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12300 SW 106TH DRIVE-1 4 4-4-1- 1 1 1 r 11 I till 1.2.:300 sw 106TH DRIVE A J 10 rA N � r o {v Cq �.- \ IU - - - n 3f` 1 Ci ` ~� tL- Aw .� E� O I." +J 0 Ln C) 0 N k aooRESS '�- -r PERMIT NO. _ PERMIT CHARGE OUNER r C 0 N N F C TION FEE `____�a — -— --._-------- -- _--___ __. PAID E3 Y TYPE OF BUILDING _� `------- -- --- DATE CONNECTED SERVICE RATE. '��Ox.� ---- I N S p E C T I 0 CONTRACTOR -d,& N FEE PAID SIZE OF COiNECTION B Y ._.. DATE �L// -_ _ ------- ASSESSMENT 1 PAID ! I! Ip w �/ 0, City of Tigard INSPECTION REQUEST for •�i rJ� L INSPECTION TIME: _ PERMIT NO. : DATE: ALLY DATE ISSUED :-- / Z OWNERS NAME : y-S 6 c2z A D D R E S S: /_;Z 30 CJ S, t t/'�,� (yOr,,LL-l—) '- CONTRACTOR : TEST : Air ❑, Woter[] , Visual [] , Laboratory ❑ RESU1'_T: Approved , Disapproved ❑ , Pending [] SKETCH: ,$TA eTT 501✓OZ 'g: N e. I 4 i 1 1 INS CTOR DATE COTE: Attach supriemenrai test dura bereto, I 8180 KXHIBIT „B" kt:.CLI V L 1 CITY OF TIGARD U'd I CERTIFICATE OF uCCUi'ANCY MID RELFASE OF IUI;THICPION CHY OF TIGARD The City of Tigard hereby certifies that the occu}sncy of the following described structure or prewlt.es with respect to which a restriction of oc(-upancy wes, on 1, - , 19 73, recorded in Book , Page /171 Deed Record of Na Iri:rct.un County, Oregon, is hereby uuthurited and approved. DESCRIITION OF 1111OPEHTY1 Tax Map 251 3AA, lot 17, Clydoedale Subdlvieion OWNER: Alpin L!ctulz BUIlyIIiG IERMIT NUMBER: 73-264 PUIIJI:IG ADDHLIS: 12300 sL;, 10fitlr privy, This i-i to cert',fy the raid Rtructure mecta with the require• marts of the Building Code of the City of Tigard and the above referenced restriction it heret-y released and termirwited. IN WITW=S) WIIERF:uF, the undersigned auttwrized officer of the City of Tigard hap caused this, certificate and release of restriction to be executed this 22nd day of May , 197' . -- Title: •0 ` l STATE OF ORWON County of Washington ) j r�r 1 on this 2rIC day of , 15075, peruonally appeared before me the above yarned Meors "ar , who-re V sigJrature appears hereon and who acknowledged to me t1at he executed the same In his offical capacity on behalf of the City of Tigard, t i Notary Public of Oregon ) a My C+mmission expires: CITY OF TIOA9111 eoo�1(lGil PAIL �1 P U eo. 1367 174201 W M�'^ Igwd.01e90^Y17]1 $o�g� cc 0 v Rog I Irl aA� � L w ~ 1 N 4- Ic W � � w w IIS w W ff !1! I ord' City of Tigard INSPECTION REQUEST for INSPECTION TIME : 6'z2 _ PERMIT NO. '. --- DATE: O. : _- DATE: DATE ISSUED:--Z--/ OWNERS NAME : `�: `J•�-�'- I CONTRACTOR * TEST*. Air ❑, Water ❑ , Visual,t, Laboratory ❑ IRESULT: Approved ,, Disapproved J Pending ❑ I SKETCH: I I I I I I INSPECTOR DATE CNOTE Attach supplemental test data hereto] v v v ei �a v v v as City of Tigard INSPECTION REQUEST for INSPECTION TIME: 4'0-0 PERMIT NO. .- -- DATE: O. : __DATE: �:Z' L.