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CITY OF TIGARD 14AR Z 8 197q
•
CERTIFICATE OF OCCUPANCY AND RELEASE OF RESTRICTION C{'TY OF TIGM)
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 -i,.5 U—'-, 19�1
recorded in Book )�/ `/ , Page (o , Deed Record of War,hinGton
County, Oregon, is hereby authorized and approved.
DESCRIPTI01? OF PROPERTY!
OWNER: GlA/1°TcJ ✓J6F1.�6Lt�p/l�c G� . !/u=
BUILD---HG PERMIT NUMBER:
LD 110 ADDRESS: 9962 S uJ CAM JT(-,,& 6/9K L)R.I_
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 -idersigned authorized officer of the'
City of Tigard has caused this certificate and relea-e of restriction
to be executed this day of �[w c� 192J--
Ti
92J-.
Tile:
STATE OF OROGON
County of Washindton )ss.
On this dhy of personally
appea_ed before we the above rvained iii . k y whose
signature appears hereon and who acknowledged to me/ hat he executed
the same in his offical capacity on behalf of the City of Tigard.
Notary P611c of Oregon
My Commission expires.
INDEX[
riled fm mood./ �.![. ../., .1.7 N PA M P M
ROGLR THUMRREM, (hm�er'A br.tr.4 riw -'s
39
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INDEXED
STATE OF OREGON
M C
C.ouity of Washington
Roger T%rwrtsun, Director of Records
and Elections and Ex-Officio Recorder of Con-
veyun es for said county, do 'hereby certify
r'J
that the within Instrun wro of writing was
re,-eivea and recorded in book of records
N.
of c id County
Witr.ess my hand and seal offixed.
ROGER THOMSSEN, Director of
Records & Ehctioro
�1
1
Deputy
Mas 19 1?. 5 PN 174
PLUMBING PERMIT APPLICATION
Jurisdiction of
No. Type of Fixture Fee Permit tin.
Permit fee 3�
2 Water Closets (Toilets Permit Issued
Bath Tubs n Approved by �L
a,,atory _ Wash Basin _ eo_ Building Perm..
Shower Receipt. No. _j VPt
i-r s. Di.sf)wa'Ting
�
Sinks, Ordinary Location B d Pig _
1n= dr_____—_ -
Sinks�Slop
Au omatic DT7i-wa�ie_Y —
Ch�rr�
_
La dr ss Tra r _ Name , Addre. s t
Drains, Floor .— _
rains Area _ _ �� �`�____.
DrainT3i-erator _r______
Rain Drains 7—
Au 77m-a i c Washer Name A- Ares
n'-Fu n t a i n 3r n rg_� __ -----
Fountains. nda 1L �' --
Hot Water Tank --.-
�_ Water Service Size
U- irtals Buil n Uld or ' w A1t:^F_s', Repair or
_ �� c: -Bas ins
x•ink�ei S stem -
Sw-Tawn Sp
immin Pool
_v
This permit becomes nul:'_ and vuid if work or construction auth,,rized is not
commenced within 60 devs; or if construction or work is su5penoed or abandoned
for a period of 120 days at any time after work is commenced ,
All plumbing firms must be licensed by the Cite of Tigard and post a $1,000 bond.
I I hereby certify that I hav read and examined this applization 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 --rovisions
of any other State or local law regulating construction or the performance of
construction.
b
AUC city ��� �� 1A
gr t; ure o Applir,ant
jo. v
i
City yard of TI r
INSPECTION REQUEST
for
SPECTION 'TIME : PERMIT
DATE ' DANE ISSUED :__-C 1_
iMEFAzi NAME '
ADDRESS!—
)NTRACTOR : 7,k4cc .0
f —
=ST : Air u, Water❑ , Visual ❑ , Laboratory ❑
ESULT: Aporoved Disapproved ❑ , Pending ❑
(ETCH.
