12430 SW 124TH AVENUE w
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EaIBIT "B" 1 3 aY`i
CITY OF T.IGARD
CERTTFICATE OF OCCUPANCY AND RELEASE OF RESTRICTION
The City of Tigard hereby certifier, that the occupancy of
the following described. structure or premises with respect Lo VY-ich
a restriction of occ.:pancy was, on _,12-5__ , 19-",
recorded in Book 955 , Page 440 _, Deed Record of Wash1n3ton
Count;,, Oregon, is hereby autnoi-ized and approved.
DESCRIPTION OF YROI_'ERTY:
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Tax Map 251 3B8, Tax Lot 100
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OWNER' Daniels.-_WiaQina_A DAn.yAIJU �+u+tracf.orw _�
BUILDING PERMIT NUMBER: 73-274 Y�
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BUILDING ADDRESS: 12430 S.W. 124th Avenue
This is to certify the said structure meets with the require-
ments or '.he Building Cade of the City of Tigard and L!ie abova
referenced restriction is hereby releas:d and terminated
IF WITNESS WHEREOF, the undersigned authoriz-�rl officer of tie
City of Tigard has cauued this certificate and release of restriction
to be erecuted h:9 day of 19�.
T!tle: __ ,u
STATE l 0R.X'rON )o e
County of Washington )
On this -�_� day of 19-;, personally
appeared before me the above nalred whose
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signature appeahereor. and who acknowledged to me gnat he executed
the same in his oi''ical capacity on behalf of the City of Tigard.
otary P liea �n
11y Commie
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ALL SPACES NJUST BE ENDORSED
PRO`d'�I OF l FiESE PLANS
PUE3LIC WORKS DEPT. lABY
BY.
PLANNING DEPT. (±,'.T_..�
BY.
;p' I BUILDING D PT. I i _— D•.-•7 -....--- _.
D$PT• EFly.i. COUNTY Hr\LT ii i
CITY AD'•11Ni5TRn T OR i'"-.,•----. -- _... .
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City of Tigard
INSPECTION REQUEST
for
INSPECTION TIME: -',Uv PERMIT NO. :
DATE: L7-q riAT E ISSUED : Z
OWNERS NAME --
ADDRESS: _—
CONTRACTOR : —. _ _----- --
TEST : Air C7, Water❑ vieual'm� Laboratory Cl
RESULT : Approved , Disapproved O , Pending []
SKETCH:
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INSPECTOR DATE
NOTE Attach supplemental test d6to beret!]
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Addles•- Permit No.
rr��rrr. rsrrarraa`r ■i rwrr�rrwrwr.r.ar
Permit charge
Owner r Connection tae 6V
- -�- Paid by --
Type of building _ �c,e pate connected �� a 4v
Service rate- -3 � In6nection fee
ContractorPaid by date
Site of connection SL's Assessment paid , ��,�
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City of Tigard
INSPECTION REQUEST
for
INSPECTION TIME: -�+�I�syl ��e PERMIT NO. :
DATE: 74- DATE ISSUED : I Z
OWNERS NAME :
ADD ESS:
CONTRACTOR : _ �d rrG
TEST : Air ❑, Water❑ , VisuoI oboratory O
RESULT: Approved Disapprovved ❑ Pending []
SKETCIN: rcj. es��4
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INSPECTOR DATE
[NOTE: Attach supplemental teff dot her efa,
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City of Tigard
INSPECTION REQUEST
I for
INSPECTION TIME ' Q PERMIT NO.:
I DATE: , 9' lill TV DATE ISSUED:__L_L_
OWNERS NAME : D
ADDRESS : 1a S43y Sw
CONTRACTOR ' D w n --
ITEST:Air D, Water p , Visual p , Laboratory p
RESULT: Approved) , Disapproved p , Pindinq p
KETCH: q .,00til.
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IfjSPECTOR GATE
ICOTE: Attooh supplsmsntoi tem .bt3 hereto
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City of Tigard
INSPECTION REQUEST
for
INSPECTION TIME : PERMIT NO. :
DATE: --'//,r,/ / DATE ISSUED:__LL
OWNERS NAME '
ADDRESS : q 3 a `/ --
CONTRACTOR : 1)-u U —
TEST: Ai►O, Water 0 , Visualg , Laboratory Cj
RESULT: Approved Disapproved O Pending p
SKETCH: c? , � cl
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NSPECTOR DATE
NOTE: Attach supplemental fest data heret,
WWWWRt W a wr n
56.