-49LDATE ISSUED : I Z OWNERS NAME :_ ADDRESS: .23W DGS CONTRACTOR : TEST : Air ❑, Woter[] , Visual, Laboratory [] RESULT: Approve dsk Disapproved ❑ Pending p SKETCH. INSPECTOR DATE COtIS: Attach supplemental test data be►etai t i 1ity of Tigard 'INSPECTION REQUEST for INSPECTION TIME . _ P"RMIT NO.: DATE : , /2VJ _14 DATE ISSUED:—/ OWNERS NAME : ti ADDRESS : J 2-3 o C) S ItiJ 10 6 t CONTRACTO R TEST. Air ❑ , Water [1 , Visual Laboratory RESULT: Approved ❑ , Disapproved , Pending SKETCH: l vo2.,rs N A/)Va��, �C�IC VAT , i j1I 0 -yE 5 31 INSPECTOR DATE COTE : Attach supplemental teat data here,] CITY OF TICARD MECHANICAL PERMIT DATE PERMIT NO. "7�f1ti/ RECEIPT N0, /OD/b BY FES 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 Inata]/lationX Replace ❑ Relocation ❑ Addition ❑ Alterat on ❑ CONTR. �, //,�/... (i, -l. ' OWNER ADDRESS WORK ADDRESS _ fLtr APPLICANT TELEPHONE NO. ` FURNACE - MANUFACTURER ,4/,A A./ TELEPHONE NO. HEAT Input rating (Btu Per Hour) l.SL GL.__ Vent Size Flue Size FUEL OIL ❑ nAS© ELECT❑ OTHER TOTAL 90. FT. Top Floor Main Floor Basement _ GENERAL ITEM NO. FEE ITEM NO. FEE For Issuance of Permit 3.00 Boilers Cher 50 HR- New Under 1001M)Q5tu � }A r andlini{ 10,000 C ' r an in Ove ( _ _ V1 orFurnace u.t vaporat ve Cooler i+n�- . a Floor - u. enVent an _ ns A ens en 1+8 emotl TIc a reat oo n .O0 00 !Aooilera Litidor _ estic Incinerator i .o eraomm. Incinera or rU C f00T'era �0 D 10 Other Not Listed F�o`�Tei•s o �i INSPECTOR'S COMMENTS ,� T APPROVED BY DATE ISSUEn BY DATE Sir,nature of Applicant Addresa ��OC� Permit IVB). a Permit charge Owner Connection fee ------._�_ Paid by Type of tailding ( Date connected >ervice rate t17 Ins 1 pection fee Contractor — �. J L Le Paid by ��— Date Size of ro.,uWetiar' Assessment N w r r WN ir Iff City of Tigard INSPECTION REQUEST for SPECTION TIME: ` 'Pz) PERMIT NL). ,� I DATE: PATE ISSUED :--Z i INERS NAME :� ZVI ADDRESS: ,,�(,�T ��� [L'L5"",zqW-SI�19 't --- )NTRACTOR : __ FEh'kef-G- -- --_-- --ST : lair U, WotrrL—J , Visual Laboratory ❑ i ZSUL.T: Approved Disapproved O Pending CETCK: i i I I INSPECTOR^ r DATE I TE : Attach supplemental teat datn heretJ City of Tigard INSPECTION REOUEST for INSPECTION TIME : �'• C-FVERMIT NO. : I DATE: -;� DATE .ISSUED: 1 , OWNERS NAME . ADDRESS : CONTRACTOR : TEST . Air- LI, Water [3 , Visual 0 , Lar jratory [1 RESULT. Approved ,Q Disapproved J Pending [I 1 -- I SKETCH' I I INSPECTOR DATE ICOTE: Attach supplemental test data hereto] I ()f Tigard INSPECTION REQUEST f c r :NbPECTION TIME. PERMIT -NIC, DATE: -)ATE ISSUED OWNERS NAME ' ADDRESS . /c7. ON rP A r,rO R EST A7, ct I RESUL. itived)e Opp, ..,,.ci C SKETCH: INSPECTOR DATE 50TE: Attacri suppiementai test iii9r-tu'l met„^ ,.,. , v, f PL MING POW APP'LICATIM F' Jurisdiotlon of Type 7f Fixture Pse Permit No. 7 Permit !ee N+ t "„set of e w Peralt Issue ;ba Approved by ori (Won Building Perm ower Receipt No. 5inks. lsh�wlfhin a n inks. nary Location of Auildins Bar e u o r, 8 wad er ,,r rays Ds — Nave A Address of Owner n or u 1 r a .na r•ee anDraltI13 ma= 7,- sTer — Name d Addrean of Plumber . nun ns A n r1jE L'0' t , L1 1 't "�,ti��dA - r n$ a0 Wa 'Jrinals —" Build1" (OOId or New) LAlt2r. Repair ol.- C - as na no tall) Aj? y,ja-l1 wrl 5REInk or >ystem_ �.