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r'.XBIBIT "B"
CIT`' OF TIGARD
UMIFICATE OF OCCUPANCY AND RELEASE OF RESTRICTION
The City of Tigard hereby ^ertifies that the occupenc• of
the following described structure or premises with respect to which
a restriction of occupancy was, on Fl,r y l j , 19 7 9,
recorded in Book 7 j- , Page �_�� Deed Record of Washington
Count,yir, O)egon, is hereby authorized and approved.
^FSCRUTIONN OF PROPERTY: / �^ "
OWNER:
BUIIALNG FERMIT NUMBER:
BUILDING ADDRESS: / `�f i�G^ r.r G�'' (�+ u-2�•, o
Thi.3 is to certify the Baia structure meets with the req-..iire-
ments of the Buiiding Code of the C.cy of Tigard ani' the above
refers:nced restriction Is heresy released and t.• .^mivatud.
IN WITNESS WHFMOF, the undersigned authorized officer of the
City of Tigard has caused thiF certificate End release of restriction
to be executed this / 3 ___ day of f-e !�, , .192L-
STATE Cl' OREGON
ss.
(bounty of Washington )
on this day� �_ day of _ 9� , 19 1�, personally
appea^ed before we the above named y6. , �,+�.t �, whose
signa.ure appears hereon and who acknowledged to we that he executed
the same in his offical capacity on behalf of the City of Tigard.
Notary Publ6c of Oregon
My Connissi.on expires:
Mod for rwcnrd.�...KG."':,.�-..IC.I,,,,. A M .
-�RCC11 TNOM9RCN,D1»ctwt d P��ytd�d. ElwMlen�
163 107
• � Dwomy
STATE OF OREGON
GSS
County of Washington G
I, Roger Thomssen, Director of Records
and Elections and Ex-Officio Recorder of Con-
veyances for said county, do hereby certify
that the within Instrument of writing was
received and recorded In book of records
No.
of said County
W, -less my hand and seal affixed. M,
ROGER THOMSSEN, Director of
Records & Elections
FEB i 5 3 3sitAt',,74
J
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�^. ✓{� :y/ b/ :✓ �:.��dyvr,I ...�' /�a �!!At df �nl/al
,�,`�'w• SIV'.✓ �
*011
l.....y �• �-ae..a-x=�.--,•.n-.-x�ea�r:cesa,��'Ffl���r4�� -� •-°- - --"'�=�` - - - - �- -_ -- _ —__ _�.a�
OF
0C
G�. CITY OF 1GARD
OREGON
�..
1OR'llC2-:......rlla-1.a.Un...De.ve-LoFAmB.nt...CA.fJ1FJany......Permit No..-.7.3-17.8.......
Building Address...15.�2II..S..W.....C.ent.ux.y-- la.ak.. Ci.r.�.1 a...............................
}r. ; Certificate is hereby given this..5th.......day of...F.e.br.uary-........... 19.7..4.... i
that said building may be occupied and x
Al
g Y 1
t' ► that it complies with all requirements of �'�,
s
the Building Code for the City of Tigard,
t ' as approved by the. Tigard City C(,oneil.
Iluilding Inspector
r�i � ,,�� /n"" /!+� y`,�'.� ,1l�3 r�4���,�1/a~�.q ���.e.��'� �ry/•�`,'"1 �"'!� �^/"!q��"�I��;�� �`:'�r ri'��
��� r°!1 �`�4, �,�.�1� C.��i� tr'�iy3 r �; ���il�//, �:!�',: �;i�J�' nrr J�`/�,',�,Y+1,�r�,a�nd',✓m ia•� C�� ��},
CIT`.' OF TIGARD HEATILNG PERMIT
Y74-
DATE — PERMIT NO. ( '� Y_ _ RECEIPT NG. `y�'/`"� —
as
�(7 �� r _ FEE _
BY LL•)C3!1/[ fez ) i!f l(0 --- --- - _— —
1. Ferfmit shall Ye obtained prier to cor.Lnencement of inst llation.
2e Permit shall be obtainod for all appliances which are to become a fixture
to the building.
3. Relccation, replacement) a; . .. . ._ changers to burners and duct war
require permits.
