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City of Tigard
INSPECTION REQUEST
for
INSPECTION TIME: PERMIT NO. :.______
DATE: L DATE ISSiIED :_ L-Z
OWNERS NAME .
ADDRESS:CONTRACTOR : -
TE
ONTRACTOR :
TE ST : Air 0, Water 0 , Vieuof ❑ , La horatory p
RESULT: Approved O , Dien
-- ----_-- " Pending U
SKETCH,
INS �_tF, DATE
GOT Attorh ,Olt a berPf?
A D 1)R E 3 S_Z PERMIT ND.
PERMIT CHARGE none
OUNER CONNECTION FEE
PAID 13Y
T'(Pt- OF BUILDING 0A f E C 0 N r,,'F-F,T E 0
SERVICE RATES INSPECTION FEE
CONTRACTOR PAID BY MTE
51ZE OF CONNECTION ASSESSMENT [,AID
City of Tigard
INSPECTION REQUEST
for
INSPECTION TIME: �' S PERMIT NO. :--
DATE:
O. : _DATE: % DATE ISSUED :_1_L_.
OWNERS NAME ', --
F
ADDRESS:
CONTRACTOR : ILiD
TEST : Air p, Water[] , Visual Laboratory p
RESULT: Approvedf ,, disapproved 0 Pending p
SKETCH:
i
INSPECTOR DATE I
[:NOtEAttach supplemental tett data berets, I
I
I
I
City of Tigard
INSPECTION REQUEST
for
INSPECTION TIME : ;krOOtll— PERMIT NO. :
DATE: 1/ /"21-"/ DATE ISSUED:—Z—L
OWNERS NAME :ADDRESS :
l
CONTRACTOR :--..-- - /--- -
I TEST: Air O, Water [3 , Visula , Laboratory Q
RESULT: Approved j�l_ , Disapproved O , Pending ❑
I
SKETCH:
0
INSPECTOR DATE
ICOTE : Attach supplemental toot data horst'
1
City of T i gord
INSPECTION N REQUEST
for
�.' PERMIT NO. . _---..
INSPECTION TIME :. DATE ISSUED:--L-/
DATE
OWNERS NAME
ADDRESS . -
CONTRACTOR
DDRESS . iCONTRACTOR -------
TEST. Air 0, Wa;Jr 0 , yieual�, Laboratory 0
pisapproved 0 , Pending U
RESULT: Approved, =-
SKETCH.
I
I
I
I
I
I INBNECTOR DATE
1 CNOTE : Attach SUPP161"ental feet data heret�
Iw w
Cl-1 r OP N°-
BUILDING PERMIT APPLICATION TIC ARD DATE
THE UNDERSIGNED HERFBY APPLIES FOR APERMIT FO,1 THE WORK HEREIN INDICATED OWNER PHONE
OR AS SHOWN AND APPROVED IN THE ACCOMPANYING/PLANS AND SPECIFICATIONS. --
s�y�.a`/Z _ ADDRESS /V I �J J�1 &yd.''-I�'�� BUILDER PHONE
OWNER - -
ENGINEER
flWl.DsA_
41r, e-4— ARCHITrCT DESIGN R
STRUCTURE _[_ EW_ -- ❑REMODEL ❑ADC�ITION Cl REPAIR ❑RENEWAL ❑FIR DAMAGE ❑DEMOLITION
aRESIDNC
EE ❑ LJ
COMM EDUCATIONAL ❑GOV'T UFIE LIGIOUS❑PATIO ❑CARPORT ❑GARAGE ❑STORAGE DSLAB ❑FENCE
❑BOND ❑MuVING ❑CONDITIONAL USE ❑DESIGN REVIEW ❑COUNCIL APPRO_VEED'!' L.JSIGNS
`BLDG. TYPE-FIRE ZONE PLAN CHECK BY /� - HEAT=
OCCUPANCY�LAND USEZONE��- -
OCC.LOAD FLOOR LOAD HEIGHT NO.STORIES AREA VALUE P f>�'�
BUILDING DEPARTMENT SET BACKS FRONT REAR LEFT SIDE RIGHT SIDE
Permit
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 HEREBY AGREED THAT THE
WORK WILL BE DONE IN ACCORDANCE WITH THE PLANS AND SPECIFICATIONS AND IN COMPLIANCE WITH
Recording ALL APPLICABLE CODES AND OfIDINANCES THE ISSUANCE OF THIS PERMIT DOES NOT WAIVE
RESTRICTIVE COVENANTS. CONTRACTOR AND SUB CONTRACTORS TO HAVE CURRENT CITY BUSINESS
I%State LICENSE. SEPARATE PERMITS REQUIRED FOR SEWER, PLUMBING AND HEATING.
