10415 SW CENTURY OAK DRIVE-1 Q
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10415 SW CENTURY OAK DRIVE
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EMIBIT 'B RECEIVED
fi923 11 uV 12 1974
CITY OF TIGARD
CITY OF TIGARD
CERTIFICATE OF OCCUPANCY AND iiMUSE OF RESTRICTION
The City of Tigard hereby certifies that the occupancy of
the following described structure or premiseB with respect to which
a restriction of occupancy was, on ^ arch a , 19_2p,
recorded in Book 967 , pagn 40 , Deed Record of Washington
County, Cregon, is hereby autnorized and approved.
DESCRIMON OF PrOPERTY.,
Summerrield - lot 23
As recorded in Book 32, Paye '.i0, Plat records
o Washington Cointy, Oreg ,n
OWNER: Tualst.n [le;Lajj='; ! ro_; in . _
BUILDING PERMIT :V.V,1 : : 74-31
BUILDING ADDRE:;;i: 10415 S, J, -enLirg flak Iliiue
This i�, to certify the said structure meets with the require-
ments of the Building C(xie +h;• Citv -" Tigard and the above
referenced restriction i:; hereby released and terminated.
IN WITNESS Y41EMOF, the unders+.gned authorized officer of the
CiL�, of Tigard has caused this certificate and relea.,e of restriction
to 'is executed this _.17, 9 day of /:;,r�`�, , ly
ww
Title: r• j- ( .,i3✓42..
STATE OF OREGON
County of Washington )ss.
on this , day of c7�� �y. ly�/t, personally
appeared before me the above named )o �, , whose
signatuze appears hereon and who acknowledge❑ to me t t he executed
the same in his offieal capacity on behalf of the City of Tigard.
y Pu is 0 e
My Commis exp s:
ru+dka wm,d ._.....fi7 .e1.LY...AM 71
Roots THOM"Iff.ft*ow of VMWJ4 i twoft"
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P1......._ . .. .. 11
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Boor, 998 PAGE Soli
STATE OF OREGON
w
Countyof Washington ,!4/0
I Roger Thomesen blreetpr a Records
and E{ectians and Ex-Officio Recorder of Can-
veyancuf for said county, do hereby certify
that the within Instrument of vnitUtg was
received and recorded In book of records
No. _ _... ..—.... _ ..
of sold County
Witness my, hand o-: seal offiruu,
ROGrtt THOMSSEN, Director of
^eveds b Elections
ollilkh
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i .� I� .� �" "' *. � � � ,�y�ti,.,si�. ..Ya ti f✓��r-•,s ��ti �r'! �v x
.,..,..r,-s�qe^:aMp'•. ._,area..,.,.,-.,.e:a --F�*'3 +v�.sscse.;�rnc-r--z's�s�rr*r.�+r.L.-.�,t�n_.. ,^� `�..\
n
OF O C
CITY Or TIGARD Cy .
OREGON }
Tualatin Oevalo ment Co. 7
rOwner:.............................. ...............P..........-----...-...........Permit No.........4--.31 ...
Building Address......1Q415... .C-enturY...Oek-..U.rive...............................
Certificate is hereby given this.......�5: .May of.....P;t.0!Pr--.... 19.7..4.....
that said building may be occupied and
,j that it complies with all requirements of
the Building Code for the City of Tigard,
as approved by the Tigard City Council. -�
L
ti Building Inspector
.....,�: trad. . r�.-Yax,Lc�Y
WE
� r moi^• Y 9 - !. 97; W'�► (`-+F" �..w H q e++ ,.
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City of Tigard
INSPECTION REQUEST
for
i INSPECTION TIME : PERMIT NO. : ---
DATE:�� l�f���' DATE ISSUED:
OWNERS NAME .-
ADDRESS :
AME .ADDRESS : %►'yam Dig.
