9775 SW PEMBROOK STREET-1 9775 SW PEMBROOK STREET
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ADORESS„97-.)S_ / C.n l ria/C PERMIT NO„ /.-- Xs—
_ PERMIT CHARGE none
OWNER LO=�3 C]2; r, y CONNECTION FEE 604
�Y PAID 8Y _ lcJaa_t2 /, CCn �r
TYPE OF HUILDING DATE CONNECTED
SFRUICE RATE INSPECTION FEE
CONTRACTOR _ PAID BY DATE
SIZE OF CONNECTION ASSE35MENT PAID
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, ? Waverly Const. Permit No. _ 1360 r�o
'svA, I Owner: ----
Building Address—
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'� -•�� i Certificate is hereby given this ._17—_. day of Mat-zb , 19-7-FL-
that said building may be occupied and Ll-,at,
it comphv:; with all requirements of Ge '
Building Code for the City of Tigard, asP
approved by the Tigard City Council. lfi�
j' Building Inspector I
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BUILDING PERMIT APPLICATION 10 Y TIGARa DATE 1i`"1"77 19—_
THE UNDERSIGNED HLREBY APPLIES FOR APERMIT FOR THE WORK HEREIN INDICATED DUILOFRPHONE "')UI-6770
OR AS SHOWN AND APPROVED IN THE ACCOMPANYING PLANS AND SPECIFICATIONS. OWNE:RPHONF-
ry
LOT NO._
OWNER ;t',!'. t t ofk� Es, t 1 OADi7RES5t, 11 l 5LJ Pu(P)I]Cw,)IC _ HOME ADDRESS
ARCHITECT
ENGINEER
BUILDER ADDRGFS DESIGNER_
STFILIq URE CJNEW ❑REMODEL LJADDITION ❑REPAIR ❑RENEWAL ❑FIRE DAMAGE ❑DEMOLITION
QR--EI1SIDENCC ❑COMM ❑EDUCATIONAL ❑GOV'T ❑RELIGIOUS❑PATIO ❑CAR PORT ❑GARAGE ❑STORAGE❑SLAB ❑FENCE
EIBOND ❑MOVING ❑CONDITIONAL USE ❑DESIGN REVIEW ❑COUNCIL APPROVED ❑SIGNS
OCC UPI.NCY ,1 —LAND USE ZONE BLDG.TYPE Jt'I FIRE ZONE L PLAN CHECK SY Eit41 HEAT k18
tuQli14f (1jdlIincA w/at Lar-bald ;,fir;----A LynrjrnrAM A t'nt-t>� —
9S���QAQ__ FLOOIl1.4AT.�----------�1StH7 �Q N.4,.;iIQCiIF�_.�..__--,4REA 221.2 NO..►�E�RQ41L�;i—.-.`.�__YALUE+'a;. ,�.�,�;,�,
BUILDING DEPARTMENT 20 62t 7 I
_� —_ SET BACKS FRONT REAR LEFTSIDE RIGHT SIDE �
Permit JL 7 . (10
-- THIS PERMIT IS ISSUFO SUgJFCT TO THE REGULATIONS CONTAINED 'N THE BUILDING CODE, ZONING
Plan Check ElCI�;3 C} REGULATIONS AND ALL APPLICABLE CODES AND ORDINANCES, AND IT IS HEREBY AGREED THAT THE
WORK WILL BF DONE IN ACCORDANCE WITH THE PLANS AND SPFCIFICATIONS AND IN COMPLIANCE WITH
Sub-total 2J0.j(; ALL APPLICABLE CODE^. AND ORDINANCES. THE ISSUANCE OF THIS PERMIT DOES NOT WAIVE
RFSTRICTIVE COVENANTS. CONTRACTOR AND SUB CONTRACTORS TO HAVE f'URRFNT CITY BUSINESS
State Tax 6088 LICFN�E.SEPARATE PERMITS REQUIRED FOR SEWER, PLUMBING AND HFATIAG.
Total 265. 38 OeDsC. #2 $1010.
BV -- --
-- AP LICA' T OR AGENT
Approved _ Receipt No. ¢ `! ,�/ •• C,_ N '/� Q �_
ADP55
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UATE INSP, TYPE INSPECTION REMARKS PLUMBING DATE
12-c1 )) �> -- -C crr — �UU��l� wITNUvr �NSr"'�c-TiContractor
' ✓'0�r e ze Permit No.ja2
h_I ���►�in, Fixture
� Final
HEATING
2--6-� t tA_- IS PROVES)) Contractor
Permit No. Q 2-6
Gas or Oil
9v� - (S A fAqvVE-0 � o-ttj Rough-in --- - --
�. Final
y/J,r�nQ G1/l.eA4 2aLL- SEWER —
-- 0/ Final
n _ DRIVEWAY
t U(< Final
Storm Drainage T
(Rain Drain) Final
Sidewalk
Curb&Street Final
Approach
BLDG DEPT, FINAL TEMPORARY CERTIFICATE OCCUPANCY Final
CERTIFICATE OCCUPANCY
f r Landscaping
.. `._ Zoning Final
5
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SEWER PERMIT o
13852
Uf fied SevrerayeAgency CITY OF Tigard DATE 1.2-1-77
of Washington County ---- -- ---~
OWNER: Waverly Const. Co. _ PHONE : 981 -67�i .-_,_
OWNER 'S ADDRESS= — - --
TYPE OF INSTALLATION:
nE*UILDING SEWER ❑BUILDING SEWER AND SIDE SEWER
TYPE OF OCCUPANCY,
XXX3oxW X (BXSINGLE FAM-L) COMMERCIAL
❑EXIST . (PRIOR '10 7- I -70 ) 0 MULL . RE_S. �J INDUSTRIAL
1
FIXTURE UNITS _ DWELLING UNITS____. `
PERMIT CONDITIQNS: THE AmPLICANT AGREES TO COMPLY WITH ALL RULES
AND REGULATION!; OF THE UNIFIED SEWERAGE AGENCY . WHEN CAL.. ING FOR
INSPECTION, PLEASE REFER TO THE PERMIT NUMBER . THIS APPLLCATION
EXPIRES IN ONE-HUNDRED AND TWENTY ( i20 ) DAYS. THE AMOUNT PAJD WILL
BE FORFEITED SHOULD EXPIRATION OCCUR.