NI SPECTOR DATE
TE: Attach supplemental test data hent]
City of Tigard
INSPECTION REQUEST
for
FZ
INSPECTION TIME '. , PERMIT
DATE: DATE ISSUED :--j _
OWNERS NAME : 7- 42- C ' �-
ADDRESS: 4-07
CONTRACTOR : ____
i E S T : Air U, Water❑ , Visual [3 , Laboratory ❑
RESULT: Apnroved K, Disapproved ❑ , Pending ❑
SKETCH.'
INSPECTOR DATE
[OTE: Attach supplemental teat data hereto]
i
City of Tigard I
INSPECTION REQUEST
for
SPECTION�TIME* rY_ ,—vwPERMIT NO
DATE . _ / / DATE f SSLJED :_.___1__ /__
INERS NAME '
ADDRESS: 1 ' �< . s -4-4
)NTRACTOR : �— --
ST : Air 0, Water[I Visual p , Laboratory I]
=SULT: Apnroved 0 Disapproved) Pendl ig p
:ETCH:
wtV 4,04V
I
I
I
I
_ � I
INSPECTOR DATE I
TF- Atlorh supplemental test data beret I CN
�J
City of Tl �jard
INSPECTION REQUEST
for
INSPECTION TIME: "ERMIT IAC. :
DATE:C� -� iY?� DATE ISSUED :--./
OWNERS NAME '. —
ADDRESS:CONTRACTOR : — -- - -_--
TEST : )%ir U, Water 0 , Visual ❑ , Lnboratory [j-
RESULT:
RESULT: Apnroved_o , Disapproved Cj Pendhig ❑
SKETCH:
INSPECTOR DATE
NOTE: Attach supplemental test do+a beret]
r
City of Tigard
INSPECTION REQUEST
for
INSPECT.'ON TIME :
— PERMIT
DATE: ''k DATE ISSUED:--Z--Z—
OWNERS NAME :
ADDRESS .
CONTRACTOR
------------
TEST: A r J, Water 0 , �Iisual tY, Lao ,rotory Et
RESULT: Approved tYDisapproved
Pending p
SKETCH:
INSPECTOR
DATE
[OTE : Attach supplemental test data heret]
I
i
-�,o
City of Tigard
I
INSPECTION REQUEST
I
for
INSPECTION TIME : PERMIT NO. :
DATE . 116 DATE ISSUED'_ l_L_
OWNERS NAME :
i A D D R E S S : _4 T t�-
I
CONTRACTOR :--r-ID-16
TEST , A r J, Water Ei , visva ix, La' ,ratory [1
RESULT. Approved )25�1 Disapproved _1 , Pending
I SKETCH:
I
I
I
I
INSPECTOR DATE
F7NvTE Attach supplemental !est data heret]
1
I
I
City of Tigard
INSPECTION REOU
EST
I for
INSPECTION TIME : PER T NO. :
DATE: 10/131 73 DATE ISSUED:
OWNERS NAME : T, �7.0
I ADDRESS ' AU '
i CONTRACTOR
TEST. A:r 10, Water p , Vi3uQPj l La'- .rotary [►
{ RESULT. Approved, Disapproved -1 , Pending p
I
I SKETCH:
I
I
I
I SPECTOR DATE
INOTE : Attach supplemental test data heret-10
453'7
EXHIBIT "A"
CITY OF TIGARD
Residential Structure Occupany Restriction
KNOW ALL MEN BY THESE PRESENTS, that occupancy of residenti '
structure (a) on the following described lands prior to the recording
of an occupancy permit releasing the restriction in the Dead Records
of Washington County, Oregon, is prohibited by the ordinance of
the City of Tigard, Oregon: (The City will issue a release
as soon as a final inspection determines that the construction
is satisfactorily completed)
DESCRIPTION OF PROPERTY:
1�a RLce .\►tia� \r. �aoe� ti.�,, `''��ti SG! E`\�+�'C
ADDRESS OF PROPERTY: ��hA,ry�,
NAME OF OWNER: 'c \sem . ._ d \. ._._..�•c �e _ �.��
ADDRESS OF OWNER: �•c��., �..� ���.� �... .�_,�
IN WITNESS WHEREOF, the undersigned has caused this
restriction to be executed this �-,'Tday of o
OWNER:
\•.c
•
4
APPROVED: •
By:
Building Official
City of Tigard
STATE OF OREGON ) as.