I
CONTRACTOR :/,- ,g, 7- 2 3
TEST. Air C], Water p , Visual ❑ , Laboratory ❑
RFSULT- Approved Disupproved X , Pending U
SKETCH:
^N0 A36M.J
I
INSPECTOR BATF
CN OTE Attach supplement-il test data hsrst1
1
. r
A',L SPACES MUSS BE _777.2 TO
ISSUANCE OF BUIL;
PL"-.IT 7.1' DEPT. _
PU-T,'--'C F'ORKS DEPT. �0 to - .2
F
- 1T--
DII?G DEPT.
T-L°. AT!IT RURAL
FILE JEPT. r
1 l
CITY C�
PERwIT # ADDLL6S _.-
BY-——-•--- — — TITLE_ DATE
nrrrrn..�rr.rr
r
City of Tigard
INSPECTION REQUEST
for
INSPECTION TIME : �•'is _ PERMIT NO.:
DATE: y�.til21 DATE ISSUED:—/ Z
OWNERS NAME : , � ' '
ADDRESS : -
CONTRACTO R --
TEST. Air 0 , Water ❑ d Visual, Laboratory ❑
RE,ULT: Approved' Diaupproved Cl Pending ❑
SKETCH:
INSPECTOR DATE
COTE '. Attach suppiamentcl t►tt data hereto
CITY OF TIGARD MECHANICAL PERMIT
DATE /P PERMIT NO. '14-l01-M RECEIPT NO. 10042--
BY
00BY LC>r r ,� t�. (:,..,'nicc. FEE
r �
1. Permit shall be obtained prior to commencement of installation.
2. Permit shell be obtained for all appliances which are to become
a fixture to the building.
3. Relocation, replacements, alterations, or charges to burners and
duct work require permits.
4. All work to be concealed must be. inspected be.�,3re cover up.
New Instfllatio ® Replace ElRelocation ❑ Addition ❑ Alteration
� �
❑
CONTR.
y, ��. r����a _ OWNER -
ADDRESS /t,a 0 D l�J. //6 WORK ADDRESS
APPLICANT L,_)NII'..,, H�_.iP... �.•c.�
TELEPHONE No.
r �,
FURNACE - MANiJt7ACTURER TELEPHONE NO.
���/"�-1.,.�C.s �=-
HEAT Input rating (Btu Per Hour) S"D D oa Vent Size Flue Size
FUEL OIL ❑ GAS El ELECT ❑ OTHER
TO'T'AL SQ. FT. Top Floor .�-- _ Mein Floor •} O R Basement —
__._ GENERAL
ITEM NO. FEE ITEM NO. FEE
For ?ss-ance of Permit 3.00 Boilers Over 50 t3
New --Under 100,000 Btu --4.00— Air Handling 10,000 CFM
_
New er 'u
oor Furnace 4-.00 Evaorative Cooler
Wall - Floor - Suspended 4.00en an _
Ir6tall Vents enys em 0
F�ce�aiair - eat Cooling _ 00 00
Boilersn ern er 5H —domes F nncinerator 1 5 0
Bo- ers 3 to 15 H 0- omm.Incinerator 120,0
er.s u 0 10 00 ' ergo Lis�w!
Boi ers o
INSPECTOR'S COMMENTS
APPROVED BY DATE _ ISSUED BY DATE
Signature'Applicant(jAr.
■
I
i
City of Tigard
INSPECTION REQUEST i
for e
INSPECTION TIME: f� _ PERMIT NO. : —.._ — I
V-TC: ` DATE ISSUED : - L1._ I
OWNERS Ni64ME . kw-
ADDRESS:
CONTRACTOR
I
TEST ' Air [), 'Wo;e;r] `w''31: 1I 0 , Laboratory p
RESULT: Approve6, Din4pproved 0 Pending p
SKETCH,
INSACTOR DATE
NOTE: Attach :upriernental test data beretel
oa =- aa aw ulFUaRXe
City of Tigard
INSPECTION REQUEST
for
INSPECTION TIME : ------ PERMIT NJ. : _._...____.
