9720 SW PEMBROOK STREET 9720 SW PEMBROOK STREET
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i G?x �A�. �1� Permit No. / r'
Permit charge
Owner Connection fee
( co ,
Paid by _
Type of building % �j
Date connected
Service rate _ ction fee �-
Contractor by
y _. Date
Size of connection
:c;sssment _ psid
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BUILGING PERMIT APPLIt"ATION 11 Y TiGARD DATE p
THE UNDERSIGNED HEREBY APPLIES FOR APEHMIT FOR THE WORK HEREIN INDICATED BUIL.DERPHONE 625-735
Olt AS SHOWN AND APPROVED IN THE ACCOMPANYING PLANS AND SPECIFICATIONS. OWNER PHONE—___
LOT
HONE —
LOT NO.
OWNER ,,,ii1la-E) Lb_ Ij _ JOB At.ORESt3 Q,y�Re j{ttrQuk. :]t■ HO�AE ADDRESS
— ARC'IITECT
OATH U ENG:NEER
DUILDER ADDRESS r DESIGNER _
STRUCTURE x010EW ❑_REMODEL ❑ADDITION ❑REPAIR ❑RENEWAL OF IRE DAMAGE ❑DEMOLITION
❑ftltSIDENCE ❑COMM [:]EDUCATIONAL 0GOV'T—❑RELIG'OUS❑PATIO ❑CAR PORT ❑GARAGE ❑STORAGE❑SLAB ❑FENCE
❑BOND 1.100VING ❑CONDITIONAL USEDESIGN REVIEW_L!iOUNCILAPPROVED ❑SIGNS
T L. 3 tLkJ HEAT- 905
OCCUPANCY_•_—LAND USE ZONE�_.,._�BLDG.TYPE FIRE ZONE_ PLAN CHECK BY__
_11is. t st(gi1 a family dwalliny w/e+.ta&j8d yarays ej liki0ruum 2 bath
4u 816
Iwer permit -,,iJ3924 sewer cutin. W6110. sewdr insp. $25.
AREA A•73�1�J� Bl:IL44MS_ ___YAI,IlEi_ 82001
BUILDING DEPARTMENT SET BACKS FRONT 26 REAR —12 LEFT SIDE 20 RIGHT SIDE 13 _
Permit 195.130 � �—_-"— ------�_—_�---- �'
—' —' THIS PERMIT IS ISSUED SUBJECT TO THE REGULATIONS CONTAINED IN THE BUILCING CODE, ZONING
Plan Check Cti U REGULATIONS AND ALL APPLICABLE CODES AND ORDINANCES, AND IT IS HEREBY /IGIIEED THAT THE
WORK WILL BE DONE IN ACCORDANCE WITH THE PLANS AND SPECIFICATIONS AND IN CCIMPLIANC.E WITH
Sub-total ;.'.914,b0 ALI.. APPLICABLE CODES AND ORDINANCES. THE ISSUANCE OF THIS PERMIT DOES NOT WAIVE
--- RES"RICTiVE ;,)VENANTS. CONTRACTOR AND SUB CONTRACTORS TO NAVE CURRENT PITY BUSINESS
State Tax _ 7.Fj f.) LICE-P,l4 8E: QA11�[VIRMITS REQUIRED FOR SEWER, PLUMBING AND HEATING.
.
Total '"' i'.[7.155 , 2iJ'; 101-I.
By .t
APPLICANT OR AC%ENT
Approved _— Receipt No.
AD� 1R 55
DATE INSP. TYPE INSPECTION REMARKS PLUMBING DATE
1 - PosCrj1+ Contractor
- ti Permit No. �� �Y' 'c/
-1n L' �-
�.x Rou h-in
4y G►+' k- Fixture
Final
HEATING
-- -L-
� Contractor _
IAA
Permit No.
Gas or Oil_ _
Rough-in ---- —
�.�5`'1`6 SEWER -- -
Final
DRIVEWAY
Final
Storm Oraina e _
(Rain Drain) Final
Sidewalk
Curb&Street Final
A roach
BLDG DEPT FINAL TEMPORARY CERTIFICATE OCCUPANCY
CERTIFICATE OCCUPANCY Final
C
Landscaping
`�-- C Zoning Final
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SEWER {'ERWi rr N'V 13924
U3/ 1/7)
Unified Sewerage Agency C ITY OF Tigard DATE
of Washington County
OWNER . U 1 ism P .1jabl PHONE
OWNER ' S ADDRESS:
TYPE Or INSTALLATION:
X12TIF3UILDING SEWER ❑BUILDING SEWER AND SIDE_ SEWER
TYPE OF OCCUPANCY:
X 'EW SINGLE FAMILY [:] COMMERCIAL
❑EXIST . (PRIOR TO 7-1-70 ) ❑ MULT . RES . ❑ INDUSTRIAL
FIXTURE UNITS DWELLING UNITS l
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 AMOI,N'I' PAID WILL
BE FORr=EITED SHOULD EXPIRATION OCCUR.