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CI'T'Y OF TIGARD MECHANICAL PERMIT p,
DATE PERMIT NO. ��(_C�� RECEIPT NO.BY FEE S
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 be concealed must be inspected before cover up.
New Installation � Replace ❑ Relocation ❑ Addition ❑ Alteration ❑
CONTR.-__ 412-ao w j-j -N'r / p4 6 C e) . OWNER n C.0 ;> - �-
ADDRESS 1 r S-7e-) (U �T 'T-�U ',Z 1--i L L",� WORK ADDRESS
APPLICANT
TELEPHONE NO. 4 L -7
FURNACE - MANUFACTURER. L c�.f c� K TELEPHONE NO.
HEAT Input rating (Btu Per Hour) It- r, Cuor, Vent Size e dFlue Size
FUEL OIL ❑ GAS Z ELECT ❑ OTHER
TOTAL SO. FT. Top Floor Pi ? Main Floor _—! Basement 7 -7
GENERAL
ITEMId0. FEE ' ITEM N0. FE '
For IssUance of Permit 3.00 Boilers Over 50 HD
New - Under 100,000 Btu 4.00 Air Handling 10 000 CFM
New -mer 3"OO 000 Btu nn Air Randling Over 100,000 CFM
Floor Furnace Eva orative Cooler .0
Wall - Floor - Suspended' . en an- _
7—nst-aM Vents Vent Sy 0
Re��__air - Heat & Coolingt+000 Hood y�- -� .(03
Boilers�nle _ sp0 Dome_�i`c�ncTnera or0
0
Boilers o H .50—'—comm. n�� or _ 20.0
Boilers 15 to G H 110.00 -
33oi3ers toil p -
INSPECTOR'S COMMENTS _ �t a�-E <" o--o
S C5
APPROVED BY _ DATE ISSUED BY DATE
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Signature of Applicant
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City of Tigard
1
INSPECTION REQUEST
for
IINSPECTION TIME . PERMIT NO.: —
I DATE: DATE ISSUED:OWNERS NAME :
Y
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ADDRESS :
I CONTRACTOR
I TEST. Air D, Water 0 , visual 0 , Laboratory p
RESULT. Approved , Disapproved L7 , Pending []
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SKETCH:
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INOMCTOR DATE
[OTE: Attach supplemental test date beret-10
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y.1 PLUMBING PERMIT APPLICATION
Jurisdiction of
No. Type of Fixture Fee Permit No.
Permit fee
y y Water _Closets (Toijetsj Permit I ssuea _111 17
Bath Tubs Approved by
4 Lavatory_s Basin _ _L ,_ Building Perm
Shcwer Receipt No.
` nTcs Di shwa.. ing
Sinks, Kitchen
Sinks. Ordinary Location of Building
inst Bar_------ ----- -- ---------- -------------------
Sinks SloesAutomatic DisFwashar
,SiSpG3 _----
L,aund_ry TraLs_N— - Name & Address of Owner -______•.____�
Drains. Floor
_Drains
Drain o R�� erator
Rain Drains .�
Automatic Washer y Name & Address of Plumber
-
Fountains, Drin n �,>.� .—vt �� 4 �h,
�ountaains, Soda _ - -
Hot Water Tank
tk
=Y Water Service Size
- urinals - Buildin Old or New) (Alter, Re air or_
_ a-;7o -rastns�ar� Install—T— _ -- _
Lairn Sprin iar-S stem ._ .__ A ��'•l�- 1. � -. [ _ --------
Swimming Pool —__ Dt�ier
�priTikler�a�stem __--- - ----__----
This permit becomes n•L11 and void if work or construction authorized is no-
commenceu within 60 days, or if construction or work .is suspended or aban" '..ed
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 do?s 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.
