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OF OCCU
F. G� CITY OF TIGARD NC�
t' C. OREG'O1V
Owner:.....D.W. D....... ... ...... ...............................Permit No. 0093 i a•
g 10495 S.W. C1 desdale Place
Building Address............................_....--.._....Y..................................................
......... � .
4 Certificate is hereby given this.....6th .day of......March............... 19....75
• A that Faid building may be occupied and �► r '
.►j< ' s that it complies with all requirements of
� the Building Code for the City of Tigard, II
as approved by the Tigard City Council..
•.t I tri rS ...�4J !- L.............. ........ i t
13t,lid.-..ing Inspector ;
.�-� �jYA' `Ci"�`� '+t v,+lr1 7il�w�r" t�.� '�� "�^g, J '��!� ,��n!' •.�,.•R ~ _tw"� y�•,�•��f��t C4� �Ay�'�� A�p�r
MIAIT ^B° 17689
CITY OF TIGARD
CERTIFICATE OF OCCUPANCY AND RELEASE OF RESTRICTION
The City of Tigard hereby certifies that the occupancy of
the following described structure or premise: with respect to which
a restriction of occupancy was, on Oct. 23 _, 11)2-L,
recorded in Book 997 , Page 701 , Deed Record of Washington
County, Oregon, is hereby authorized and approved.
DESCRIPTION OF PROPERTY:
lot 9, Clydesdale Subdivision, Tex :hap 251 3AA
OWNER: D.W.D.
BUILDING PERMIT NUMBER: 0093
BUILDING ADDRESS: 10495 S.W. Clvd-"dale Place
This ig to certify the said st.rur • ire meets with the require.
ments of the Building Code of the City (,f Tigard and the above
referenced restriction i:; hereby released and terminated.
IN WITNESS WHEREOF, tho undersigned authorized officer of the
City of Tigard has, esuaed thi, certificate and release of restriction
to be executed this day of �/a /I
Title: �Ijy AEEvF1BfR-
STATE OF OREGON )
County of Wt tihington
On this 5th day of l9arch , lye, personally
appeared before me the above named _Doris Hartig , whose
signature appears hereon and who acknowledged to me that he executed
the same in his offical capacity on behalf of the City of Tigard.
r i k :•4�
�� ,;-•' ,,��; '• Notary Public of Oregun
My Commission expires:
11 1.1.=`.,
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ADDRESS
,ADDRESS D 9�fC PFIIMIT N0.
PERMIT CHARGE
(IWNFR 1 Y _ _ ____ CONNECTION FEE
--------- -- _ -- — - — PAID BY • ___ _
TYPE" OF 13UILDING _�;?�, S.,L ____ _ DATE CONNECTED
SLI V I U E RATE a�;� ---- T--------- INSPECTION FEE
CONTRACTOR .lL'.y���i��% � PAID BY DATE
1ZF. OF CONNECTION _ __� ��� _ ASSESSMENT �� PAID __ _
City of Tigard
INSPECTION REQUEST �
for
INSPECTION TIME: PERMIT NO. :`
DATE:'_- /ji /T DATE ISSUED :.--L-Z--
OWNERS
SSUED :.__.L_1__OWNERS NAME :
ADDRESS:/0,04-S- ,w llyb e� ,de _
CONTRACTOR : .
TEST : Air ❑, Water[] , Visual ❑ Laboratory _ I
❑ IRESULT: Approved Disapproved [ Pending ❑
SKETCH.'