- �Ty Other -- r tiier System This permit becomes null and void if work or construction authorized is not c.aisnenced within 60 days, or if construction or work is suspended or abandoned for a period of 120 days at any time after work 1s commenced. All plumbing firms must be licensed by the City of Tigard and poet a $1,000 bond. I hereby certify that I have road and examined this Application and know the sass to be true and correct. All provisions of laws and ordinances governing this type 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 provisions of any other state or local law regulating construction or the performance of construction. �• f pasture of Applicant ` ! WIIFMWIt ,WXW§WMWW City of Tigard INSPEC70N REQUEST for SPECTIOR TIME: _, U__ PERMIT NO. : DATE : / DATE ISSUED : I Z INERS NAME : �� - �� '�.1 ' — ADDRESS: `'� )N TR A C T O R : --- ---- - =ST . %�:( u , Water[] , Visual ❑ , Laboratory ❑ _SlJLT . Aprtroved 5l, Disapprov3d ❑ Bending [_] CETCH: } INSPECTOR DATE TE Attach supplemental test dotn hereto I � City of Tigard INSPECTION REQUEST for INSPECTION TIME : PERMIT NO. .' — DATE O. : —DATE: W DATE ISSUED'— L1--OWNERS NAME . '-V I ADDRESS : J I CONTRACTOR : x-/141 t� : T /CTS .� i TEST'. A r '1.7, Water r] , Viscal 9, La" ,ratory (l I RESULT: Approved .Q Disapproved 1 Fending [] I SKETCH: I I I I I _11 , INSPECTOR DATE ICNOrE Attach supplemental 'est data heret] 1 00 EXHIBIT "A" CITY Or TIGARO 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 Oaed 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 fleel lnspv+ctlon determines that the construction is satisfactorily co Plated) DESCRIPTION OF PROPERTY: Tax Map 251 3AA, lot 17, Clydesdale Subdivision AOORESS Or PROPERTY: i2mn 5_u_ lnfith nriun NAME Or OWNER: •Inv& SrhnI7 AOORLSS OF OWNERS 11975 S.W. Walnut IN WITNESS WHEREOF, the undersigned has caused this restriction to be executed this __jj_ day of Noretber 191�_. OWNER: U'�U1 '� �1 Mass Omer APPROVED: Title B y t �� _ Bul l r g c • City of Tigard STATE Or OREGON County of Washington November 13. , 19 2.3�— Personally appeared before ma the above nosed Mora _ gghuls and acknowledged the foregoing Instrument to be his voluntary act and dead. o ary u c or re on My Commission Expires: 12/23/75 If ef .:rll T11eMA:M. If.,•+wr +1 ®Ll�Kl��►.GNom 4 ��55 ' 410 •A y� A V. d �r STATE C.'-, nt W a+,Nyt.+n {fi r I, "t TlnrwtMn. U+gttor cA R�rardr ad E+.ct-w. ord E.C11t'+'a �rtM b W4crnrMr. eeimmebw #MSM H A{rMn Mqt M+ r�tcMd1 .�c.+•.A ord r.ra+M+d ry. A vkf Cuv+r W.•va e•.. ".1 Ord tw+ oth..d R!X;tP 1"OMSSEN. t�•.r+ P.tadr ► [U+t+a+r EXHIBIT •A" CITY OF TIGARD Residential Structure Occupany Restriction KNOW ALL MEN BY THESE PRESENTS, that occupancy of residential structure (e) on the following described lends prior to the recording of an pccupency permit releasing the restriction in the Chad Records of Washington County, Oregon, is prohibited by the ordinance of the City of Tigard, Oregon: (The City will issue a eelsass as soon as a ?tool Inspection determine@ that the construction is satisfactorily completed) DESCRIPTION OF PROPERTY: Tax Map 231 3AA, lot 17, Clydesdale Subdivision