9705 SW PEMBROOK STREET 9705 SW PEMBROOK STREET
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Address / JD x��-��_as- Permit No.
r -emit charge �j vr�
Owner l-�. �[L�,�e ��, CaMa Connection fee4-Gc,
Paid by
Type of building _ h-�.,� ^ Date connected `
Service rats /cel Impaction fee
Contractor Paid by Bate
Size of connection Assessment � � paid
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BUILF)ING DEPARTMENT, TIGARD N()
PLUMBING PERNH-r •
holder of a valid plumbing contractors license is hereby
authorized to cause plumbing work as herein noted to be installed in accordance with the plumbing code of
Tigard. Such installations require i.lspection by the City Inspector who shall be notified not less than four
(4) hours prior to the time the installations are ready for inspt'ztion. CityO Tigard Business License required
for all contrartors and`su`b-contractors.
�V AC',v���2.V ! C` ►
Add res; i�Vf 1 catl�t'��►� -- Dare_2" ('s —�
NUf.18F.n OF TOTAL PERMIT NO.'S
TYPE OF PERMI•r ITEMS FEE ON EACH AMOUNT (Office Use Only)
Sinulr_Farnilv_1 bath-each 25.00_` _
Oig,ltx_Each 1 beth unit _ _ 25.00
Additional bathrounts-each _ � 10.00
Mobile Home Sp jca-each — 15.00I-NDIVIDUAL FIXTURE FEES —_--
1 to 50 Fixtures in 1 buildin -each 3.00_
�51 to 100 Fixtures in 1 building-each_ _ _ _ 2.50
101 to 20o F;xtures in_1 building-each 2:00____
_201 or more Fixtures in 1 bu+biing_each —__ — 1.60
S M I SC E L L A N E O U S -
8uiIdir•g Sewer-1st SO ft, 10.0_0__
1 SRW-jr-each additional 100 ft. 10.00
' Water Service to building____ i_ 5.00 _
Privite Water Svstamt_each 100 10.00
iOthnr (Specify): ------ - _. __— I 1%(
PERMIT For Plumbing inspecrinrr Phune 639.4171 t`
' 30S State Plumbing Contractor By
TOTAL _- V----_-_ RECEIF'i NO. Issued By
r a
BUILDING PERMIT APPLICATION c FY TIG IBRD DATE __ _. 19- 1 t -X77
THE UNDERSIGNED HEREBY APPLIES FOR APERMIT FOR THE WORK HEREIN INDICATED 13UII_DERPHONE
OR AS SHOWN AND APPRnVED IN THE ACCOMPANYINI; PLANS AND SPECIFICATIONS. OWNER PHONE-- -
LOT NO.
r_ —,
OWNER CiV®tly [01181, JOB ADDRESS. J5 SL! P JMUrQUk St• HOME ADDRESS _
ARCHITECT
ENGINEER
BUILDER 3. Ii, ADDRESS DESIGNER
STRUCTURE ❑NEW ❑REMODEL ❑ADDITION _UREPAIR ❑RENEWAL ❑FIRE DAMAGF ❑DEMOLITION
O TIESIDENCE ❑_COMM ❑EDUCATIONAL ❑GOV'T ❑RELIGIOUS❑PATIO ❑CAR PORT ❑GARAGE ❑STORAGE❑SLAB [:]FENCE
_❑BOND ❑MOV ING LJCONDI fIJNAL USE—�LJDESIGN REVIEW —❑COUNCIL APPROVED COSIGNS
OCCUPANCY LAND USE ZONE 2—77 BLDG.TYPE_ FIRE ZONE_ PLAN CHECK BY_-`'` HEAT —
uu,ist. scidiT9..,.,n LU oxisting bldg, lot ff5
11.EII;x1L—._. AR A.-----NQ IWRQOMS_—.__YALU Il„ _
BUILDING DEPARTMENT SET BACKS FRONT REAR LEFT SIDE_—_–_ RIGHT SIDE_ �—
Permit 24.00
THIS PERMIT IS ISSUED SUBJECT TO THE REGULATIONS CONTAINED IN THE BUII.UING CODE, ZONING
Plan Check L2*00 REGULATIONS AND ALL APPLICABLE CODES AND ORDINANCES, AND IT IS HEREBY AGREED THAT THE
WORK WILL BE DONE IN ACCORDANCE WITH THF PLANS AND SPECIFICATIONS AND IN COMPLIANCE WITH
Subtotal 1,44 ALL APPLICABLE CODES AND ORDINANCES. THE ISSUANCE OF THIS PERMIT GOES NOT WAIVE
RESTRICTIVE COVENANTS. CONTRACTOR AND SUB CONTRACTORS TO HAVE CURRENT CITY BUSINESS
State Tax 37,46 LICENSE. SEPARATE PERMITS REQUIRED FOR SEWER, PI.UMBING AND HEATING.