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INSPECTOR DATE I
EQtE: Attach supplemental test data berets] I
AM7r.
ftolmft . CE OF 13 L"ORS�
SPT, G 2N,
PU'BIIC PJ '
ORBS DEP 7,,
IDI1;G DEPS',
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City of Tigard
INSPECTION REQUEST
for
INSPECTION TIME : /' - PERMIT NO. : --
DATE:
O. : __ _
DATE: IP-1&IJ1' DATE ISSUED:--2_ L
OWNERS NAME :
A D D R E S S :
C 0 N T R A C T 0 R :
TEST. Air ❑, Water ❑ , Visual ❑ , laboratory ❑
RESULT: Approved)Or Disapproved' Pending ❑
SKETCH' ._._
i
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I I SPECTOR DATE
IOTE At tech supplemental test date heret],
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City of Tigard
INSPECTION REQUEST
for
INSPECTION TIME :� ✓�`_� PERMIT NO. : ---- -
DATE:
O. : ____ _DATE: DATE ISSUED:_..LL
OWNERS NAME :
ADDRESS : 'r--�-�
CONTRACTOR :—
TEST'.
ONTRACTOR :_TEST. Air ❑, Water ❑ , Visual/4, Laboratory [p
RESULT: Approved Disapproved ❑ Pending I]
SKETCH:
I
INSPECTOR DATE
CNOTE : Attach supplemental toot data hereto
1
i
I City of Tigard
I
INSPECTION REOUEST
for
IINSPECTION TIME : =� _ PERMIT NO. :
DATE: //' ITY DATE ISSUED:--L1_
I OWNERS NAME :
ADDRESS : ��1 ._ ,<`� ".-;�
f' CONTRACTOR
1 `
TEST: Air O, 'Water Li,, Visual Laboratory []
RESULT. Approved Disapproved 0 pending p
SKETCH:
I
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INSPECTOR ATE
[OTE : Attach supplemental l.aol dale harofo
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witiMP•«,.'IM.1i`M►1:'r'.+"R' "'wr•.F°",'. .�..Fi..+t-�.Ma+r OR*
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ciTr opt
BUILDING PERMIT APPLICATION TIGARD DATE .?/ tg__ N� 0093
THE UNDERSIGNED HEREBY APPLIES FOR APERMIT FOR THE WORK HEREIN INDICATED
OR AS SHOWN AND APPROVED IN THE ACCOMPANYING FLANS AND SPECIFICATIONS. OWNER PHONE
I'.U.C. dont 104 S.6J. L'lydescl«. .,
OWNER — ADDRESS BUIL DEH PHONE
ENGINEER
BUILDER _ — — ARCHITECT DESIGNER
S+T
�RUCTURE ❑NEW 13REMODEL ❑ADDITION ❑REPAIR_ ❑RENEWAL []FIRE DAMAGE ❑DEMOLITION
CJ RESIDENCE ❑COMM ❑EDUCATIONAL ❑GOV'T ❑RELIGIOUS❑PATIO ❑CAR POPT ❑GARAGE ❑STORAGE❑SLAB [:]FENCE
❑BOND —❑MOVING ❑CONDITIONAL USE _ ❑DESIGN REVIEW ❑COUNCIL APPROVED ❑SIGNS
OCCUPANCY _ —LAND USE ZONE_ BLDG.TYPE —FIRE ZONE—_ PLAN CHECK BY FIEAT..
--- -- Uunstrut,t l �jJc, :')quare tan I ;- :h dwolliny with
- — -- attachad Garay® sod rtu Basement According to Approved plans
CC LOAD _ FLOOR LOAD— HEIGHT NO.STORIES AREA 1536 VALUE '�U• 00
BUILDING DEPARTMENT SET BACKS FRONT REAR LEFT SIDE lq RIGHT SIDE 1U
Permit
THIS PERMIT IS ISSUED SUBJECT TO THE. REGULATIONS CONTAINED IN THE BUILDING CODE, ZONING
Plan Check J7a `t'U 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 4*0() ALL APPLICABLE CODES AND ORDINANCES. THE ISSUANCE OF THIS PERMIT DOES NOT WAIVE
. RESTRICTIVE COVENANIS. LUNIRAUIUR AND SUB CONTRACTORS TO HAVE CURRENT CITY BUSINESS
1%State LICENSE. SEPARATE PERMITS REQUIRED FOR SEWER, ^'.UMBING AND HEATING.
Total —
By ^
APPLICANT OP AGENT
Approved Receipt No.