FEES:
PERMIT FEE $ 25 -
CONNECTION CHARGE bnn.
SIDE SEWER INSTALLATION
I GSUF.D BY
OTHER
TOTAL_ $ 625• _
APF' -I C ANT DATE
AUT., ,.,.TF, �c���,� ��;: : �': 13852
CHARGE WILL UEQIW fVR THIS SEWER PERMIT
PERMIT.
ADDRESS OF STRUCTURE 9775 SW Pemhrook
TAX MAP ,_ TAX LOT____-,._ . -. SYSTEM Fanno creak
LOT BLOCK OF _
APPR,JVED BY PATE ISS ' D BYJ DATE
REMARKS bldg. # 1807
CITY OF TIGARD
ORDINANCE
7r'7?-�
STREET SYSTEM DEVELOPMENT CHARGE
GATE : 12-1-77 ESTIMATED SALES PRICE: $x,,000.
APPLICANT NAME ►,►avariy Cnnst. Co. TELEPHONE
JOB ADDRESS 9775 SW PAmbrook BLDG. PERMi 1 19
AMOUNT O F F E E F O R S. D. C. 3 Q0
DESCRIPTION OF IMPROVEMENT S.F.D.
EXEMPTIONS -PER ORDIN"JCE 1177-26
FEE RATES:
A. Single family dwelling unit under $60,000.---------- $300.00
0. `.Single famity HL,elling unit over S,60,non.---------
C. Mobile Home Court Space (flew Development)---------- $150.00
D. Multi-Family Cwellings--per unit-------------------- $240.00
E. Commercial, Industrial & Institutional(Park.. Space) $ 50.00 each
F. Single Family unit under $40,000. ----------------- $250.00
CITY OF 7IGARD
ORDINANCE #77-71
PARK SYSTEM DEVELOPMENT CHARGE
DATE : 12-1-77 ESTIMATED SALES PRICE
APPLICANT NAME Waverly Const. Co. TELEPHONE #
JOB ADDRESS 9775 SW Pembrook BLDG. PERMIT # _ 1gp7
AMOUNT OF FEE FOR P. D. C. __$100.
DESCRIPTION OF IMPROVEMENT__ S.F.D
EXEMPTIONS - PER ORDINANCE #77-71.
FEE RATES:
A. Single family dwelling unit under $40, 000. -------------$ 75. 00
0. Single family dwelling unit over $40, 000- --------------$100. 00
C . Mobile Home Court Space (New Development)-------------- 5U. 0
D. Multi-Family dwellings--per unit------------------------ 60. 00
CONSTRUCT Int. IS LOCATED ONXXXX S.W. _ N. E . SIDE OF S.W. PACIFIC
HIGHWAY. N.E . is Park District #I . 5.W. is Park. District #II .
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City of Ticlard Mechanical Pertnit N? Per init-__51 00
0 - -3 Fie---- _11,d-cl
❑ Relocation 0 Addition CD Allbralion State
Npw Installation TOTAL___X2 W
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CONTRACTOR 4*w1e_ U,
ADr)RESS _?
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WORK ADDRESS_ Z7 J .
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PHONE APPLICANT
4" Flue Size '
Heat -iput Rating (BTU Per Hour) Vent Size W__ ___A6_-�
FUEL OIL ❑ GAS ELECT ❑ OTHER
ITEM NO. FEE ITEM
NO. FEE
3.00 Air Condition Compressor 15 to 30 HP 10.0t
For Issuance of Permit --Air �;-an�,—Ing 10,004 CFM 3.0C
New Un:'er ,
,660 BTT f 00
—>. Naw 100,000 BTU h E.00 'Air Handling Over 10,000 CFM 5.0C
4.00 vapurative Cooler 3.01;
Floor Furnace
4400 _Range Vent Fan
Wall - Floor - Suspended
3 0,(�
2.00 Vent System
Install Vents Only __ - t 3 0 ,
4.00 Hood Commercial
Re�a�IrH�aj & Cooling C
4.00 Commercial Duct System_;��r Condition Compressor Under 3 HP -e...
;C,,es,;r 3 to 15 HP 7.50
%ir Condition o
INSPECTOR'S COMMENTS_...—..._— .-- ---------- ------------`—__
CITY BUSINESS LICENSE REOUIRED FOR ALL CONTRACTORS OR SUB-CONIRACTORS
DATE ISSUED BY DATE
APPROVED BY,
NO.
R E CE IPT
;7n�;ttwnl Arinlicint