Signature of Applicant��
City of Tigard
INSPECTION REQUEST
for
INSPECTION TIME: 09.20 PERMIT NO. :—__
DATE: m2 //tZ2!f— DATE ISSUED
OWNERS NAME : ---
ADDRESS: 12w 5 w • -- -- --
CONTRACTOR ----
i EST Nair u, Woter❑ , Visual [I , Laboratory ❑
RESULT: Apnroved 0 , Disapproved O , Pending ❑
SKETCH.*
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NSPECTOR � DATE
CN OTE Attach supplemental test data her Pt
UNIFIED SEWERAGE AGENCY 4934
WASHINGTON COUNTY DATE __ -- - --^ --
CITY OF --_—_ - Tigard
APPLICATION FOR SEWER CONNECTION PERMIT
OWNER:
OWNER'S ADDRESS: P'0• Box 23551
sTVFFT
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- - STATE
BUILDING SITE: LOT_.l_00ZIP
BLOCK - ADDITION . _Lake_Terrace_ _
TAX LOT N0. TYPE OF OCCUPANCY Residence
,;2 y 3c-) /:?y7� J e -- — ----- -
ADDRESS _ temporary 1—*
DWELLING UNITS _ � FIXTURE UNITS
SURCHARGE IF APPLICABLE ___-__ _
PERMIT FEE 9.50 INSPECTION FEE _25_..__ TOTAL DEPOSITED 47-1
(NEW) (EXISTING) BUILDING SEWER SYSTEM -_ _TiQ�r1l�_�
The Applicant ailrees to comply with all rules and regulations of thr, Unified Sewerage Agency.
APPLICANT\
SEWER PERMIT
THIS PERMIT AUTHORIZES CONNECTION TO THE SEWER SYSTEM,
LINE SIZE -- " -- INSTA'.LER
RECEIVED BY _
IA ENCU OR ITS AOENTI
COMMENTS. _
This Application and pe:mit expires in ninety (90) days. The amount paid will be forfeited
should expiration occur.
CITY OF TIGARD
12490 S. W. MainSfrMf
TIGARD, OREGON 9722.7
APPLICATION FOR BUILDING PERMIT
New Construction ❑x Demolish ❑ Addition ❑ Remodel Move❑
ZONING R-7 DATE ISSUED 11-13-73 BUILDING PERt1IT
DA'L'E RECEIVED BUILDINV FEE $ 151 50 No.
• PLAN CHECK $ 75.75 __ "3-274
BY 31 4.00 rscordi4+UATIOtd $ q _ 716
OTHER $� i 51 state RECEIPT NO.�j.7.1 )
TOTAL $ 232.76 H-13 74
TAC SETS OF PLANS AND PLOT PLANS MUST BE FURNISHED WITH APPLICATION
LOT N inn MAP N ?S1 app CENSUS TRACT JOB N _
Architect or Engineer_ ].W_D_
Addiess p.0. box 23551, Tigard - Phone-
Owner --
A,ddi ae ___ Phoned
Builder___eamH — ---- -------
;Nddress Phone
BUILDING USE Single Res. [;] Multi Res. ❑ COMM. ❑ Industrial❑
OCCUPANCY GROUP I No. of Stories_ 2 Total Height17 _ Area of Lot
Type of Construction IXX)=XXO=XX:N V Floor Area B` --- 1_11_gL 2 :Baa 5t
Set Backs: Front 29 Back 82 _ L.Side_ 18 R.Side 23
Private Sewor Pipe Size 411 Sewer iss TigardSeptic Tank �J
Water Service Pipe Size 3/4"_ Storm Sewer ❑ Ditch ❑ Dr ?11l _1
Street: and Curb Requirements ePtIlt as raruj i red b4-aclhd AL+A a=--Ur_riir ztl--
Driveway Width 1B1 —No. of Parkinq Spaces
SEPARATE PERMITS REQUIRED FOR SEWER AND PLUMBING
SPECIAL INFORMA'- LON
ADDRESS ASSIGNED temporary address - ,MQMY S.W. W -t. _
FIELD CHECK BYJ9 - -�-- ----•--DATE 11-13-73
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PERMIT APPROVED BY
It is understiod that all work will conform with apnlicahle codes and ordinances
of the State of Oregon and the City of Tigard, Oregon, anu that the building will
not be occupied until a Certificate of Occupancy has bee issued by the City of
Tigard Building Inspector. ( /10.41 '
gnat re o Applicant
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EXHIPIT "A"
CITY OF TIGARD
Residential Structure Occupany Restriction
KNOW ALL IGEN PY THESE PRESENTS, that occupancy of residential
structure (s) o:f th-v 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:
Z 5I 3613
"-AJ! to—I v 0
ADDRESS OF PROPERTY: / Z C>L., S-V✓• tiJAL��'i!
