9735 SW PEMBROOK STREET 9735 SW PEMBROOK STREET
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Permit t Mo.
Permit charge
ConnRct;ion fee
Paid by
Type of bili. !ding �ir'�,
D<3te connected
service ra ;,
e Inspection fee
' ontrnctor Paid b --
Size of connection _ A.�sessr��nt � .._._.,.,�.
Paid
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BUlI-DIN G DEPARTMENT, T{uL1r^.DO
FLUi,JI :i�JG PERNUT •
CAP! �rag11 4-C&Nolder of a valid pl .w,-6ing contractors license is her 'ay
authorized to cause plumbing work as herein noted to be installed in accordance with the plumbing code of
Tigard. Such installations re.luire inspection by the City Inspector who shall be notified not less than four
(4) hours prior to the time t1w installations are reach for inspection. City of Tigard Busines License required
for all contractors and sub-contractors. y
OwnerW46--1-1f-- —— LO n_S'rr Address_. 1 — �
-------.. Date-/—z------1._ 7
NUMBER OF TOTAL. PERMIT NO.'S
TYPE OF PEWArr ITEMS FEE ON EACH AMOUNT (Office Use OnPy)
Single a Femil -I-1 bath each -- -- -� -25_00
Duvlex-Each 1 bath unit _ _ __ 2500
_Additional bathrooms-each -- ��--_- � - 10.00 -
-While Noma S each 15.00 t1
I N D I V I D U A L FIXTURE FEES
_-1 to 50 Fixtures in 1 building each -__ _3.00
51 to 100 FiA_ure9 in 1 tuildin ewh -�_-_ ---.--_. -2,50
101 to 200 Fixtures in 1 building, .i,;h 2.00
------------
- 201 or-mora Fix .: -, it 1 bui'• 0
-- �----- - - ------ - - - - _ 1.5 - - -_ Y -Y -- --- -
MISCELLANEOUS
_Bu_Idinr, Seer--1st 50 ---
5ewar--each addi:lural 101 ft.
Water Service to buildi;,u __� ___ -_
Privates Water Svstems" esch 100 ft._ _ 100(1
Other 15ay -i
`� �__._..
I-PUIM1T T S Fn-r Pmmhing lns,t r:'irr►Phare 6.19 171
i 3%S.'stP - -�- Plurt,bir g Cnrt;racWr By
TWAL Yi RECEIPT NO. 16111•^•.1 Ry
R PERMIT
SEWER M , s35
Uf
Unified Sewerage Agency CITY OF Tigard DATE
of Washington County --
OWNER : Waverly Con^t. — PHONE : 9B1-6770
OWNER ' S ADDRESS: -
TYPE OF JNSTALLATION:
XkX]BUILDING SEWER ❑BUILDING SEWER AND SIDE SEWER
TYPE OF OCCUPANCY:
> WEW XX❑(XSINGL_E FAMILY [j COMMERCIAL.
❑EXIST . (PRIOR TO 7-1 -70 ) ❑ MUL_T. RES. ❑ INDUSTRIAL
1
FIXTURE UNITS 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
EXPIRrS IN ONE-HUNDRED AND TWENTY ( 120 ) DAY'S. THE AMOUNT PAID WILL
BE FORFEITED SHOULD EXPIRATION OCCUR .
FEES:
PERMIT FEE $ 25•+
CONNECTION CHARGE_ 600.
SIDE SEWER INSTALLATION
ISSUED BY
OTHER
TOTAL $ 625. _
APP ICANT DATE
N il"NA OF TEE
nFVILL os,lID" FOR Ta1� SEWER PERMIT N! x.3835
ADDRESS OF STRUCTURE 9755 SU Pemb rook
TAX MAI' TAX LOT — SYSTEM fanno creek
LOT _ BLOCK OF
A.
ZX;
APPROVED BY DATE ISSUED BY DATE
REMARKS_ titaq_ —_--
. ._. ._ ,« ...,y.. ..... .«+..,ZI.....f...�..-,.... f..wiS w.u.«..y.«.«�vt..w.- ."^+'++'r"^�Mr^lwf.P'�M►fW/� •�MYiN`uR�'�c`-.^+iT7r«�..0
BUILDING PERMIT APPLICATION 11 Y TIBC ARD DATE « �-"i 11 ,A _ �» 1781
THE UNDERSIGNED HEREBY APPLIES FOR APERMIT FOR THE WORK HEREIN INDICATED BUILDER PHONE
OR AS SHOWN AND APPROVCD IN THE ACCOMPANYING PLANS AND SPECIFICATIONS. OWNERPHONF
LOT NO.—.—
OWNER
O.—.OWNER 1.lVt '.,y 1,�JIlat, JOBADDRESS /3J dl EJ61111LJ1HOMEADDRESS
ARCHITECT
ENGINEER
BUILD,-.R f'(11kR'� _ ADDRESS DESIGNEP
S1RUCTURE �'LNEW GREMODEL _❑ADDITION ❑REPAIR ❑RENEWAL ❑FIRE DAMAGE ❑DEMOLITION
❑MESIDENC-9 [:]COMM ❑EDUCATIONAL ❑GOV'T ❑RELIGIOUS❑PATIO ❑CAR PORT ❑GARAGE ❑STORAGE❑SLAB ❑FENCE
❑BOND ❑MOVING ❑CONDITIONAL USE ❑DESIGN REVIEW ❑COUNCIL APPROVED ❑SIGNS
OCCUPANCY LAND USE ZONE__ . _BLDG.TYPE—_' —FIRE ZONE_) PLAN CHECK BY tI tw HEAT
to Cadet. 1276 sq. ft. dwelling w/b94 sq.ft. finiahed brisement ano
'.94 sq/ft. otttarhed ij a1 eys 4 bedroom 3 both
QCC. LOAD _____ FLOOR LOAD 40 _..HEIGUI—WU NO.. RLL .j AFEA 1iZ6 NO BEDROO'AS-4 VP- 111 U0l].