Total `
t
By -
APPLIG NT OR AGENT T
Approved Receipt No.
- A DRESS
DATE INSP. TYPE INSPECTION
REMARKS PLUMBING DATE
Contractor �D
Permit No. � GUS� t
- • -
Rough—it,
Fixture — --
Vrial
-- - HEATING
Contractor _
Permit No,______ -
-- Gas or Oil
- ---- — Rough-in -
- --.�.—_ --- FinalJR
SEWEFinal
DRIVEFinalStorm Dr(Rain Drain) FiSidewalk
Curb R Street FroachBLDG.DEPT, FINAL TEMPORARY CERTIFICATE OCCUPANCYFinal —
CERTIFICATE OCCUPANCY
Landscaping
Zoning Final
- -- - -
�J�t-Ila y/o
UNIFIED SEWERAGE AGENCY rlo. _._ ._ 4985 ___
WASHINGTON COUNTY DATE __ June 28s 1974
CITY OF ------ --- --- Tigard.---
APPLICATION FOR SEWER CONNECTION PERMIT
OWNER: Schulz --- -- -.
OWNER'S ADDRESS: ----10485 S.W. Clydesdale
STREET
- -I i a r d- ------------. _. Oregon
_
CITY --- -."STATE---�_.._ ------21': --
BUILDING SITE: BLOCK __.___.______ ___ ADDITION KIMY.NAXAM_INX Cl des0.1
TAX LOT NO. TYPE OF OCCUPANCY
ADDRESS 10475 S.W. Clydesdale Place
DWELLING UNITS---...-- 1 FIXTURE UNITS
SURCHARGE IF APPLICABLE
PERMIT FEE _..._500 _ INSPECTION FEE TOTAL DLPOSITED -_525
(NEW) (EXISTING) BUILDING SE'NEP. SYSTEM Tig.grd__
The Applicant agrees to comply with all rules and regulations of the NN Uni le Sewerage Agency.
J-Z
APPLICANT_— �✓ -!�� t
t SEWER PERMIT
THIS PERMIT AUTHORIZES CONNECTION TO THE SEWER SYSTEM.
LINE SIZE _.a!!_-_ _ INSTALLER
RECEIVED BY_ c.>.c�''
AGE OR ITS AG 1 � ��
COMMENTS: .'/���
This Application and perrr:it expires in ninety (90) days. The amount paid will be forfeited
should expiration occur.
12420 S. W. Main Street
TIGARD, OREGON 97223
APPLICATION FOR BUILDING PERMIT
New Construction Demolish l� Addition ❑ Remodel ❑ Move ❑
ZONING- v DATE ISSUED•`-,:�L)S-'7 V BUTLDING PERMIT
BUILDING FEE $ ?.00 No.