FEES,
PERMIT FEE $ 25.
CONNECTION CHARGE 600. _--
SIDE SEWED INSTALLATION —I —
ISSUED BY
OTHER --
T.LY $ 62-5.
_
��F(PPLICAN T DATE
M h
*..h
J i .:
Srdbi ,
WILL DIGIN FOR- SEWER PERMIT N" 13924
ADDRESS OF STRUCTURE r__ 9720 SLI Pembrook St. _
TAX MAf-
7AX LOT SYSTEM fanno creek
—'
LOT 6 B L 0 C is _O F
APPROVED BY GATE -7ISSUED BY CATE
REMARK'; bldg. #1905 _.__
CITY OF TIGARD
ORDINANCE #77-71.
PARK SYSTEM DEVELOPMENT CHARGE
la �
DATE : � /7ESTIMATED SALES PRICE
APPLICANT NAME �� �L ��! TELEPHONE #
JOB ADDRESS BLDG. PERMIT #
�•v
AMOUNT OF FEE FOR P. D. C . y-
DESCRIPTION OF IMPROVEMENT
EXFFIPTIONS - PER 'IRDINANCE #77-71
FEE RATES :
A. Single family dwelling unit under $40,000.-------------$ 75, 00
B. Single family dwelling unit over $40,000.-------------- -XT)
C. Mobile Home Court Space (New Development)--------------$ 50600
D. Multi-Family dwellings--p r unit--------------------------$ 60. 00
CONSTRUCTION IS LOCATED OS.E . N.W. SIDE OF S.W. PACIFIC
HIGHWAY. N.W . is Park District #I. 5,E'_ is Park District_ II.
CITY Of' TIGARD
OROTtIANCE #-77-26
STREET SYSTEM DEVELOPMENT CHARGE
DATE : ESTIMATED SALES PRICE
APPLICANT NAf'IE%� ,� TELEPHONE
JOB ADDRESS � 12 BLDG. PERMIT
AMOUNT OF FEE FOR S. D. C. rL-
DESCRIPTION OF IMPROVEMENT
EXE1'1PTI'JN5 -PER ORDINANCE #77-2E:
FEE RATES: ,
A. Single family dwelling unit under "aG0,000.---•--• - - $300.00
0- Single family dwelling unit over
C. Mobile Home Court Space (New Development)-------•--_ �SItT.-tr0
0. Multi-Family Dwellings--per unit--------------------- 3240.00
E. Commercial , Industrial & Institutional ( Park. Space) 5 50.00 each
F. Single family unit under S4U, O00. ---------- ;;250900
D'UILDING PERMIT APPLICATION IIOF
T' TIG, RD DATE �?'_?1- iZ _ N2
�c ONDF PSIGNFD HEREBY APPLIES FOR A PERMIT FOR THE WORK HEREIN INDIC,,4TED BUIL.DER PHONE40
,�P AS SHAWN AND APPROVED IN THE ACCOMPANYING PLANS AND SPECIF ICAT IONS OWnrR PH
/,/ � Lor n�7.
..�.._ y
JLj JOB AOORESS 72y HOME AU!�RESS
ARCHITECT — -
ENGINEER
ADDRESS _ DESIGNER
TF.W IRE ❑RFMODEL� ❑ADDITION �QHEPAIR +! `JRENEWAL OFIRE DAMA(a" ❑DEMOL17ION
IJINrF ❑•-'f:MM ❑EDUCATIONAL OGOV'T ❑RELIGIOUSOPAT10 ❑CARPORT ❑GARAGE ❑STORAGEOSLAS ❑FENCE
IH"ND - ❑MOVING OCONDITIOI' AL USE ❑DLSIGN E.VIEW_ QCOUNCIL APPROVED ❑SIGNS
uF uNCYc L AND''t E ZONEXL�i—l_BLDG TYPE_ !'._F IRE ZONE PLAN CHECK BY_ G- �� HEAT—
r,_ :
EAT^c,_ : U9D_ FLQDR-LQAR.—�---- HEIGHT �!!� NS2 �IS�RIE� - g_!Y9 b�1?RQQMS VgLU. 7j_�_O _
BUILDING DEPARTMENT SET BACKS FRONT0�_ REAR LEFT SIDE JRIGHT SIUE�THIS PERMIT 19 ISSUED SUBJECT TO THE REGULATIONS CONTAINED IN THE BUILDING CODE, ZONING
'tan Check �-0I 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
`;ub Total ij G� l� ALL APPLICABLE CODES AND ORDINANCES. THE ISSUANCE OF THIS PERMIT DOES NOT WAIVE
--tlf 1 T2 RESTRICTIVF COVENANTS CONTRACTOR AND SUBCONTRACTORS 10 HAVE CURRcWT CITY AUSINESS
a1F Tax �1 V LICENSE SEPARATE PERMITS REOUIRED FOR SEWER, PLUMBING AND HEATING.
By _
- APPt ICAN
o T OR AGENT
ac' ved Receipt No
A 0 E)R E 55 -----
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