DATE : ____ Z J DATE ISSUED'.-..—'-L—
OWNERS
SSUED:-..L_LOWNERS
A D D R E S S : —�
CONTRACTOR :-_—_ —
TEST:Air 0, Water ❑ , Visual L7 , Laboratory ❑
RESULT: Approved, Disapproved ❑ , Pending []
SKETCH:
i
INSPECTOR DATE
COTE . Attach suPPIGMSMOI t*st data heret]
PLUMBING PERMIT APPLICATION
Jurisdiction of
No. Type of Fixture Fee Permit No. -7 -1.,�-P
Permit fee .i"i�
S Water Closets(Toilets 'r- Permit Issue_
Bath Tubs Approved by
Lavatory (Wash Basin _ .a�,' Bu�ldi.ng Perm
/ Shower Receipt No. 9 ,:Lu
n s Dishwas ling
/ Sinks it
Kchen _
Sinks Ordinary Location of Bjiilding
Sinks Bar �
Sinks, Slop �
Automatic Dishwasher �2!y �;,,,=< .' , • !;,r ,�;1 Disposal _ /�
Laund Tra s Name & Address of erii ��
Draing, Floor --
brains Area V/
Drains Re ri erator ir, „
Ran Drains }- /
/ Automatic Washer Name; & Address of., Plumber-
ountalns r n n�
Fountains Soda
Hot Water Tank
Water Service Sizes _ -
Urinals Building (Old or New) (Alter, Repair or
atc =Basins - -Ira -al '• --
Lawn Sprinkler System r %_ IM' �/
Swimming Pool __ O1,yier
S rinkler System E_
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 typ
of work will be complied with whether specified herein or not, the granting of a
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.
Signatpre of Applicant
r
i
City of Tigard
INSPECTION (REQUEST
for
INSPECTION TIME : —57_ PERMIT NO. : ---
DATE: ,.� DATE ISSUED:--L-1—
OWNERS NAME * '�' C"
ADDRESS : .��T ` cl
fig
CONTRACTOR :
TEST*. Air ❑ , Water [3 , Visual Laboratory p
RESUL.T. Approved, Disapproved ❑ Pending U
SKETCH:
I
I
I INSPECTOR DATE
rNOTE : Attach supplemental test data hereto
i
EXHIBIT "B"
CITY OF TIGARD
CERTIFICATE OF OCCUPANCY AND RELEASE OF RESTRICTION
The City of Tigard hereby certifies that the occupancy of
the following described structure or premises with respect to which
a restriction of occupancy was, on Marrh 14 , 19-Z40
recorded in Book 967 , Page 40 , Deed Record of Washington
County, Oregon, is hereby authorized and approved.
DESCRIPTION OF PROPERTY:
SummerFi.eld - lot 23
As recorded in Book 32, Page 500 Plat records
or Washington CoOnty, Oregin
OWNER: Tualatin n�opfrkrif rn- - Tnr-
BUILDING PERMIT NUMBER: 74-31 _
BUILDING AUD?tE9S:�1�(�F R�J,Iy C n uS nak nriye
This i, to certify the said structure meets with the rejuire-
rments of the Building Code of the City of Tigard and the above
referenced restriction is hereby released and terminated.
IN WITMS WHEREU17, the undersigned authorized officer of the
City of Tigard has cauLied this certificate and release of restriction
to be executed this _ day of
Title:
STATE OF OREGON )ss.
County of '.:ashington )
On this clay of _ _, 19_, personally
appeared before me the above named _, whose
signature appears hereon ind who acknowledged to me that he executed
the same in his offical capacity on behalf of the City of Tigard.
Notary Public of Oregon
My Commission expii"s:
w w w
City of Tigard
INSPECTIOiN REQUEST
for
INSPECTION .TIME : PERMIT NO. ; .
DATE: �' /l�/ DATE ISSUED"— .,.Z----'-
SSUED _..[__ _ _
_1
OWNERS NAME : _ 7`p. C,
ADDRESS 'lQ -
CONTRACTOR '_.___ .__
TEST:,air ❑, Water [3 , Visual 13 , Laboratory ❑
RESULT: Approved l", Disapproved ❑ Pending ❑
SKETCH:
INSPECTOR DATE
ENOTE Attach Supplemental tae# data heret]
i
I
City of Tigard
I NSPECT ON REQUEST
I
for
INSPECTION TIME: PERMIT NO. :_ I
DATE: -;-, LE 1-74 DATE ISSUED :--L
OWNERS NAME :
1 C.
��, L,
ADDRESS:O :)-� in. i 5
CONTRACTOR :
TEST : Air O, WoterO , Visual O o Laboratory p I
RESULT: Approved Disapproved O , Pending p I
SKETCH: I
I
NSPECTOR DAT:..