Total
BYE) _ APPWCANT OR AGENT - , --
Approved ^� Receipt No. -
-- -- ArIb ER S9 PSE
..'��111111tiNtii-«e.:r._'•""'"ri:J�YIWim�wLn D waauF�wd r�.ww.rw.f:.Mb::..rAa::.'y.
��Il_DING PERMIT APPLICATION 11T TIG ARD DATE__-Ir~5�� �r_.3g7$�. T9--- NO
OF
oc'r'Nfr HEREBY APPLIES FOR APERMIT FOR THE WORK HEREIN INDICATED BUILDER PHONE -
^� V,'N ANC` APPROVED IN THE ACCOMP,ANYINC FLANS AND SPECIF ICA1 IONS. OWNER PHON
LOT NO 5► C OU Cap _
I Waverly COL78t.---- JOB ADDRESS _•9-705--r. W -pembf-c O HOME A DRESS
ARCHITECT
ENGINEER
FADDRESS �� LSIGNER
same
aE rC 'sCW ❑REMODEL C ADDITION � []HEPAIROFIENE
_ _ Wt-AL �OFIREDAMAGE - ODEMOLITION
rvrCx rA9M ❑EDUCATIONAL- ❑_GOVT ORFIf ,JUSDPATIO OCARPORT OGARAGE OSTORAGEOSLAB [:]FENCE
_V'ND t__1MOVING� OCONDITIONAL USE ODLSIGN REVIEW []COUNCIL APPROVED �OSIGNS
;a'F NC•Y �I' LAND USETOrJE_- .. BLDG.TYPE _.S'V__FIR: 70NE.� PLAN CHECK BY _ HEAT-____
C_ ; J9Q_._- -- F l C'S?R l,.yA_D-_ .__-._.___. HEIGHT_•�.Eti-I..__._fV�.$TS2RIES.---�---PRE•3.__ig�--N4•.flE,QPQ.S?.NL_ VALUE�.�_
BUILDING DEPARTMENT SET BACKS FRONT REAR— LFFT SIDE 81 RIGHT SIDE 16-1 _-
- - THIS PERMIT IS ISSUED SUBJECT TO THE REGUL4TIONS CONTAINED IN THE BUILDING CODE, ZONING
;'Ian Check .�-Z/ REGULATIONS AND ALL APPLICABLE CODES AND ORDINANCES, AND IT IS HEREBY AGREED THAT THF
----- -- WORK WILL BE DONE IN ACCORDANCE WITH THE PLANS AND SPECIFICATIONS AND IN COMPLIANCE WI TN
;ih tcital 6'v ALL APPLICABLE CODES . ND ORDINANCES. THE ISSUANCE OF THIS PERMIT DOES NOT WAIV'
--- — — -- RLSTRICTIVF COVENANTS. CONTRACTOR AND SUB CONTRACTORS TO HAVF CURRENT CITY RUSINE:S
' of Tex L.�LJ LICENSE SEPARATE PFRMITS RE'lUIRED FOR SEWER, PLUMBING AND HEATING.
