9940 SW CENTURY OAK DRIVE 1
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! ;gATHO XVO 1CMINT) MS 0666
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EXHIBIT "B"
4059 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 Apra- 1F
recorded 1n Book 970 , Paip 694 , Deed Record of Wnehington
County, Oregon, is hereby authorized and approved.
DWCRIPTION OF PROPERTY:
5ummerf9.eld lot 94
4e recorded in Book 329 Page 50, Plat Records of
Washinqton County, Oregon
OWNER: 1]ara_ d L-- L 11irninin I _ Marf'in
BUILDING PERMIT NUMBER: 74-45
BUILDING ADDRESS: 9940 S-1.1. century Oak Drive
This is to certify the said structure meets with the require.
,
meats of the Building Code of the City of Tigard and the above
referenced restriction in hereby released and terminated.
IN WITNESS WHEREOF, the undersigned authorized officer of the
City of Tigard has cau,,ed thi; certificate and relea..e of •estriction
to be executed this day of
.ALL L�)t 4•.. �✓✓+`— �--�—�—
Title:----ClIY AECQADCR ��
STATE OF UREGON
County of Washington )
On this _ ^� day oil , lgal' personally
appeared before me the above named1i,;7",711- _, whose
signature appears hereon and who ackn6wledged to we that he executed
the same in his offlcal capacity on behalf of the City of Tigard.
o ry uflic Oregon
My s on expires: _
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City of Tigard
INSPECTION REQUEST
for
tiCTION TIME : PERMIT NO. :
DATE: TLS 4-- DATE ISSUED*:....L1.
-RS NAME : Q _C_
ADDRESS : _y9,/o
r R A C T O R :
r: Air ❑, Water [] , Vieuul ❑ , Laboratory ❑
ALT: Approved Disapproved d-,'-Pending p
SCM:�1 t
L_
I!r&, E CT0R DATE
.�
{tt:ach supplemental test elate AeroPJ
ALL SPACES MUST BE EITDORSpl)
ISSLTA"'E 0-11? -131]ILDII-IG pEj?PMRIT�COR TO
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D,
63
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City of Tigard
INSPECTION REQUEST
for
X>1u0�.e 0�e74hrd eL M,
INSPECTION TIME : / ' 3o PERMIT NO. : —
DATE:
O. : ____DATE: G L 8/ 7dy DATE ISSUED: L
OWNERS NAME : TO if .
ADDRESS ' -
CONTRACTOR :
TEST: Ai► ❑, Water [j , Vis jal W , L aboratorY ❑
RESULT: Approved S. , Disapproved ❑ Pending C]
SKETCH:
INSPECTOR DATE
GOTE : Attach supplsmsrttol fast data hsrst:01
s>A
(moi #y of Tigard
INSPECTION REQUEST
for
INSPECTION TIME : PERMIT NO. ' -
DATE'.
O. :DATE: _Z4_11VZ1 DATE ISSUED: _ Z
OWNERS NAME : -
ADDRESS :
AME : _ADDRESS : �y -�qy" '�`✓ :
CONTRACTOR :----
TEST'.
ONTRACTOR : —_TEST. Air 0, Water ❑ , Visual [I , Laboratory ❑
RESULT: Approved , Disapproved ❑ , Pending []
SKETCH:
INSPECTOR DATE
NOTE : Attach supp;.ment,tl test data hereto
City of Tigard
INSPECTION REQUEST
for
INSPECTION TIME, 0 PERMIT
DATE. 2o 7 DATE ISSUED :--L-Z__
OWNERS NAME : C
ADDRESS: jq'
CONTRACTOR
TEST : Air U, Water 0 , Visual a , Laboratory p
RESULT: Approved 0 , Disapproved 0
Pending 0
SKETCH:
I
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INSPECTOR
DATE
ENO?E: Attach Supplemental test data beret j I
PLUMBING PERMIT APPLICATION
Jurisdiction of
No. Type of Fixture Fee Permit No.
I Permit fee
.s'��+Qutc�c�c
Water closets Toilets Permit Issues
Bath Tubs Aprroved by
Lavato Was Basin - _ Building Perm
Shower ^^y Receipt No. /&v,;1-
Sinks,
&v,;1. in s, -Dishwas�iing
Sin s Kitchen
Sinks,• Ord'in_aLoca ion Of Building
ar
nTt�s _ _ /�i.�
Sinks, Ste_
u oma its Dis washer _. t 1:, —
Disposal —
Laund_ry Trays Name Owner ..-.,Address of Own � ;�
Drains Floor r' - —
r- ,
rains res
Drains, Refrigerator ------
Rain Drains )
Au oma is as er Name & Address of P1umbGr l _.h
_ Fountains,- r n in
Fountains o a ' � �• ^ + /=
--
Water ServiceSize,%. -
Urinals Buildin Old or+IwT lAlter. Repair or
Ca cF-Baasins-Yat+ Inst` -—
awn Spr�ii�nk��le��r��STyyStem
Swimmi.n Pool
Oder
_STinhlery5 stem
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 ani 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 prestme to give authority to violate or cancel the provisions
of any other state or local law regulating construction or the performance of
construction.
i'
Signature of Applicant
'�
CITY OF TIGARD MECHANICAL PERMIT
DATE -�/,<�; �� PERMIT N0. -7 RECEIPT NO. LaD C
BY FEE
1. Permit shall be obtained prior to commencement of installation.
2. Permit shall be obtained for all appliances which are to become
a fixture to the building.