ADDRESS --
DATE INSP. TYPE INSPECTION REMARKS --TPLUMBINGDATE
Contractor ...
�..7 r _ "• ': �'—� z. ; Permit No. IP-oob -7
Rough-in
Fixture
,,�/ Final
-7� C�?t HEATING
Contractor
Permit No.
Gas or Oil
Rough-in
—. Final
SEWER
Final
DRIVEWAY
Final
Storm Drainage
—_ (Rain Drain) Final
[Final
walk
&Street Final
oach
BLDG.DEPT.FINAL TEMPORARY CERTIFICATE OCCUPANCY
CERTIFICATE OCCUPANCY scaping
ng Final
ti248
EXHIBIT "A°
CITY OF TIGARD
Residential Structure Occupancy Restriction
KNOW ALL MEN BY THESE PRESENT, that occupancy of residential
,structure (a) on the following described lands prior to the i_-ord—
ing 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 es
soon as a final inspection determines thst the construction is
satisfactorily completed)
DESCRIPTION OF PROPERTY:
lot 9 Clydesdale Subdivision Tax Map 251 3AA
ADDRESS OF PROPERTY: ,1049� S.W. Clydesdale Pla .w
NAME OF OWNER: D.U.D.
ADDRESS OF OWNER: P.O. Box 23»i_„_ Tioa,Ffj1Qrsyun
IN WITNESS WHEREOF, the und3raigned has caused this restriction
to be executed this-I Lday of , , 19
OWNER:
� .---�
ems
Title
APPROVE
g y: Yi 1
B 1 ding O ' irfal
City of Tigard
STATE OF OREGON
County of Washington ss i o . ,a/ 7 i , 19
Personally appeared before me the above named
r—ar^al[; 1 4. L+and acknowledged the foregoing instrument
to be hl " voluntary act and deed.
�.�_ -
STATE OF OREGON Miry Public ��r Oregnn
a
County of Washington Itl'::i_,• My Commission ExpirrQ _�
1 Roger Thomtsen, Olreotgr of Records "Q�( '
and Elections and Ex-Officio Reeerder of Con- f�
C veyan!ss for sold tounty, do h"y certify
(' thri the Within Instrurnent of wilting was (�+� +/(�'1
received and record800
ed In book of ilcorde 9 / mal"01
V
Vo.
of wed Caunly
N9tneu my hand and seal affixed,
ROGCR THOMSSEN, Director of
Records & Elections
1��Ix.ti4�1
Deputy
3 G
UNIFIED SEWERAGE AGENCY NO. _-_ 5013
WASHINGTON COUNTY DATE - -- -
CITY _-
APPLICATION FOR SEWER CONNECTION PERMIT
OWNER: -
P.O. Box 23551
OWNER'S ADDRESS: _ ------- ---- ----- -
STREET
- ---- D r e gu n► ------- — —�` �?3—iia-�--—
TigRjr — STATE
� Clydesdale
BUILDING SITE: LOT 9 BLOCK --___--_____� ADDITION —
TAX LOT NO. - TYPE OF OCCUPANCY
Residence
ADDRESS 10495 S.td. Clydesdale Place
DWELLING UNITS 1 --- - -- FIXTURE UNITS
SURCHARGE IF APPLICABLE -.-___.50 to Derry Dell
PERMIT FEE _----525-----..-- INSPECTION FEE -25_____ TOTAL DEPOSITED __—_._ 550
(NEWL (EXISTING) BUILDING SEWER SYSTEM Fanno Creek -- —
The Applicant agrees to comply with all rules and regulations of the Unified Sewerage Agency.
APPLICANT._ _ --- - -- --- ._ _
i
SEWER PERM'T
THIS PERMIT AUTHORIZES CONNECTION TO I'HE SEWER SYSTEM.
LINE SIZE _ . —_. ___ --._.- INSTALLER
RECEIVED BY__._ ...�J aENCY�11 AGE
V
COMMENTS: f ''
This Application arid permit expires in ninety (90) days. The arnount Maid will be forieited
should expiration occur.