 5-6 No.
-
PLAN CHECK $ 70- 7.5'
OTHER $ q.00VALUATION $ ffj7
$ S7A13, RECEIPT No.-!ZliS,�7-
T aT>i�-
TWO SETS OF PLANS AND PLOT 'LANS MUST BE FURNISHED WITH APPLICATION
LOT if _��_-� MAP M oZS/�// GL CfR�NSUS TRACT _ JOB Nom-Zr____
Arc}iitect or TngineerT��Ssl 4-Lit1_.1.1_--- ��_--
Adcr,-er,s +�.. -T-�� v Phone
�3�j
()wr,rr
Address- - --- -- - __—� -- —Phone_ _.
I,ui 1der
Address -- -`Phone -.--
BUILDING USE ".Ingle Res. ?❑ Multi Res. ❑ Comm. ❑ Industrial❑
ru'r'UT nNCY GROUP Z No. of Stories`— Total Height_—__— Area of Lot
Tyne of Construction I II III IVFloor Area B-__-`- 12�� Z.
Set hacks: Fronty (�V Hack kl'-� L.Stde y'-(e R.Side -_n_�
Private Sewer Pipe Size_y ~ _ Sewer KrNACry Septic Tank ❑
Water Service Pipe S.ize__?/ - Storm Sewer a Ditch ❑ Drywell❑
!:trcet and Curb Requirements 9 r:4ksubc9ij; ���'- -k
S L
DrivAway Width_ l� _-- -____—,No. or Parking Parses
SEPARATE PERMITS REQUIRED FOR SEWER AND PLUMBING
SPECIAL INFORMATION
AI)I PESS ASSIGNED/�2Sr (�(/• C'L37JLwe 04K7 'ly�
DATE,--- -----
(/ PERMIT APPROVED ,c yl�L- T
it is unde.=-;.00v that all work will conform with applicabler codes and ordinances
of the state of Oregon and the City of Tigard, Oregon, and that the building will
rust he occupied until a Certificate of Oc_upancy has been issued by the City of
T'iga.d Building Inspector. ;- 1 /�
SS g�re of Applicant
EXHIBIT "A"
CITY OF TIGARD
Residential Structure Occupany Rcatriction
KNOW .ALL MEN BY THESE PRESENTS, that occupancy of residential
otructure (o) on the following deccribod landu prior to the recording
of an occupancy permit releauing the rootriction in she Deo ' Rocordo
of Washington County, Orogon, is Nrohibitod by the ordinance u
the City of Tigard, Oregon: (Tho .ity will iocuo a roloaes
as coon no a fincl inopuction dotermineo that the construction
ie catiefacto•:ily comploted)
DESCRIPTION OF P':OPERTY:
ADDRESS OF PROPERTY: ��, ._, �acZ
NAME OF OWNER:
ADDRESS OF OWNER:
IN WITNESS WHEREOF, the undersigned hao caused this
restriction to be executed this day of
OWNER:
Nano
APPROVED: Title
tli ding Oftic al
ty of Tigard
STATE JF OREGON
County of Washington 0°' y�Ja«.� �19 ✓
Polo ally epuoarod before me tho above norad
and °cknowlodgod the forogning
instrument to be ,, ,J voluntpry act and dead.
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AD ry Public foV 0 o�on
ny Cczaioaion Expires:
�?- 9 7d'
1400
EXHIBIT "A"
CITY OF TIGARD
Residential Structure Occupany Restriction
KNOW ALL MEN BY THESE PRESENTS, that occupancy of residential
atructurR (s) on the following described lends prior to the recording
of an occupancy permit releasing the restriction in the Deed Records
of Washington County, Oregon, is prohibited by the ordinance of
the City of Tigard, Oregon: (The City will issue a release
as soon no a fincl inspection dotorminea that the construction
is satisfactorily completed)
DESCRIPTION 0 ' PROPERTY:
40'1,v�.
ADDRESS OF PROPERTY:
NAME OF OWNER:
ADDRESS OF OWNER:
IN WITNESS WHEREOF, the undersigned hoo caused this
restriction to be executed this \y day of
OWNER:
Name ^
APPROVED: Title
By:
' Uilding Official
City of Tigard
STATE OF OREGON
County of Washington B°' a 6 �j 19 7
Persz!pal.l.y appeared before me the above Aamod
? and acknowledged the foregoing
instrument to be volu-ptery act and deed.
vaI
Nbary Public/ r Dragon
MV Commicaion Expires:
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Po(;ER tNOMRCEM.Ehtw.»nr,d Mnord�ti Elwr•nen
)NDEXhU 7vr"v
96 7 750
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STATE OF OREGON
u
County of Washington
I, Roger Thomssen, Directpr of Records
and Elections and Ex-Officlo Recerder of Con-
veyonces for said county, do hereby certify ra
that the within instrument of writing was
received and recorded in book of records
No. _..of said County
Witness my hand and seal affixed.
t QOGER THOMSSEN, Director of
Records & Electbrw
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