4. All work to be concealed must be before cover uv� ❑
New Installation N K place ❑ Pelocation ❑ Addition u- Alteration
OWNER
CONTR. l /�!! 3 y / :Q�_
ADDRESS WOI?K ADDRESS _/yc.._�O s��1)' n
--- - .-•-:ice 1�.�_�.___.__ - � �L�
✓lc' L� _.t:2�a.�.__ APPL_T CA.NT
TELEPHONE NO.
FURNACE - DmwjFACTURER TELEFKCNE. NO. -
HEAT Ir put :ating (mt.�r nzer Hour ) �►,�r �;a Vent Size r y Flue Size
FUEL OIL ❑ GAS 4.,.1 EI:ECT ❑ OTHER
TOTAL SQ. FT. Top Floor I'-
GENERAL Floor 1�_'l_�—r Basement _ -'�-
GENERAL
1TEM NO. FL'E AM'T .ITEM NO. FEE AM
For Issuance of Permit 3 ,Oa Boilers_ over 50 Hp__ _'5.00
New - Under 100,OGG Btu 4�00' u Air—Handl inq�10,�000 CFM 3.00
New - Over 100,000 _Btu 50 Air Handling Over 10, 000 CFM 5_00
Floor Furnace _ 4, G Evarorative cooler r 3.0 _
Wall - Floors Suspended _ 4, 0 Vent. Fan 2.00
Install Vents _ 2 A _ _ Vent •st,sm __ 3_00
!Repair - Heat & Cooling _ 4A _ _ Hood^ 3000
Boilers Unair 3 Np _ 400 Damestic Incinerator � 5o00
Boaters 3 +-o-15_ p 7� 5 _ Comm. �Incinerator _ 0.00—
Boilers 15 to 30 Hp — 000 Other Not_ Listed � 3.0
Boilers 30 to 50 Hp 15 u 0
IN: PECTOR' S COMMENTS _
P^PROVED BY ,__ DATE _Y _ ISSUED BY _ DATE _
S,graatare �b f Applican
i
City of Tigard
INSPECTION REQUEST
I
f c r
INSPECTION AIME- PERMIT N0. : l
DATEDATE ISSUED : I Z
OWNERS NAME . ,
ADDRESS: LvT �� `'��' Cr' < c'
CONTRACTOR :TEST : Air U, Water❑ , Visual 0 , laboratory ❑
RESULT : Apnroved LR( , Disapproved O , Pending _
SKETCH:
IN. PECTOR DATE
[NOTE : Attach supplementnl test data h iretp, iI
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ALL SPACES MUST BE ENDORSED
PRIOR 1"0 APPROVAL OF TN`SE PLAN'S
PUn!_!rr W()-,!,S D,PT. BY
l IG t CI:r. DY
U a
N. %J. NAT'URAt_ GAS LAY -_-_ C'
P. !i. E.
T. R. F. D.
':+d.fi;; 'tN11]'f`?�+b� (t�`�# i�j1 !t`"�,^,':'a4�`.E►i'"��
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City of Tigard
INSPECTION REQUEST
for
IINSPECTION TIME : PERMIT NO. : .�_____
i DATEDATE ISSUED
OWNERS NAME .
ADDRESS
C O N T RA C TOR :- --- -------�.._ - --- -- ---
TEST'. A r J, Water [] , \inial O , 1-a' ,ratory [I
RESULT: Approved , Disapproved -1 Pending rLj
SKETCH
I
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INSPECTOR DATE
ILNO1C : Attach supplemental test data heret]
1
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t �f Tigard
y
INSPECTION REQUEST
for
;NSPECTION TIME. ��''��dM_ PERMIT ",iC. .
DATE : DATE ISSUED
OWNERS NAME : -To ,C
ADDRESS:
"ONTPA(,TOR : - .�o: -- -- --- -
EST ' h', ter 0 ,
RESUL_ q, rovedx ; .uppr ..ed G LJ
SKETCH:
ee
INSPECTOR DATE
LNOTE: Attach suppiementel test uuta her-t�
amity of Tigard
INSPECTION REQUEST
f 0 r
.Nt;PECTION TIME . PERfAiT NC
DATE.- /0 ,'s '93 -)ATE iSSLJED
OWNERS NAME :;E__
Ar)DRESS'-4:o�7
,,,oN rRArTr)R
-
EST ' ,.',- -.1 , jy,-ter C , V:
RESLIL- roved)-ill upp,o.tfd 0 -evidioq Lj
S K'E IT,H
DATE
FNOTE: Aitacri suppiemental test u ul'0 hflr :t 01
II
f
r�
of Tigard
INSPECTION REQUEST
for
NI SPECTION TIME . _.��"�_ PERMIT NC. : .