3. Relocation, replacements, alterations, or changes to burners and
duct work require permits.
4. All work to be concealed must be inspected before cover up.
New Installation Replace ❑ Relocation ❑ Addition ❑ Alteration ❑
CONTR.� , / ( , OWNER . -L ,
ADDRESS r r I I�^ �•_-- WORK ADDRESS r"i"��1 %/� ( •. r
0 . APPLICANT
TELEPHONE N0. �1 •'.� - /�
FURNACE - MA14LJFACTURER l _ TELEPHONE NO.
HEAT Inputtgating (Btu Per Hour) _LC r rVen -ize --- - Flle Size
FUEL OIL ❑ GAS❑ ELECT v OTHER _
TOTAL SQ. FT. Top Floor Main Floor f.' Basement
GENERAL
ITEM NO. FEE ITEM NO. FEE
For Issuance of Permit V 3,00 Boilers Uver 50 lip 25 n
New - Under 100 000 Btu 00 Air Handling- 1-.0 000 CFM
_
ew - Over 100.OUU Btu nn Xrr Handling0ver 10.030 CFSnr
Fl
oor urnaze 4, va orative CoclerM _
Fall=mspenUed 4.00en an �.� 2.
Ins—aInsf-all Vents 2, en
eat & Coolin .00 ood
Boilers Un er A-� 4 _ omesE1c� nc nera or 0
Boiler.3 3 to150Comm.-Mc net' for-� 20 0
Boilers o 10.00` ~�ot Lisl—ed—
Boilers
e
Boilers�a --
INSPECTOR'S COMMENTS
APPROVED BY DATE ISSUED BY _� DATE
City of Tigard
INSPECTION BEQUEST
c for
INSPECTION TIME : 1I M PERMIT
DATE: V /11/7Y DATE ISSUED :_j
OWNERS NAME : �T 0 C-
ADDRESS:7� Cculitu�� �
_ _�riJQ
CONTRACTOR :
TEST : Air U, Water[] ,, Visual , Laboratory ❑
RESULT: Apnroved Disapproved ❑ Pending p
SKETCH:
INSPECTOR DATE
[OTE. Nttacn supplemental test ddta beret]
e
I
°
Cit of City Tigard
INSPECTION REQUEST °
for 0
NSPECTION TIME: —Q-� PERMIT NO. :�., I
DATE: 4i DATE ISSUED :_L./ t
DWNERS NAME :
T Dc-
ADDRESS: S.
u
O N T R A C TO R :
TEST : Air 'I, Water❑ , Visual p , Laboratory p
RESULT: Approved ',, Disapproved 0 Pending p I
SKETCH. C
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INSPECTOR DATE
N 'TE: Attach fupwafrentol test data beret] °
EXHIBIT "B"
CITY OF TIGARD
CERTIFICATE OF OUCUPANCY 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 ^April t , 19-7-4,
recorded in Book 970 , Page Y 694 , Deed Record of Washington
County, Oregon, is hereby authorized and approvers.
DESCRIPTION OF PROPERTYi
Summerf=e.td lot B4
As recorded in Book 32, Page 50, Plat Records of
WeehingLon County, Oregon
OWNER: CArn1d I _ & 11irgin�i,gg I _ martin
BUILDING PEPMIT NLMER: 74 -45
BUILDING ADDRESS: 9940 R. J. rent ry Oak Drive
chis is to certify the said structure meets with the require•
ments of Lhe Buildin5 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 cau;jed (his certificate and release of restriction
to be executed this _ day of ` l9_
Title:
STATE OF OREGON
County of Washington )ss.
On this day of , 19`, personally
appeared before me the above named _ , whose
signature appears hereon and who acknowledged to me that he executed
the same in his offical capacity on betalf of the City of Tigard.
Notary Public of Oregon
My Commission expires:
CITY OF TIGA RD
12420 S. W. Main Street
TIGAItD, onscoN 97227
APPLICATION FOR BUILDING PERMIT
r:'-w r,,,,:t.r uction Demolish ❑ Additi,.n ❑ Remodel ❑ Move❑
DATE ISSUED_ -T� BUILDING PERMIT
BUILDING FEE $ Q p No.