NAME OF OWNER: y :.f/'G(i/NS
ADDRESS OF OWNER: _J C? &Y Z3;S I
IN WITNESS W11CREOF0 the undersigned has caused this
restriction to be executed this day of Nps/. , 19'.
OWNER:
Name
APPROVFD: iT -
Ei y
/Building ficial
City of Tinard
STATE OF OREGON
County of Washington °°' YtU\� __, 19 1
Personally appeared before me the above named
_ and arknowledged the foregoing
instrument to bs voluntary act and deed.
NotaryPubi or sequn
My Commission xpires: _
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pnata THOU38".D404"f M ee zMmfefr
!AV.440
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STATE OF OREGON ( ss
County of Woshlnyton `
tds
I, Roger Thamssefllc10ol Recorder Re�_A
and Elrctlons and E�O certlf
veYances fr saki county, do hereby Y
ti, , tid and recorded
Inenbook f of.
records
No.
of said County
Witness MY hood and seal affixed.
Records THOMSSE , Director of
Elections l CO7Gi
« f4m�ty
38 PN'13
EXHIBIT "A"
CITY OF TIGARD
Residential Structure Occupeny Rsstrict.iin
KNOW ALL MEN BY THESE PRESENTS, that occupar,^y of residential
structure (e) 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 as a final inspection determines that the construction
is satisfactorily completed)
DESCRIPTION OF PROPERTY:
Z5 / 3313
ADDRESS OF PROPERTY: /—Q V
NAME OF OWNERS 1 1114 IV 1701 C I,
ADDRESS OF OWNER:
F
IN WITNESS WHEREOF, the undersigned has caused this 4
restriction to be executed this T— day ofd_, 19Tr.
OWNER:
ams
APPROVED: T:7 r`.- "� s
By: _�_
u ng c�—
City of Tigerd
STP'r OF OREGON
Coui ;y of Washington ) ee' 19 r-�—
Personally appeared before me the above named _
and acknowledged the foregoing
instrument to be voluntary act and deed.
a�5
Nary Publi.r,— artrf ragot
aa0 My Commissibn Expires:
I,7
CITY OF TIGARD
12420 S. W. Ma:n Strsat
TIGARD, ORE",ON 97227
APPLICATION FOR. BUILDING PERMIT
New Construction ❑ Demolish ❑ Additio ❑ Remodel ❑ Move ❑
`--- - � --- UILDING PERM `----
ZONING D ISSUED--� '� -7 3
BUILDING FEE $ No.
DATE RECEIVED -- PLAN CHECK $ 75 - a -7 -
BY OTHERVA ,
` TOTAL $ RECEIPT No.---?&15;V
y/
TOTAL S mss, 7S l-
TWO SETS OF PLANS AND PLOT PLANS MUST BE FURNISHED WITH APPLICATION
LOT # MAP #—__— CENSUS TRACT f _ _- JOB #` _
Architect or Engi
Address_
Owner —---------- --
Address — Phone-----.�—_--
Builder-
Address _ _- - ____Phone__---- _
BUILDIN USE Single Res. ❑— Multi Res. ❑ omm. ❑ Industrial❑
OCCUPANCY GROUP No. of Stories Total height__---- 'Area of Lot----
Type
ot__ —Type of Construction I TI III IV V Floor Area B------ 1,
Set Backs: Front---- Back_ L.Side ___ R.Side-__r_
Private Sewer Pipe Size____. Sewer---------` .- Septic Tank L-1
Water Service Pipe Size____ _- Storm Sewer a Ditch ❑ Drywell❑
Street and Curb Requirements—
Drive%,ay Width_ ,i No. of Parking Spaces.----_
SEPARATE PERMITS REQUIRED FOR SEWER AND PLUMBING
SPECIAL INFORMATION
ADDRESS ASSIGNED----,----
FIELD
SSIGNED_-- -FIELD CHECK BY -- ---`- --_--I—.-----DATE-- ,--
PERMIT
----DATE-- ,--PERMIT APPROVED
It is understood that all work will conform with applicab a codes and ordinances
of the State of Oregon Ind the City of Tigard, Oregon, and that the building will
not tie occupied until a Certificate, of occupancy has bren issued by the City of
Tigard lluilding Inspector.
S gnature of Appl cent ��