9805 SW PEMBROOK STREET 9805 -W PEc]RROOK STREET
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,address i� �S��s- l )F r„ �,r 3d K �� Permit No.
Permit charge 2�?o-�y e--
JWner 1�JG v �y � s t Connection fee
.� Paid by _ 4-Za
Type of building D,�te connected _
Service rete JS/ Inspection fee o7$`°'
,-antractor �7 Paid by _ date
Size of connection _ Assessment Paid _
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BUN GING DFP.A.RTNIENT, TIGARD
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i PLUMtsi "" PERMIT
i C�1C1(i1c_ ±LUI�tt3�t✓� p I1f��CN,cC,JiR(1LC%10 S _-, holder of a valid plumbing contractors license is hereby
authorized to causr, plumbing work as herein ne M to be installed in accordance with the plumbing code of
Tigard. Such installations require inspe:tion by the City Inspector who shall be notified not less than four
(4) hours prior to the time the installations are ready for inspection. City of Tigard Business License required
for all contractors and sub-contractors.
1 LOT y
i 0_wner_Ww_I�IS-y r e4-.(R4 cr'o'`!---._.—_ Address----_9- '.. w.--. _wV' !'�%nr Rvt/ _ Date. ._'
TOTAL PEPMIT NO.'S TYPE OF PERMIT NU TEM5MBER 0F -FEE ON EACH AMOUNT (01 ice Use Only)
Single Fam111 beth=Asch _ _—`—_ — _— 25.00 ✓
Duplex_--Each 1 beth unit _—
Additional bathrooms--earh 10.00
Mobile Ham,Ham'—pace-each —
INDIV1DUAL FIXTURE FEES _ - - -- — --
_ 1_to 50 Fixtures in 1 building-eu.., — `--- --„--� -- 3.00
100 Fixtures in 1 bu:ldir, -h _ - - _ 2.50
101 to 200 Fixtures in 1 s
201 or more Fixtures in 1 buildip"eeh
1.50
M_ISCELLANEOUS__
-auildln�Sewer�l�t 5-. rt __-_-----~— ..._ I --- —10,00- --_�-
5ewer_each addi5ntill 100 Ft� - 1000
_Water Service to buildings -
-Privets Water syliern+_each 100 ft. 10AU - --
Dth.'r (5 ecifyl:
PERMIT --15-°Lt For Plumbing Insp crionPhone6394171 C�
3%State L' Plumbing Contractor 9y -
�' ` TOTAL //� 0 RE(",FIPT NO. Issuers By -
req.a_ ^-*:^t.^n+k"*^ .^-1,...'rt�+•:"grM �- 4�;l m r
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BUILDING PERMIT APPLICATION �o Y TIGARD DATE `�"+17._____
THE UNDERSIGNED HEREBY APPLIES FOR APERMIT FCR THE WORK HEREIN INDICATED BUILDER PHONE-_
OR AS SHOWN AND APPROVED IN THE ACCOMPANYING PLANS AND SPECIFICATIONS. OWNERPHONE.�
LOT NO.
verly LuuK
OWNER J06 ADDRESS HOME ADDRESS _
ARCHITECT -
60M ,, ENGINEER
BUILDER ADDRESS DESIGNER _
STRUCTURE X'UNEW 0REMODEL OADDITION OF12PAIR LIRENEWAL - ❑FIRE DAMAGE - ❑DEMOLITION
❑ RESIDENCE ❑COMM ❑EDUCATIONAL 0GOV'T ❑RELIGIOUSDPATIO ❑CAR PORT DGAFIAGE D STORAGE{SLAB ❑FENCE
❑BOND ❑MOVING ❑CONDITIONAL.USE 0:1 .SIGN REVIEW DCOUNCIL APPROVED []SIGNS
OCCUPANCY — LAND USE ZONE__=_--.BLDG,TYPE —_ FIRE.ZONE— PLAN CHECK BV___._..____ __-___ HEAT a ia_ .fir
D•LOAD HEI-,BHT--------- --- NC?,STB1 $— AREA NQ.BDOrMS ---..____YALE
BUILDING DEPARTMENT73 / t�
__. SET BACKS FRONT REAR LEFT SIDE RIGHT SIDE
Permit 1 J'2.00
THIS PERMIT IS ISSUED SURJECT TO THE REGULATIONS CONTAINED IN THE BUILDING CODE, ZONING
Plan Check E'6, i0 REGULATIONS AND ALL APPLICABLE LCDES AND ORDINANCES, AND 11 IS HEREBY AGREED THAT T14E
WORK WILL BE DONc H4 ACCORDANCF WITH THE PLANS AND SPECIFICATIONS APiD IN COMPLIANCE WITH
Sub-tot:,; ALL APPLICABLE CODES AND ORDINANCES, THE ISSUANCE OF THIS PERMIT DOES NOT WAIVE
- RESTRICTIVE COVENANTS CONTRACTOR .AND SUF3 FONTRACTOAs TO HAVE. CURRENT CI(Y BUSINESS
State Tax LICENSE. SEPARATE PEETMITS REQUIRED FOR SEWER, PLUMBING AND OEATING.
