12160 SW 127TH AVENUE-1 . N
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EXHIBIT "B"
COW CITY OF TIGARD
CERTIFICATE OF OCCUPANCY AND RELEASE OF RESTRICTION
The City of Tigard hereby certifies that the occupancy of
the following described struc-cure or premises with respect to which
a restriction of occuT,ancy was, on October- 23_ _, lye,
recorded in Book 997 , Page 699 , Deed Record of Washington
County, Oregon, is hereby authorized and approved.
DESCRIPTION OF PROPERTY:
lot 97, Bellwood I1, tax lot 8800, tax map 251 4AA
OWNER: Allen Drew
BUILDING PERMIT NUMBER: 0087
BUILDING ADDRESS: 12160 5.L1, 127th Ave.
This is to certify the said structure meets with the requirt-
mer.ts of the Building 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 caused this cer.iii-ate and release of restriction
I
to be executed this 9th day of - May
c`
Title:
STATE OF URE00N )ss.
County of Washington )
On this 9th day of MAY , lye ,personally
appeared before me the above named Doris Hart! j _, whore
signature appears hereon and who acknowledged to me that be. executed
the same in his offical capacity ci behalf of the City of Tiaard.
t�! Led
Notary Publ.- of Oregon
My Commissicin expires: _
1NDE—)77
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CITY OF TIGARD
OREGON
Owner:.............An.en-Or-eu................................ ........Permit No.......0 0 8 7
..........
Building Address.........21 .
.bO...S...W....1.2.7.th...A.v.e............................................
.... . .. .. . ....
Certificate is hereby gi-ven this.......Bt.h..flay of.....MaY...................
that said building may be occupied and
4 that it complies with all requirements of
the Building Code for the City of Tigard,
as approved by the Tigard City Council.
............................................ ......
Building Inspector
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City of Tigard
INSPECTION REQU .",: , E
for
IINSPECTION TIrr, . � fi~� _ ..___.._..
• PeWT t.:-Cl
_ ..
DATE: DATE
OWNERS NAME
CU.3'rRACTOR :— _
TEST:Air D, Water c , ViSUGI C7 , t.a!+nrn#,
RESULT: Approved , Disapproved 0 .
SKETCH:
U/ - e
IN :CTC
DOTE: Attach euppleutient,l Idt Ono hr' „
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)jL SPACES MUST BE E?IDORS 'D PRIOR TO
i ISSUANCEOFL;;TI:LlT ;CT 17-,r,i,:T_T
PLANNING DEPT. 41-
PUBLIC
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PUBLIC WORKS EL-n _ �, -- -- -
BUILDING -
TbLT,AiIN RUa.'1L >.w
FIRE
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BY TITLE
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City of Tigard
INSPECTION REO U E ST
for
iINSPECTION TIME : � �� _ PERMIT NO. : —
DATE : 111 DATE ISSUED:__1J
OWNERS NAME : .
I
ADDRESS :
CONTRACTOR : 13✓A ����LIc- ET –.__
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TEST: Air 0, Water ❑l Visual,,< Laboratory ❑
RESULT: Approved Disapproved ❑ , Pending ❑
IKETCH: �
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I INSPECTOR DATE
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[OTE : Attach supp.omsntai toil dato hsroto7
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City o and g
INSPECTION REQUEST
for
IINSPECTION TIME : PERMIT NO. :
! DATE: DATE ISSUED:
OWNE9S NAME :
AIvDRESS : 1Z���� ,3 -dZ� _
CONTRACTOR : 04-41-4K
I
PEST. Air❑, Water ❑ , Visual Laboratory ❑
I e,
RESULT: Approved)(1 Disapproved ❑ Pending 0
SKETCH: lEr%Di.��a C!L%P� �-� 7" �'F�.,�' f><��
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INSPECTOR DATE
[OTE Attach supplemental foot date beret
WWBW I Ip` !I► i[ //`
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City of Tigard
-INSPECTION REOUEST
for
INSPE=CTION TIME : O•,OD / PERMIT NO.: —
DATE:
O.: —DATE; 6 ' DATE ISSUED:__L_L
OWNERS NAME
ADDRESS : '
CONTRACTOR :
TEST: Air ❑, water Visual Laboratory ❑
RESULT: Approved , Disapproved [) , Pending ❑
SKETCH:
I
Itell 9-7 7N/
I1-21(,o '-JA
t2.7VI
I INSPECTOR DATE
INOTE' Attach supplemental feet date herel:03
y.•.e:�w(a^.vr.,•w�....R!rnm...�e,,..,.-,ww..�.,w:..r-R���y:e�rN�M��.ryrwro.. . . ,_ ,. - .. .. - ...e, w�..r•,�prPw.