DATE RECEIVED ����,f-�'�Y _ 7�l-�
BY j �•! PLAN CHECK $ 5-0 --
_ OTHER $ :�, 00 2c;��-�'.�'G�i�VALUATION $
T4n-A-h $ .y90 1nfn S2,1111-e RECEIPT No. /Oy/O
--'r-r3'7".4 L --_ - -�- - _
TWO
/S,ETS OF PPLANS AND PLOT PLANS MUST BE FURNISHED WITH APPLICATION
M
LOT # CX a� APS # 444 CENSUS TRACT JOB #` - -------
Architect or' Engineer
Address Phone
Owner
Address �r Phone
Builder
AddressjPhone�v �0�_
BUILDING USE Single Res . Multi Res. ❑ Comm. 171 Industrial ❑
OCCUPANCY GROUP---.-- No. of Stories`------- Total Height_'_- - Area of Lot---
Type
ot^ —Type of Construction II III IV V /Floor Area B 11s7/ 2�_
Set Backs: Front—_-__ Back----.--- -- L.Side _ R. Side
Private Sewer Pipe Size _ Sewer` Septic Tank ❑
Water Service Pipe Size____ — Storm Sewer U Ditch ❑ Drywell ❑
Street and Curb Requirements
Driveway Width____ _ —No. of Parking Spaces _______
SEPARATE PERMITS• REQUIRED FOR SEWER AND PLUMBING
SPECIAL INFORMATION
)RES: ASSIGNED
ELD CHECK BY DATE
--- --- -----------
PERMIT APPROVED BY
is understood that all work will conform with applicable codes and ordinances
the State of Oregon and the City of Tigard, Oregon, aist11at tle building will
be occupied until a Certificate of Occup cy has be sued *.he City of
yard Building Inspector.
magna ure a Applicant -
14095
EXHIBIT "A"
CITY CF TIGARD
Residential Structure Occupancy 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 dutermine,s that the construction is
satisfactorily completed)
DESCRIPTION OF PROPERTY :
Tax Map 2S1 3AA, lot 11 Clydesdale Subdivision
ADDRESS OF PROPERTY „ 10475 S.W. Clydesdale Place
NAME OF OWNER : Aloys Schulz
ADDRESS OF OWNER : 10485 S.W. Clydesdale Place
IN WITNESS WHEREOF , the undersigned has caused this restriction
to be executed this, day of �,� , 19-791.
nWNFR :
24— c.
_._._ a m e
Title
APPROUF•6:-> 1 IS
u rg Official
f.R TN QMH N. '
Citv of Tigard V ►�► �, r.
ev...............
STATE OF OREGON (/
County of Washington ss __ 'fu mi 22 194
Personally appeared before me the above named
Aloys Schulz and acknowledged the foregoing instrument
! F voluntary act and deed.
Notar Pu irr or Oregon
My Co i ion Expires:
BOOK 984 FLE306
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14095
EXHIBIT "A" t
CITY OF TIGARD
Residential Structure Occupancy Restriction
a KNOW ALL MEN BY THESE. PRESENT, that occupancy of residential I
structure s on the following described lands
j ( ) g prior Co the record-
ing of an occupancy permit releasing the rQstriction in the Deed
Records of Washington County, Oregor•, 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)
I
DESCRIPTION OF PROPERTY:
Tax Map 291 3AA, lot 11 Clydesdale Subdivision
ADDRESS OF PROPERTY: 10475 S.W. Clydesdale Place
NAME OF OWNER: Aloys Schulz j
ADDRESS or OWNER: 10465 S.W. Clydesdale Place M
II
;
o IN UITNESS UHEREOF, the undersigned has cau3ed this •re3tr.ic-tion
i
o to be executr.d thtsay of .19_77_- II
, a
f i OUNER:
M 1 !�
G
�I H Oro 1
APPROU ''ri
v a
By 06 1
ng � '.114M
u s
sae
w
City of tl-�^'A
STATE OF OREGON
as
County of Washington -Ilona In , I9-21,_
Personally appeared before me the Above named��� F
Aloys Schulz and acknowladgnd the foregoing inatTument
tri be- voluntary act and dead. t
W0ar^ u a or Ure on
_ 9
My fo mi ti1U.i Expirr+s:�w
084 KE306
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