Total
By -----... - ---- —-- — ------.
AP°" ICANT OR AGENT
Approved t � Receipt Nu '
ADD _:;S bH(rvI
w w
UATE INSP. TYPE INSPECTION REMARKS PLUMBING DATE
Contractor
Permit No.
q-2Q-�� fi1 Gosc 11,c..�/
Rough-in �—
„,� FiAtore �—
q (3 �i a�. tti• Final -- — —
HEATING i
-
n(3 Contractures
Permit No.
Gas or Oil -
t' -7 Ove Rough in --
u, Final
SEINER — -
Final — -- ---
�y DRIVEWAYell IL
Y—
i
Final
Storm Drains e
(Rain Drain) Final
Sidewalk —
Curb&Street Final
BLDG DEPT FINAL � TEMPORARY CERTIFICATE OCCUPANCY Final
CERTIFICATE OCCUPANCY —
Landscaping
Zoning Final
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SEWER PERMIT M 13499
Unified Seg-erage Agency 24-77
of Washington County CITY OF Tigard DATE B-
T
OWNS RPHONE : 981-6770
OWNER ' S ADDRESS:
TYPE OF INSTALLATION:
BUILDING SEWER ❑BUILDING SEWER AND SIDE SEWER
I -TYPE OF OCCUPANCY:
XDNEW E3XS 1 NGLE FAMILY ❑ CONMERC I AL
❑EXIST . (PRIOR TO 7-1-70 ) ❑ MULT . RES. ❑ INDUSTRIAL
FIXTURE UNITS DWELLING UNITS 1
PERMIT CONDITIONS! THE APPLICANT AGREES TO COMPLY WITH ALL RULES
AIID REGULATIONS OF THE UNIFIED SEWERAGE AGENCY . WHEN CALLING F=OR
INSPECTION , PLEASE REFER TO THE PERMIT NUMBER . THIS APPLICATION
EXPIRES IN ONE- HUNDRED AND TWENTY ( 120 ) Dl',YS. THE AMOUNT PAID WILL
BE FORFEITED SHOULD EXPIRATION Or-CUR.
FEES:
PERMIT FEE g 25.
CONNECTION CHARGE -699. ----
SIDE SEWER INSTALLATION _ — ISSUED Py
OTHER —
TOTAL g 625.
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APPLICANT DATE
SEWER PERMIT N" 13499
ADDRESS OF STRUCTURE 9805 SW Pembrmok St.
TAX MAP TAX LOT SYSTEM fanno gree-
LOT L_ BLOCK OF
APPROVED BY DATE ISS ED BY DATE
REMARKS Bldg. #1660
CITY OF TIGARD
ORDINANCE #77-71
PARK SYSTEM DEVELOPMENT CHARGE
DATE. : � � �72 ESTIMATED SALES PRICE
APPLICANT NAME ,--f , TELEPHONE #
JOB ADDRFSS__..2'�Q �3_ Q -trt, BLDG. PERMIT (c(0
r. C
AMOUNT OF FEC FOR P. D. C . � C)G
DESCRIPTION OF IMPROVEMENT
EXEMPTIONS - PER ORDINANCE #77-71
FEE RATES:
A. Single family dwelling unit under $40, 000--------------- 75.00
B. Single family dwelling unit over $40, 000. ------------- ? CTU,U
C. Mobile Home Court Space (New Development)--------------- 50. 00
D. Multi-Family dwellings--per merit-------------------•----$ 60. 00
CONSTRUCTION IS LOCATED ON S.W. _ _ N . E . SIDE OF S.W. PACIFIC
HIGHWAY. N.E . is Park District #I . S .W. is Park Dist:•ict #II .