ADDRESS Of PROPERTY: ivinn S-u- inRath nneimg NAME Of OWNER1 &lay& 9rhulf ADDRESS OE OWNERS 11975 S.W. Walnut IN WITNESS WHEREOF, the undersigned has caused this restriction to be executed this III _ day of Nnweh—r__. .19,7. OWNER: •Af APPROt'EOs ownar Title Bys / City of Tigard STATE OF OREGON County of Washington as. Nn•.mhrr 13_ 19 2 Personally appeared before as the above named ♦lnsm �__ Snhula and acknowledged the foregoing instrument to be _ him voluntary act and deed. vo s��� ' 7i�Fo eiy'Public for Ore on Ry Commission Expires: �3/2117% --- - c7 z� UNIFIED SEWERAGE AGENCY NO _____ 4925 WASHINGTON COUNTY DATE 11-13-73 CITY OF Tigard I APPLICATION FOR SEWER CONNECTION PERMIT OWNER: __ Al ya-Scbulz___—..___ ---_-- — - ------ I 11975 S.W. Walnut Street OWNER'S ADDRESS: _11975 I STREET -� Tigard CITU STATE ZIP BUILDING SITE: LOT 17_.__ BLOCK .-.... _ _- _ _ ADDITION CAydeedale Sub. TAX LOT NO. —__—__ TYPE OF OCCUPANCY Resideme¢_ ADDRESS 12300 S.W. 106th Drive DWELLING UNITS - } FIXTl1RE UNITS i SURCHARGE IF APPLICABLE PERMIT FEE 450 INSPECTION FEE 25 TOTAL DEPOSITED 475 NEW) (EXISTING) BUILDING SEWER SYSTEM Tigard The Applicant agrees to comply with all rules and regulations of thXQi edSewerage Agency. I APPLICANT "� ' SEWER PERMIT THIS PERMIT AUTHORIZES CONNECTION TO THE SEWER SYSTEM. 411 LINE SIZE INSTALLER RECEIVED BY AGE OR ITS A(;FNT) j COMMENTS 7 3".,711 ` �� I LV4 _ This Application and permit expires in ninety (90) days. The amount paid will be forfeiter+, i should expiration occur. G� CITY OF TIGARD 11420 {. W, MOW TIGARD. ORROON PFM APPLICATION FUR BUILDING PERMIT Now Construction X� Demolish Addition El Remodel lm ZONING p1F2__ DATE ISSUED� ly�3_ BUILDING PERMIT DATE: RECEIVED BUILDING FEE S_- 0,00 No. 73-264 - PLAN CHECK S 49.00 BY -----ZfM1'tacordln9 VALUATIOU $ 211064 OTHER $ t a t a 5 RECEIPT No.J;- TOTAL3-2 TWO SETS OF PLANS AND PIAT PLANS MUST BE FURNISHED WITH APPLICATION LOT 1 17 MAP 1251 3AA CENSUS TRACT .� JOB 1� Architect or Engineer_ _ _�____ —.-• -- ---- Addres; ______�—_.._ Phone-- Owner Address 11475 5,J.&.-W110UL,.L §A" TLWrd - --Phone_ Builder_ --:renis-- Address BUILDING USE Single Res. Multi. Res. Comm. Industrials OCCUPANCY GROUP No. of Stories—1 Total Height . Area of Lot- Tyne of Construction XkX02X%WXXJNXXV Floor Area B_ --- 1 _ 13a�1_ Z _-- Set Backs: Front_I Back aV L.Side__ 9' R.51 ie Private Sewer Pipe Site�4" - Sewer--"A-UQA1O5elrt is Tank water Service Pipe Site 3/4 _ Storm Sewer El Ditch ❑ uryweI1 EJ Street and Curb Requirements f-xeitinq_rY I Driveway width -_ 161 V� No, of Parking Spaces 2 SEPARATE PERMITS REQUIRED FOP SEWER AND PLUMBING SPECIAL INFORMATION ADDRESS ASSIGNED �12300_SsY— 106th A Drive__ FIELD CHECK dY— --- ----.___J8 ---- -___._ __ .__._.—DATE. 11-13-73 PERMIT APPROVED BY r .,. It is understood that all work will conform with applicable codes and or inances of the State of Oregon and the City of Tigard,. Oregon, and that the. huildinq wil; not bws occupied until a Certificate of OCgu r1t•y has Coen i;tnued the City of Tigard Building Inspector. ( qna ure o App I i cant _�...4