.- - .,,, R"ANI (lA AGF
.ipI. oved Receipt No. ��Y 'T_ I CO
1�*_Ak_j 'X56wi_1-_ - --- -
7r- WrA)SOX 412C
WIN WO 0"M - WWMAD Oft 97032
Otto X" t -IV
•rr�NouanatlNo���tianrM
BUILDING PERMIT APPLICATION II'� TIGARD LATE_ ,.fmu.LLy
THE UNDERSIGNED HEREBY APPLIES FOR APLRhIIT FOR THE WORK HEREIN INDICATED BUILDERPHONF
OR AS SHOWN AND APPROVED IN THE ACCOMPANYING; PLANS AND SPECIFICATIONS OWNERPHONF y
LOT NO.=1_ya
OWNER ^Y 4'° '308 ADDRESS 970 I Pewirook. HOME ADDrrtS5 t 1 80,K 4120 Hub T"
�. ARCHITECT
BUILDER San erg �-1'' ENGINEER
�� ADDRESS DESIGNER �7_
STRUCTURE UNEW 0 REMODEL ❑ADDITION ❑REPAIR ❑RENEWAL ❑FIRE DAMAGE r+ ODF-40LITION
ORES113ENCE OCOMM ❑EDUCATIONAL OGOV'T OREI_IGIOUSOPATIO ❑CARPORT11 ❑GARAGE DSTORAGEUSLAB ❑FENCE
OBD ��
OND ❑MOVING
CONDITIONAL USE ❑DESIGN REVIEW LICOUNCIL APPROVED LISIGNS
OCCUPANCY LAND USE ZONE BLDG. TYPE:' FIRE ZONE-L PLAN CHECK BY C TW HEA1 _
,nitruct Sil'lglL r amily IJtIC:1 `. y ui Lh ai tac:.hod .,,gage — 3 bodruom/2 bath
'I,:;i,.I uv of Lot r;7 -- —
J�Q6LQ912____E�4Qft.l.OAD _._1iEl�ikiT_ lU ___RQ.-$S9Filj$1ARLA172tJ �BEDROOMS__. ---VAL�1.�4 nD'
BUILDING DEPARTMENT SETBACKS FRONT 20' REAR 201 LEFT SIDE � RIGHT SIDE ,_0 4 4.
Permit 172.fall -_
1,�.Q1� THIS PERMIT IS ISSUED SUBJECT TO THE REGULATIONS CONTAINED IN THE BUILDING CODE. ZONING
Plan Check REGULATIONS AND ALL APPLICABI._E CODES AND ORDINANCES, AND IT IS HEREBY AGREED THAT THE
WORK WILL BE DONE IN ACCORDANCE WITH THE PLANS:.,vu srts-IFICATIONS AND IN I.OMPLIANCE WITH
Sub-total ALL APPIICABLE CODES AND ORDINANCES. THE ISSUANCE OF THIS PERMIT (DOES NOT WAIVE
—' RESTRICTIVF COVENANTS. CONTRACTOR AND SUB CONTRACTORS TO HAVE CURP-4:NT CITY BUSINESS
State Tax G•t. LICENSE. SEPARATE PERMITS REOUIRED FOR SEWER, PLUMBING AND HEATING.
Total ffiH. fl.6
ark jUi. — 41U(j,UU I
By f 71.1
-- APPL'CANT OR AGENT
Approved Receipt No)
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alr
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DATE INSP. TYPE.INSPECTION REMARKS PLUMBING t ATE
(3 Contractor
OK
2- 16-91 ) —QJ Permit No.
2—- - r� r�. [A -O!C Rough-in
,- Fixture
Final
,.a�.� HEATING
-Qot, . Contractor
Cc Permit No.