County of Washington ) October 11 , 19 73
Personally appeared before me the above named
Ray Brown and acknowledged the foregoing
instrument to be his voluntary act and dead.
o sr� Public For Oregon
My ammi••ion Expires: },[1/75
!!:x:ER Tito SUN.D!�6oc1ft of Itevade 6 ElecMnn
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949 ,,L,.566
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EXHIBIT "A"
CITY OF TIGARD
Residential Structure Occupony 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 permit releasing the restriction in the Deed Records
of Washington County, Oregon, is prohibited by the ordinance of
the City of Tigard, Oregon: ('rho City will issue a release
as scon as a final Inspection determines that the construction
is satisfactorily completed)
DESCRIPTION OF PROPERTY:
P -a Fi�LarA�a \r. lath.rs�
ADDRESS OF PROPERTY: \ �. v
NAME OF 1)WNER .lb\% a!1a..� t7_
ADDRESS
ADDRESS OF OWNER i ��S�oo\ �'�w ����` 1.-�►`�+�a�-
IN WITNESS 6IHEREO1', the undersigned has caused this
restricti.on to tie executed this 1-vlw' day of nc-Je , 19��
OWNER:
IL
�e 1
APPROVED: •
By,
Building Official
City of Tigard
STATE OF OREGON
County of Washington ae' October 11 , 19 73
Personally appeared before me the above named
T.oy Brown and acknowledged the foregoing
instrument to be ,hie_. voluntary act and deed.
Notary Public for Oregon
My Commission Expires: 1/1/75
CITY OF TIGARD
17420 s. W. MWn slnM
T16ARD,ORIG M ASA
APPLICATION FOR BUILDING PERMIT
New Construction EJ Demolish Addition Remodel 13 Move
ZONINGP.D DATE ISSUED 10-11-73 BUILDING PERMIT
DATE RECEIVED BUILDING FEE $� _ No. ►'3 • 237
BY — PLAN CHECK $ _IJI, recording 6llAUATIOti -19,448
"--� OTHER $ _74-1!$ state
TOTAL $ 88.74 RECEIPT No. J
/O-//_ 1 3
TWO SETS OF PLANS AND PLOT PLANS MUST BE FURNISHED WITH APPLICATION
LUT M jam_ MAP �'c� inn CENSUS TRACT _W JOB
Architect or Engineer- -
Address 16999 ve. .----Phone
_
-� -S�m�
Owner
Address —_ ___ ____— Phone` _—
B u i l d e r --------------------
— sere
Address ___ _— _`— Phonei—
BUILDING USE Single Res. ❑X Multi Res. LJ Comm. 1-1 Industrial[-]
OCCUPANCY GROUP I No. of Storie.4 1 Total Height___j7 ___ Area of Lot
Type of Construction X%XX)j%XxTRXX.jyXXV Floor Area B ___
Set flacks: Front___jRL Back fin, L.Side_ cit R.Side
Private Sewer Pipe Size 4,, SewerSeptic Tank
Water Service Pipe Size Storm Storm Sewer Ditchl_J Drywell
Street and Curb Requirements as reguired by 8ubd;.yjjll2UaSdiance
nriveway Width 18, _ _ No. of Parking Spa.:es—_ ?
SEPARATE PERMITS REQUIRED FOR SEWER AND PLUMBING
SPECIAL INFORMATION
ADDRESS ASSIGNED ggRn S L rX, t,,nf, nn4 n r i y-
FIELD CHECK B'f - --____ DATE-
PERMIT APPROVED BYE
It is understood that all work will conform with applicab1cod do ordinances
of the State of Oregon and the City of Tigard, Oregon, and that the building wil
not be occupied until a Certificate of Occupancy has been issued by the City of
Tigard Building Inspector.
Signature o Rplicant