CITY OF i*IGARD
ORDINANCE =77-26
STREET SYSTEPi DEVELOPMENT CHARGE
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DATE : n I a q -7 ESTIMATED SALES PRICE $_��' p0 �
APPLICANT NAME LA. CKA,'- IZc., C �buz t TELEPHONE
JOB ADDRESS �' ��� ,� �-_.� Q �--�y,� BLDG. PERMIT m�
AMOUNT OF FEE FOR S. D. C.
DESCRIPTION OF IMPROVEMENT e
_. .�.�7 -
EXEMPTIONS -PER ORDINANCE #77-26r_ _
FEE RATES:
A. Single family dwelling ur it under
B. Single family dwelling unit over $60, 000. ---------- $400. 00
C. Mobile Home f--lir* Space (New Development)----------- $150. 00
D. Multi-Family Dewi'_ings--per un:t------------------- $240.00
E . Commercial , Industrial & Institutional(Park. Space) $ 50. 00 each
F. Single family unit under $40, 000. ------------------ $250. 00
EMMA
'7_ I)ILDING PERMIT APPLICATION loF TIGA RD DATE-Au,a.. NA
tiF L1hIL)f R5IGNED HEREBY APPLIES FOR APERMIl FOR THE WORK HEREIN INDICATED BUILDERPHONE
_�.
C,R AS SHOWN ANCPROVED IN THE ACCOMPANYING PLANS AND SPECIFICATIONS. OWNER PHONNv_.J
LOT NO.- Ou Cap
B ADDRESS 4 � ADDRt:SS
J ARCHITECT
rNGINEER
R- WaveAty Coact. CO. ADDRESS Rt 1 Box 412 C HubbaAd, 9703 ESIGNER
,HE C %r W - D REMODEL `— ❑ADDITION ___DHEPAIRY_yDRENEWAL ❑FIRE DAMAGE Y❑DEMOLITION
x r N(j n' �. r,'nn L_JEDUCATIONAL UCOV'T ORF L I10OUS OPATIO ❑CAR PORT OGARAGE O STORACE❑SLAB OFENCE
�NOLD
MOVING � IONAL DLSI
OCONDIT -USE --C� GNREVIEW —_LICOUNCII_APPROVED OSIGNS
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+NCV L oND USE ZONE_ BLDG TYPE l[. FIRE ZONE. PLAN CHECK BY HEA etet". ^
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;C.- ;.Q9U--- --- F I pDA_1.4AD__-._-..__._ N.E.I.G►�x____¢�t - ----Ns2 S.�RI€S_._.I��P-f3...,��.IY��EDgQS�MS..�.YBl.l���11Q.__
-EiLILDING DEPARTMENT SET BACKS FRONT_ 201REAR 71-1. 'uLEFT SIDE Lj!# _ RIGHT SIDE
r rmit
--- - THIS PERMIT IS ISSUED SUBJECT TO THE REGULATION:, CONTAINED IN THE BUILDING CODE, ZONING
,"Ibn Check 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
Sub total ALL APPLICABLE CODES AND ORDINANCES. THE ISSUANCE OF THIS PERMIT DOES NOT WAIVE
- -- ---- ------ RESTRICTIVE COVENANTS. CONTRACTOR ,AND SUB CONTRACTORS TO HAVE CURRENT CITY BUSINESS
tais, Tax 54 LICENSE SEPARATE PE RMITS REOUIRED FOR SEWER, PLUMBING AND HEATING.
Total (/ r �l
�Y wavehtoCOnet. Co. ►/(,�i'Gt,,
A APVI cANI ORA,f NI
Y—
App,oved Receipt No. Rt 1 BOX_ ttl _412 _C.-HubbaAd2OA.9 __9.7_.032 - _ --
------ _.--- -- ArJ1rkE55 PHONE 981-6770
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