[-OTE: A' ^.h fupplernwal tett data he►et]
CITY OF TIGARD
1242E S. W. Main Street ��
TIGARD, OREGON 9722.1
APPLICATION FOR BUILDING PERMIT
New Construction Lemolish ❑ Addition ❑ Remodel ❑ Move
ZONING DATE ISSUED BUILDING PERMIT
- --- BUILDII'r FE'r $ p ` No.
1)ATE RECEIVED -14-31
BY- PLAN CHECK $ /O• O� �E•�ssuE{�
-"- "- "-- - OTHER $ �/- 00 ? ro,aGfm VALUATION
L„,* $ -7y //V `JATe RECEIPT No.�73c%
- -nrL
TWO SETS OF PLANS AND PLOT PLANS MUST BE FURNISHED WITH APPLICATION
LOT # 3M -,, _ MAP # v?5/- /OOr CENSUS TRACT W-Fl -- JOB # `5 d1 �
Architect or Engineer-��o� �� c��v -.nuc C
Address�`S-��r, 4i.,p� �,�' lama_ q�S1__Phone
()caner --_—
Address - _ Phone-
Builder ` c+..�- - -- - -------- - -
Address -! `Phone
BUILDING USE Single Res. Multi Res. ❑ Comm. ❑ Industrial❑
OCCUPANCY GROD1- I:y_ No. of stories- \ _ Total Height-- Area of Lot
Type of Construction --" EY V Floor Area B 1 \>o$ 2_ •---
S?t Backs: Front LaI Back-, L.Side- - R.SideI
Private Sewer Pipe Size -.- Sewer.-._ eptic Tank ❑
I Water Service Pipe Size,-��_'% Storm Sew`err K \Ditch ❑ DryweIl❑
Street i.nd Curb Requirements 9-5 _�jPU1,e:-rJ
Driveway width - L%_- ----No. of Parking Spaces__
SEPARATE PERMITS REQUIRED FOR SEWER AND PLUMBING
SPECIAL INFORMATION
ADDRESS ASSIGNED /O'V/S c7<t/
FIELD CHECK BY `,_ -_---_ -_ -,--_-_ __-_-DATE--. _
PERMIT APPROVED BY-��./-�.=�r�T—�
It is ur '.erstood that all work. will conform with applicable codes and ordinances
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 Inspectrr.
33gna ure of pplicant
• � lyse
R��,EIV ED
EXUBIT "A" Ir1AR Z' lyre
CITY OF TIGARD CITY nF TIGARD
Residential Structure Occupany Restriction
KNOW ALL MEN BY THLZE PRESENTS, that occupancy of residential
atructurs (a) on the following described lands prior to the recording
of an occupancy permit 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 Issue a release
as soon no a final inapbction determines that the construction
is satisfactorily completed)
DESCRIPTION OF PROPERTY:
ADDRESS OF PROPERTY:
NAME OF OWNER: ---y—
ADDRESS OF OWNERS
IN WITNESS WHEREOF, the undersigned hao caused this
restriction to be executed this day of y o N , 19��
OWNERS
ams
APPROVED: e `
B y:
€luvl ndi g Ofd' c °
City of Tigard
STATE OF OREGON
County of Washington ; ' _ "P 7 19
ParsRnally appoarod before me the above named
and acknowledged the foregoing
instrument to be voluntary act and deed.
Lj
oay Public or eon
My Commiooion Expiress
I- 9F
INpDEXEEL)
Mod for roeord./.I.� .�.7.,.. IQ./..74, M P M
ROOM 7110MARCN. INN" r if tb�rA.8 F.Ir.rhnn.
AL
H,uur 967 PACE 10
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