CITY oP a.Ce-��:�— N° 0087
BUILDING PERMIT APPLICATION TIGARD DATE 19
THE UNDERSIGNED HEREBY APPLIES FOR APERMIT FOR THE WORK HEREIN INDICATED
OR AS SHOWN AND APPROVED IN THE ACCOMPANYING PLANS AND SPECIFICATIONl$vr. OWNER ONE —_
OWNER ADDRESS _ BUILDER PHONE_
Herb E. MtJY'.LB6!ette ENGINEER
L*
SUILDER - ARCHITECT _ - __- DESIGNER
STRUCTURE ❑NEW 0REMODEL _❑ADDITION ❑REPAIR ❑RENEWAL ❑FIRE DAMAGE ❑DEMOL.IT!ON
C3 RESIDENCE ❑COMM []EDUCATIONAL ❑GCV'T ❑RELIGIOUSCPATIO f3CARPORT ❑GARAGE ❑STORAGE❑SLAB ❑FENCE
— ❑BOND ❑MOVING ❑CONDITIONAL USE ❑DESIGN REVIFW ❑COUNCIL-APPROVED EIS IGNS
OCCUPANCY----LAND USE ZONE BLDG.TYPE _FIRE ZONE_ PLAN CHECK BY HEAT _
--- sinyl.e Yestalgy dwaixing to uwconstructsd as per plsnb
!—
submitted
40 lb*
OCC. LOAD FLOOR LOAD HEIGHT __— NO. i70RIES — AREA VALUC -
BUILDING DEPARTMENT SET BACKS FRONT REAR LEFT SIDE RIGHT SIDE
Permit ., ..17 - ------------ -_.-�--
�— ,fie THIS PERMIT IS ISSUED SUBJECT TO THE REGULATIONS CONTAINED IN THE BUILDING CODE, ZONING
Plan Check REGULATIONS AND ALL APPLICABLE CODES AND ORDINANCES, AND IT IS HEREPY AGREED THAT THE
WORK WILL BE DONE IN ACCORDANCE WITH THE PLANS AND SPECIFICATIONS AND IN COMPLIANCE WITH
Recording 4.00 ALL APPLICABLE CODES AND ORDINANCES. THE ISSUANCE OF THIS PERMIT DOES NOT WAIVE
RESTRICTIVE COVENANTS. CONTRACTOR AND SUB CONTRACTORS TO HAVE CURRENT CITY BUSINESS
1 !{ State '1104 LICENSE. SEPARATE PERMITS REQUIRED FOR SEWER, PLUMBING AND HEATING.
Total 4
BY o
----
_.. APPLICANT 09 MENT
Approved Receipt No.
ADDRESS
DATE INSP. TYPE INSPECTION REMARKS PLUMBING DATE
Contrz ,
Permit No. ren �i �% �•�
�f7 3✓�1Y ft4�.�[aJ _ -
Rough-in _
�� " `>' LSC rot-t�• / -1e-�r ,o Fixture
I-1Z. �C l� i i� t C4�._ < /a.G. : Final
HEATING_—.—
� ��.-� L� C_� ��e•i -��z-'I��,�'[z'.0-� Contractor�y� r^ �s�_"
O 7 I a
i /��• iy�,/Cc-�_A(.�� W1fTP7/C (/Li' Permit No.
wcG l� a r/t� L.� UcS c Ocatf0 as or Oil
L,= C� i� l�� _ CCJ��/ Rou h-in --
Final --
SEWER
Final
DRIVEWAY
Final _ —
�_ Storm Drainage
(Rain Drain) Final
Sidewalk
Curb&Street Final
A roach _
BLDG.DEPT.FINAL TEMPORARY CERTIFICAIE OCCUPANCY
CERTIFICATE OCCUPANCY Final
Landscaping
Zoning Final
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ADDRESS PERMIT NO. _ jS✓/�
PERMIT CHARGE
OWNER CONNECTION FEE
---- — — PAID By
TYPE OF BUILDING ��r�uc.e. DATE CONNECTED /:1-/6`7,q
SERVICE RATE .&)kpx& INSPECTIOV FEE -*iS ,,
CONTRACTOR PAID BY DATE
SIZE OF CONNECTION __ ASSESSMLNT �_�� PAID
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City of Tigard
INSPECTION REQUEST
for
Sa.A,,e.-k
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INSPECTION TIME� __ p77 PERMIT NO. :
DATE: DATE ISSUED:--Z--L
OWNERS NAME : —
ADDRESS .