/-/ Gas or Oil
-.� Rough in
617111 f r 1 ,Q1�-,Z Fina! . ---_--
----- --- - SEWER
_ Final
CRIVEWAY
Final
Stcrm Drainage
(Rain Drain) Final
Sidewalk
Curb&Street Final
_ Approach _
BLDG DEPT.FINAL TEMPORARY CERTIFICATE OCCUPANCY Final
CERTIFICATE OCCUPANCY -_—
C Landscaping
Zoning Final
1
or
6
SEWER PERM' v 13870
Uflww
Llnitied Sewerage Agency
of Washington County CITY OFJinard4_ DATE .__!]r". azvr 1 1 , 1978
OWNER o — WavPi•lyonstructi.un Corap a ly___ PlIONE. ._�9H1--�7_Q
OWNER ' S ADDRESS:
TYPE OF INSTALLATION:
BUILDING SEWER ❑BUILDING SEWER AND SIDE SEWER
TYPE OF OCCUPANCY:
®NEW SINGI.L FAMJLY UJ COMMERCIAL
❑EXIST . (PRIOR TO 7-1-70 ) E] MUL7 . RES. 0 INDUSTRIAL
FIXTURE UNITSy_ DWELLING UNITS ,___
PERMIT CONDITIONS: THE APPLICANT AGREES TO COMPLY WITH ALL RULES
AND REGULATIONS OF THE UNIFIED SEWERAGE AGENCY . WHEN CALLING FOR
INSPECTION, PLEASE REFER TO THE PERMIT NUMBER. THIS APPLICATION
EXPIRES IN ONE—HUNDRED AND TWENTY ( 120 ) DAYS . THE AMOUNT PAID WILL,
BE FORFEITED SHOULD EXPIRATION OCCUR.
FEESe
PERMIT FEE $ z5• ()Q_
CONNECTION CHARGE
-
SIDE SEWER INSTALLATION _ _
I SSUED BY
OTHER
TOTAL $_�iL �[1.. _
--- Iaaia>_y .I.1 . I.q_.H__,.______.
APPLICANT DATF
NOTICE, J DAYS DE THE
AVOIlCHARS DATE, SEWER SERVICE
THIS SEWER
PERMIT N;t 138'70
CHARGE WILL BEGIN FOR tHl3
PERMIT.
ADDRESS OF STRUCTURE _9:7(15 1.1 pAmht ans,_I_i.g��_rd,
TAX MAP _ TAX LOT----.—.—.-- SYSTEM F a n r,Io .reek_,
LOT 5 _ BLOCK O
— F .T .Walden -.l - Z_Q__
APPR(1VE D FlY DATE" ISSUED Bl' DATE
REMARKS
CITY OF TIGARD
ORDINANCE #77-26
STREET SYSTEM DEVELOPMENT CHARGE
DATE: January 11-, 19,78 ESTIMATED SALES PRICE 4nnn_
APPLICANT NAME Waverly Cuntruc iu;-i TELEPHONE # 981-f�77n
JOB ADDRESS 9705 SW Pembrook BLDG. PERMIT #1
AMOUNT OF FEE FOR S. D. C. 5300. 00
DESCRI1 ;ION OF IMPROVE:MENTSingle Family Reside ij ,j, (npW)
FXEMPTI9PJS -PER ORDINANCE #77-26 1-10D2
FEE RATES:
A. Single family dwelling Us Jt under 360,0011. ---_'_-___ 4300. 00
G. Single family dwelli.nn unit over $60,0110. --------- $400. 011
C. Mobile H:,me i3OUrt Space (New 0eveinpment)----------- $1.10.0(1
D. Multi-Family Owel.lings--per unit-----__.____ .._______ $240. 00
E. Commercial , Industrial b InstitutionP1(P - rk. 3pace) 5 50.00 aer-11.1
F. Single family unit under $40,000. --------------- $250. 00
CITY OF TIGARD
ORDINANCE #77-71
PARK SYSTEM DEVELOPMENT CHARGE
DATE : „ash 11 , 1978 ESTIMATE.D SALES PRICE $ 45, UOU .