DATE : DATA' ISSUED :,._r
OWNERS NAME : ;Z- D. � _r
ADDRESS.
N r R A TOR
EST w', ter�❑// , `Y'
RESUL'!- ' , roved Imo, app! :,�d G e�ldi �r7 ❑
S KETCH; � aT -7 0
IN3PECTOR
SATE
[OTE: Attach supplemental test data he►rt ']
PLUMBING PERMIT APPLICATION
J,ir� sdiction of
No. Type c,f Fixt.t,r - Fee Permit No. "fir
Permit fee 77
Water Closets Tc:i1.F�+,3) Permit Issued-
_
_ Bath Tu5s el Approved by
Lavatr,ry_ WaShB_f1___H,:__ _._1 72 Building Permit;
;;hewer Receipt No.
- ---
Sl.jik5�i tcri;-n
_ ^ink_y C,rdc in_a_zy Loca ion of Builg ng
Sine�t. S:1� -- ----•-------�� � � .•.. M..�r�_ -
Au
Name Addr
--,.nr + r[' Narn� & A�1drH:;; : P . _,tnI:
r_Taik -
- Bull in * C:,d '-=.� �itor HF; air r-
I'h� !::I vu;.,) 1..f w-,T-k e r ,,,, r., '.: r
if nstruc + . n ^r w. :.
I a t any ti
of tet wor}:
G.11 plumbing fir':: : ',ru licensed by the City of 'I :.,.-.a: d +rid pc.zt a $1 ;,000 bone
I h,-rt-bv certify t',,�t I. -ievp read and exarnmed thi:; and know the san
to b(' tru— and :'Tr(. - All pro'!1�_].ens )f law.- arW r,' 1nanrp- r l - rning this t'
f wc-,k dill be c. : with whether sped find he! . r r. r � , ., grantin; of
pe-mit dt,es nut pr, . give aut.homty tc r . anc� i tlrt prc;visl :ns
,in-, other s;.atf, i s al law rer elating con:true r1 the •rfcrmance of
Sign urp rt. App: i .:a
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City of Tigard
INSPECTION REQUEST
I fo
INSPECTION TIME :__ PERMIT NO. : ._
DATE: //)/J3 DATE ISSUED'__L_L_
I OVINERS NAME : _ T •(-" ,
I
ADDRESS 2d1-F1���
I CONTRACTOR : _�__
TEST A r L.J, Water
j , ��isci,�La rater J ("I
RESULT.' Approved Pr , Disapproved 1 P-nding J
}•4l
SKETCH:
I
I
I
I INSPECTOR DATE
OTE : Attach supplemental teat Jaro hergr]
City of Tigard
INSPECTIOiA REOUEST
for
NsPECTION TIME :. 4v_ t'ERMI'r NO. --
DATE .