AME : _ADDRESS : Bcllw��f 1T Lo G .
CONTRACTOR .---
TEST'
ONTRACTORTEST: Air O, Water p , Visu:.: �, Laboratory p
RESULT: Approved O Disapproved .,, Pending
- SKETCH: 12 - 2`74
�Q/�G'" G✓i�-x''1%2- %�'`��'� 9�
Z10,006�4
INSPECTOR DATE
LNOTE Attach supplemental feet data he►et]
UNITED STATES l•'IDF.LI'lY AND GUARANTY COMPANY
KNOW ALL MEN BY THESE PRESENTS: That we, HY CONTRACTORS,
INC., as Principal and UNITED STATES FIDELITY AND GUARANTY COMPANY,
as Surety, are _held and firmly bound unto CITY OF TIGARD, UREGON, as
Obligee in the sum of FIVE HUNDRED AND N0/100 ($500.00) DOLLARS, for the
payment of which well and truly to be made, the said Principal and Surety bind
themselves, their heirs, executors, administrators, successors and assigns,
jointly and reverally, firmly by these presents.
WHEREAS, the said Principal has completed contract for Lo"t No. 97,
sewer cut and has promised and obligated himself to maintain said project
for a period of one year following acceptance of December 5, 1974.
NOW, THEREFORE, the condition of this obligation is such, that, if the
Principal shall maintain said project and correct any defects for a period
of one year following acceptance then this obligation shall be void; otherwise
to remain in full force and effect.
SIGDTED, SEALED AND DATED this 5th day of December, 1974.
HY Q CONTRAC'T'ORS, INC.
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UNITED STATES FIDELITY AND GUARANTY COMPANY:
By
Carol A. McAllister, Attorney.in.fact
izi4o atuJ
1:'74AA.e, ...► .. �..�Y..
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Box 62 G
Garden Hume, Oregon 97223
a December 4, 1974
Mr. A. A. Hiebert
Director of Public Works
City of Tigard
Tigard, Oregon
Dear Sir:
This will confirm our request that you allow us to move the sewer
connection on Lot 97, Bellwood #2, Washington County, Oregon, to the
ten foot easement that exists on Lots 98 and 99 of said subdivision,
and also to hook our sewer into the line on SW Katharine Street.
We will place our sewer and storm drain in a plateau ditch separating
the two linea and we will also use 4" sewer pipe.
We hope you will contact us should you require any additional information,
and we assure you the construction will conform to the U. S. A. and City
of Tigard specifications in every way.
Sincerely,
44rer E. Morissette
Builder.
P. S. Attached is a diagram showing location of the sewer line.
:E: S-12°1220= W 325.20', THENCE: S-77047'40'=E 370.00' ; THENCE: N-56"22'29'= E 69.31'; THENCE: S-77
5' TO THE POINT OF BEGINNING, CONTAINiNG 9.77ACRES
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6246
EXHIBIT "All
CITY OF TIGARD
Residential StructurQ OL-�upancy Restriction
KNOW ALL MEN BY THESE PRESENT, that occupancy of residential
structure (s) on the following described lands prior to the record-
ing 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 determine,; that the construction is
satisfactorily completed)
DESCRIPTION OF PROPERTY:
lot 97.in Bellwood II, tax lot 8800, tax map 2S1 4AA
ADDRESS OF PROPERTY;: 12160 S.W. 127th Ave.
NAME OF OWNER: Allen Drew
ADDRESS OF OWNER: 1910 S.E. 157th Or.
IN WITNESS WHEREOF , the undersigned has caused this restriction
to be executed thi-, day of l.Jct. 19'74/.
OWNER.
Name
Ti e
APPROU� /
uA,-
I ding Official
City of Tigard
STATE OF OREGON
County of Wast,ington ss /I) iS 21. , 19
Personalli appeared beFore me the above named
4'. V; ,,._ __end acknowledged the foregoing instrument
to be 1,, .. --voluntary act and deed.
n ary Pu it t Orega
STAfE Of OREGON My Commission Expirabi
e
County of Washington - -,LSI',�1`+
I Roper ThorrllUnn,, Director at Records ��� F�G�Ol!V V
and E�ecfions and ER•Offlclo Recorder of Can- Boni
veyances for sold county do hereby certify
that the of thin Instrw wird of writing was
received and retarded In book of f/Curds
No. _...� _... _ ..
of sold Cow"
Witness my hand and seal offixed,
ROGER THOMSSEN, Oirectm of
Recwds b Elections
l i'L, .,I-
11110 � '�l