APPLICANT NAME Waverly Construction _ TELEPHONE. # 981-6770
JOB ADDRESS 9705 SW Pembrook BLDG. PERMIT #
AMOUNT OF FEE FOR P. D. C . $100. 00
DESCRIPTION OF IMPROVEMENT_ Si.nglem Family Residential (new)
EXEMPTIONS - PER ORDINANCE #77-71 none
FEE RATES :
A. Single family dwelling unit. under $40,000. -----------$ 75.UO
B. Single family duelling Unit over $40, 089. --------------$1 D0. UO
C. Mobile Home COLIT't Space (New 50. 00
D. Multi-Family dwellings--per unit------__._-_._--_------_ $ 60.00
CONSTRUCTION IS LOCATED ON S.F. '-9—.F:7.
N.W. SIDE OF S.i PACIFIC
HIGHWAY . N11 . i:. Park District #I . S.F , is Park District #II.
r
ciTv TIG,�.RD GATE-. JAN.4 _.._�/�._. 1A____- N2
BUILDING F CRMIT APPLICATION OF
•ir LINOi RSIGNED HEREBY APPLIES FOR APERMIT FOR THE WORK HEREIN INDICATED BUILDERPHONE-OW 6770
-F AS ` H;ritit: AND APPROVED IN THE ACCOMPs� PL NS AND SPECIFICATIONS, OWNER PHONE
CAp
/Ll� LOT NO
�F �
ccoj-pr. JOB ADDRESS 5 T. 4 CL&XA) CAP YHOME ADDRESS 12M It �9k 41%c Hu pAp
------ __ --.-- -- - ARCHITECT
�/� ENGINEER
r- 4WHe, �5 AI�0� ADDRESS____-_.-�-____-- DESIGNER ---
E ICJ'•' W, _ ORF MODEL ❑ADDITION, ❑HEPAIR - ❑RENEWAL ❑FIRE DAMAGE []DEMOLITION
V f ❑EDUCATIONAL -OGOV'T 0RFUr+IOUS0PATIO-OCARPORT nGARAGE ❑STORAGEDSLAB ❑FENCE
IWIND DMOVING ❑CONDITIONAL USE ❑DLSIGN REVIEW- DCOUNCIL APPROVED []SIGNS
L ANOUSE ZONE -fT�'j BLDG. TYPE_.�.'IL-FIRE ZONE. Pl_AN CHECK BY— "�' ._ HEAT
RAD _ FLQQ.P_ �lb----N-Q-llQfRIE----I------ % wQ-u.Et?RQQN►S_ �1►1-1�.E_. DOO
BUILDING DEPARTMENT SEI BACKS FRONT Zvi _-REAR Z�, LEFT SIDE RIGHT SIDEcirnit
n ( THIS PERMIT IS ISSUED SUBJECT TO THE REGULATIONS CONTAINED IN THE BUILDING CODE, ZONING
( an heC i / 6 Cl REGULATIONS AND ALL APPLICABLE CODES AND ORDINANCES, AND IT IS HEREBY AGREED THAT THE
-f-( WORK WILL BE DONE IN ACCORDANCE WITH THE PLANS AND SPECIFICATIONS AND IN COMPLIANCE WITH
uU total ALL APPLICABLE CODES AND ORDINANCES. THE ISSUANCE OF THIS PERMIT DOES NOT WAIVE
/%� RESTRICIIVF COVENANTS CONTRACTOR `ND SUB CONTRACTORS TO HAVE CURRENT CITY BUSINESS
A;t� Tax - LICENSE SEPARATE PFRMITS REQUIRED FOR SEWER, PLUMBING AND HEATING.
Total
----- _ Avc1 'WX'WLY CONSTRUC IOT N CSO.
.I pp,(wed Recelpl No. ••
I- __--I - ADUNIII
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