O. —
DATE : �� 'SATE ISSUED--Z'-.j'—
OWNERS
SSUED'—Z'_.JOWNERS NAME ' . � �--• _
4 D D R E S S ' ='.5!1722
.s I j , '✓inter
RESJL?- -ppr .,�vdO , -AxpprovsO 1 rd ,-
SKETCH:
c7 >D
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INSPECTOR DATE
IL:ATE : Attach supplemental !est " o•r; neret]
1
CITY OF TIGARD
12420 S. W. M4in ff►Mf
TIGARD, ORIGON 97117
Ar,PLICATION FOR BUILDING PERMIT
Near Construction xQ Demolish Addition Remodel Move
ZONING DATE ISSUED 8.8.,73 BUILDING PERMIT
DATE RECEIVED BUILDING FEE $_ 71.00 No. '23 ,1 i Fj
BY PLAN CHECK $ _ --
CTNSR $ 10.00 VALUATION $ _
TOTAL $��tQQ— RECEIPT No. 2j�L
SETS OF PLANS AND PLOT PLANS MUST BE FURNISHED WITH APPLICATION
LOT #__ 70 __W_ MAP N 281 10D CENSUS TRACT �.$ _- JOB N
Architect or 'ngineer
Address_- 15300 B.N. 116th Bne.. Tigerdy OTemn __---�--Phone
(-hlner
Address --- — ---------— --Phone`—
Builder
Address
BUILD?NG USE Fingle Res.-U `Multi Res. LJ Comm. Industrial C
OCCUPANCY GROUP I No. of Stories 1 Total Height 1Q Area of Lot_12
Type of Construction " UXIU333331 V Floor Area B`__i 1 �;�d_ 2
S_t Backs: Front 11+1 Back 2,* L.Side LJ R.Side__�
Private Sewer Pipe Size— )so Sewers Septic 'rank LJ
Water Service Pipe Size` �/`�-_ Storm SewerEl Ditch ❑ Drywell �
Street and Curb Requirements Y'
Ur.vel,ay Width 2- No. of Parking Spaces 6
SEPARATE PERMITS REQUIRED FOP SEWER AND PLUMHING
SPECIAL INFORMATION
ADDRESS ASSIGNED 1597) B.W. Oentury 'lak A circle
FIELD CHECK BY EWc _ — .----.-DATE__ 8.073
PERMIT APPROVED BY e �
It is understood that all work will conform with applicable codes and ordinances
of the State of Oregon and the City of. Tigard, Oreo ,n, and that the building wil
not be occupied until a Certificate of occupancy has been issued by the City of
Tigard Building Inspector.
Signa urs Applicant
1480
EMBIT "A"
CITY OF TIOARD
Residential Structure Occupancy Restriction
KNOW ALL WN BY THISE PRESENTS, That occupancy of residential
structure (s) on the following described lands prior to the recording
of an occupancy permit rel^aginA the restriction in the Deet. Records
of Washington County, Oregon, is prohibited by the ordinance of the
City of Tigard, Oregon:
DESCRIPTION OF PROPERTY:
ADDRESS OF PROPERTY:
NAME OF OWNER:
ADMILSS OF OWN At
(J
IN VITNR5S WHEREOF, the undersigned has cai-.eed this restriction
to be executed this _ `-��= day of
OWNER: Tualatin Development Co., Inc.
/ Name
APPROVED:
T.tle
le
By: Mod 1W Mxe...._8,-�-� :o y ep.. . M PA
Building 0 sial 8009A THOUSM,OU-**W ROMde 6 M meow
City of Tigard PP............_............6�. ._..
STATE OF OREGON ) ss.
County of Washington ) August 7 19-7-3-
Personally appeared before me the above named Roy Brown, Vice President
of Tualatin Development Co., Inc. and acknowledged the foregoing instrument to be
hie voluntary act and deed.
Notary Public for Oregon
Pty COmm'rtaton Expires:January 16, 1975
eoa� 939 ME966
0
o
EXHIEIT "A"
CITY OF TIOARD
Residential Structure 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 Deeu Records
of Washington Coun'y, Oregon, is prohibited by the ordinance of the
City of Turd, Oregon:
DESUI1TION OF PROPERTY:
Y>8 Civ``eoc.0 IY• \�OC•K.. 3«� \ ...•r^su LAC
Y�L.l Cb1'OS OY Lam•r,':,•� A I.IO • �`r... ,:'. '+ � �l'Y2 EC•C�...
ADDRL;S OF PROPERTY:
NAME; OF OWNER: *-K'�
ADDRSd73 OF OWNER: X\
IN WITNESS WHEREOF, the undersigned has caused this, restriction
to be executed thi:• day of
OWNER: Tualatin Development Co., Inc.
i
APPROVED: TA-e
By:
Building Offic11I.
City of Turd
STATE OF ORMON
County of Washington ) August 7 ly 71
Persone.11, appeared before me the above named Roy Blown, Vice President
m Iualetin Development Co., Inc. and acknowledged the foregoing instrument to be
his volw,Lary act and deed. J
Notary Public for Oregon
My Comm'.,.sion Expires:January 16, 1974