BUILDING DEPARTMENT
SETBACKS FRONT 22 REAR LEFT SIDE RIGHT SIDE (-
Permit 1 _1•UO _.—�----- �__----�__----------= -–`"-_----
-- THIS PERMIT IS ISSUED SU13JFCT TO THE REGULATIONS CONT.INED IN TNF 8011.13ING (,ODE, ZONING
Plan Check 7J.bll REGULATIONS AND ALL APPLICABLE CODES AND G^D!N:LACES, AND IT IS HEREBY AGREED THAT THE
WORK.WILL HE DONE IN ACCORDANCE WITH THE PLANS AND SPECIFICATIONS AND IN COMPLIANCE WITH
Sub-total ALL APPLICABLE CODES AND ORDINANCES. THE ISSUANCE OF THIS PERMIT DOES NOT WAIVE
RESTRICTIVE COVENANTS. CONTRACTOR AND SUB CONTRACTORS TO HAVE CURRENT CI'Y BUSINESS
State Tax b.04 LICE SE.i..SEPA AT PERMITS REQUIRED FOR SEWER. PLUMBING AND HEATING.
,l. . • ,J1_�)•
Total t;'.a. !:,4 1J.Q.C• don.
By
f
RPPLICANT OR AGENT
Approved RNcf lipf No.
S I
DATL INSP. TYPE INSPECTION REMARKS PLUMBING DATE
\\ Contractor
Permit No. ��O �/(, � 12-f-��
fopR O f/r b r.1.1y Rough-in
Fixture
Final
HEATING
IS A PPR oyC�11 �/a p�r�y a Contractor
- 10-9? Qi3 - Ok Permit No,�(_O�_
/y -2?• 7
c4v-cn - (-1)js,4p/op1ovc-b Gas or Oil
wgZ4 Rough-n
Final
SEWER
`zFinal
` 9.P PR0VG1 �Q,�P ,t,1re GLur„e DRIVEWAY
AZIJ- D K Storm Drainage
(Rain Drain) Final
FIS!s'��0/NG glove AAAgeir 007- Sidewalk _ - --
AvIo -mu Curb&Street Final
BLDG DEPTL FINAL TEMPORARY CERTIFICATE OCCUPANCY
CERTIFICATE OCCUPANCY Final 4004 4 tj r is
ILandscaping
J 7omng Final
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CITY OF TIGARD
ORDINANCE 7/77-26
STREET SYSTEM DEVELOPMENT CHPRGE
DATE : Xj 7 ESTIMATED SALES PRICE
APPLICANT NAME1`C,'L ;9_t1? << ;, �` TELEPHONE it
JOBA[�DRE3S BLDG. PERMIT ��7
AMOUNT OF FEE FOR S. D. C.
DESCRIPTION OF IMPROVEMENT .�
EXEMPTIONS -PER ORD?NANCE V77-26
FEE RATES:
A. Single family dwelling unit under $60,000------ •-- C.
?
B. Single family duf�ll3.ng unit over ?;60, 000.-- ------ I {C�pp
C. Mobile Home Court Space (New Development)---------- 5150.00
D. Multi-Family Dwellings--per unit------------------- $240.00
E. Commercial, Industrial & institutional(Park. Spece) $ 50. 00 each
F. Single family unit under 540,000. ----------------- 5250. 00
CITY OF TIGARD
ORDINANCE #77-71
PARK SYSTEM DEVELOPMENT CHARGE
DATE : f.;77z7 ESTIMATED SALES PRICE $,Mo 7
APPLICANT NAME ,t�Z-iu- �c+,t��7 ., TELEPHONE #
JOB ADDRESS �/ `� (I�� >r_ �1 trti� k S4 BLDG. PERMIT #
AMOUNT OF FEE FOR P. U. C.
DESCRIPTION OF IMPROVEMENT
EXEMPTIONS - PER ORDINANCE #77-71.
FEE RATES :
A. Single family dwelling unit under $40, 000. -------------AA-5. 00
B. Single family dwelling unit o,,er $40, 000- ---------------
C.
-------•------`C. Mobile Home Court Space (New Development)---------------$ 50. 00
D. Multi-Family dwellings--per unit-----------------------$ 60. 00
CONSTRUCTION IS LOCATED ON �L_S.W. N.E . SIDE OF S.W. PACIFIC
HIGHWAY . N.E . is Park District #I . S.W. is Park District #II .
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