BY PLAN CHECK
OTHER e"Y
=rnn-, RECEIPT No.
TWO SFTS OF PIANS AND PLOT PLANS MUST BE FURNISHED WITH APPLICATION
MAP N CENSUS TRACT - JOB N l�
Archi t,'et or FngineerTF �-:.^ t^t? ,n
'�t'T ( Phone�3� 1t��
AL3„- :,s - ------- Phone
Sar
raSs- - ----- - _ Ph
H1111,1ING USE Single Res. Q Multi Res. ❑ Comm. L___I Industrial❑
n(_,'UI>.AN:.Y GROUP-_ _ No. of Stories ( Total Height Area of Lot`__
TYiw f Construction I II III IV -V Floor Area B,- 1170 2
riot Isacks: Front )S?'_.C2L Back_ L.Sid e,-.,-'-(o' R.Side
n
Priv,it_e Sewer Pipe Size y " Sewer k;._ jci Septic Tank ❑
,%%-ii or Sery.ce Pipe Size---Y# " Storm Sewer Ditch ❑ Drywell❑
:-3 -rt r,nd Curb Requirementsr,
vo'w iy Wirlth_ j j, - T No. of Parking Spaces
SEPAPAPE PERMITS REQUIRED FOR SEWER AND PLUMBING
SPECIAL INFORMATION
,I,I�I ..; .A557Gh3FD---99_�___s:L�• ��n����.
E'1! LIQ 1'IIFc'Y HY -- _ - — --- - DA'PF
I'ERTdIT APPROVEDL.B �-,
TL is ur,Icrst:ood that all work will conform with applicab a codes and ordinances
(,f th" state of Oregon and the City of Tigard, Oregon, and that the building will
n"t e c)eCupied until a Certi.f.icat�, of Occupancy has been issued by the City of
ril,,,rd 111ilding Inspector.
1 nature of Applican
3'753
EXHIBIT "A"
CITY OF TIGARD
Residential Structure Occupany Restriction
KNOW All MEN BY THESE PRESENTS, that occupancy of residential
structure (e) on the following dwacribsd lands 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 raise
as soon as a final inspection determines that the construction
is satisfactorily completed)
DESCRIPTION OF PROPERTY:
AS r�c_c�rc\ r\ ire \ -�"k- i�1 l \ y yc� E'1t�-
ADDRESS OF PROPERTY: gcjyU �.�/, C � �.,•.: C'�crl� l)�rvp
NAME. OF OWNER:
_ADDRESS OF OWNER; N
IN WITNESS WHEREOF, the undersigned has caused this
restriction to be executo)d this t~ 7
_ day of 1��u-, L 19 ,;L.
OWNER:
Ny+ss �
APPROVED: Title
By:
Building Orr c�—�
City of Tigard
STATE OF OREGON
County of Washington so. r)19
Parses ally appeared before me the abovl named
4'. Igia --i � and acknowledged the orsgoing
instrument to be _� , vit111_ntery act and dead.
\A 2,f/w
tit E�ry Publit-rot Aragon
My Commission Expires:
Z.
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n1.4 for r.—Il.. *C-1..,SI�..L../al 42 P%" fi M
T, ;1R ;HriM4Qf N. N:—". M Pe•r...i. A. r... ..
M
AnnK 970 iAA94
EXHIBIT "A"
CITY OF TIGARD
Rosidential Structure Occupeny Restriction
KNOW ALL MEN BY THESE PRESENTS, that occupancy of residential
structure (a) on the following described lands prior to the recording
of an occupancy pormit releasing the restriction in the Deed Recorda
of Washington County, Oregon, is prohibited by the ordinance of
the City ,f Tigard, Oregon: (The City will icaus a release
os 000n as :: fianl inspection determines that the conatructio^
to oatiofactorily complote4.)
DESCRIPTION DF P' OPERT
e".C`..: i'C`e f 1 1 \ i r.:��. S•.Z } 17G C L— (� 4 T
��r�_._ r �5 �� Wu-,�-�,c��. To,� C:.=•�� .� rte.
ADDRESS OF PROPERTY:
N';IE OF OWNER: /'—�•_,^c,�C1 L V..'n};n;c. L • t"lc, {-•r�
ADDRESS OF OWNER: ►r �yL,C_� '� �/ -1`�,.1..,�-� �;
IN WITNESS WHEREOF, the undersigned hats caused this
restriction to be executed thio L' day of Al l , 19�.
OWNER:
APPROVED: it s
By:
BuildIng Off c a
City of Tigard 1
Be.STATE OF OREGON ( fl
County of Washington J 19 7
Per nally appoared before me the above nomad
and acknowledgod the foregoing
inotrument to be i v ary act and dead.
o try Public Xot Oregon
My Cornmioaion Expires: