15760 SW SERENA COURT-1 15760 SW SERENA COUW
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ME-ECHANICAL PEAMI'T
CIT"Y"' OF TIGA RD I::'1L-PO882RA6
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COMMUNITY DEVELOPMENT DEPARTMENT
13125 S.W.Hall Blvd..P.O.Box 23397.Tigard.Oregon 97223,(503)6394115 1:441M . NO OH221,4116
6ADDRE!*G45 : It-5760 SW (".y
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61 11 F-URNACE;'. LOOK A334 1-1ANDI-P <1.0
1.00I(.+. AAP HANDL.11:4 10K
COW0 I Yl:)I;:. I-J.00P FUMCU. EUAP. COOLER
011'.X11P . C.'Ar." 1"IEA11.,:11:4 VFN V FAN
VE'N'T' VENT . Si'(Sifl:.:M
1-100D
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P, 3 1.151-4) :L N(:.1 NE WA'TOW(DC)M
115—'301lip I NC I NE PA I'C P(COM
Ul RIC."UMP 130 ".110HIP PEPAIP UNI'T'S
ULAXIOMP) 50+111P 01 FIC.,P 1.
G05 PIPING, LAY11 VI'S
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I I V.M A V4 K 1-5
I i)1.)E-0,C)V E. V-1 E.I P 1:1.
1!11 iT 1 $10 . 00
W !e'o w c"r I L.(1N PEVIAHM
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I I G A P 1.) (M-1 97r?12/4 11,71,X T Li PUS 10,el 5 o
F A'11'1.:, 1'A X $ 13
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This permit is issued subject to the regulations contained in Title 14
of the TMC. State of Oregon Specialty Codes. zoning regulations 1.6.41.11 VIL.I.) INSPECIA'.011NIF-ii
and all other applicable code:; and ordinances. and It is hereby F: 1NOI,
agreed that the work will be done In accordance with the plans and
specilications and in compliance with all applicable codes and
ordinances The issuance of this permit does not waive restrictive
covenants Contractor and subcontractors shall have current city
business tax permits This permit will expire and become null and
void if work Is not started within 180 days,or It work is suspended or
abandoned for a period of 180 days any time after work has
commenced It shall be the responsibility of the permittee to asqurr,
all required inspections are requested and approved
Permittee Signature
Issued By ol L, I OP 1N5P[J:,'1
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE
Ur I IUAHU IVlLGHANIGAL PERMIT -
Permit #
CMscrlpUon ^^
City of Tigard
Table 3A Mechanical Code _ CITY PRICE AMT
— -
13125 S.W. Hall Blvd. 1) Permit Fee -0- -0- 10.00
P.O. Box 23397
71gard, OR 97223 2) Supplemental Permit 3.00
639-4175 Furnace to 100,000 BTU
1) incl.ducts&vents 6.00
Furnace 100,000 BTI.( t
2) incl.ducts&vents 7.50
Name of DevelopmentFloor Furnace
3) incl,vent 6'00
•htl, Address — Suspended heater,wall heater
Address ^7�Q ��� SF.O 4) or floor mounted heater 6.00
rax Lot Map No. 5) Vent not incl.in 3.00
Lot Block Subdivision appliance permit —_
Name(or name of business) Repair of heating,refr ig.,
— 6) cooling,absorption unit 6.00
Melling Address PhoneBoiler or comp to 3 HP
Owner S �`. 7) absorp.I.-.It to 100,000 BTU 6.00
City/State ZipBoiler or comp to 3 HP-15 HP
77 L-) �-,�, 7 ,Z,Z B) absorp.unit to 500,000 BTU _ 11.00
Name Boiler or comp 15-30 HP 9) absorp.unit Yz-1 million 15.00
Mailing Address Phone ) Boiler or comp to 30-50 HP
10 ahavip.unit 1-1.75 million 22.50
Contractor City/State Zip Boiler or comp to 50 HP
11) absorp.unit 1,750,000 BTU 31.50
State Registration No City Bus.Tax No, 12) Air handling unit to 4.50
10,000 CFM
Air handling unit I 7.50
I hereby acknowledge that I have reed this application that the information given is 13) 10,000 CF;M 4
xxre.t,that I am the owner or authorized agent nt the owner,that plans submitted are in
compliance with Stale laws,that I am registered vtlh the State Buildors'Board,that the 14 Non portaNt-
number given is correct.(it exempt from State rogistralion ptease give reason below). ) evaporwa cooler 4.50
Vent f en connected
— -� - - 15 to a s ngle duct 3.00
- - Ventil.ztton system not
y 16) includes!in appliance permit 4.50
Hood served by
,��� .�� _ — 17 mechanical exhaust 4.50
Ig5 nature(owner or agenq Date Domestic type
Describe work El addition [I alteration ❑ repair [] 19) incinerator 7.5G
to be done residential ❑ non-residential ❑ 19) Commercial or industrial _ 00
Existing use of type incinerator
building or properly_ _ _ ) Other i.e.,woodstove,water 4.50
Proposed use of 20 heater,solar,clothes dryers,etc.
building or property_ _.__ 21) Gas piping one to lour outlets 2.00
Type of fuel- oil ( I rtatural gas 1-1 LPG L 1 electric I I
22) More than 4-per outlet
NOTICE --
SUP.-TOTAL
"HIS PERMIT BECOMES NULL AND VOID IF WORK OR CON- }� --- - --
;;TRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 1B0 SD10 Mr.SURCHARGE
DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR PLAN REVIEW 25%OF SU13-TOTAL
ABANDONED FOR A PERIOD OF 190 DAYS AT ANY TIME AFTER —
WORK IS COMMENCED. TOTAL.
Special Conlitions ��/G L_ f ��- '" C� - y/
<<"�Z' sr �_•---!!L_� --__ ____--- Dale issued
by
a4
�—Mr --- - 0-
PERMIT N0.
PERhIT CHARGE � none
J, ,;;EH c LCL_, �` CONNECTION FEE 6CO.
PAID BY
VME OF BUILOING DATE CO i ECTED
riERUICE RATE /g, ItISPE(:TION FEE
UiNTRACIOR PAID BY DATE
SIZE OF C 011 N F C T I O N .._ A S S E S S I l E N T . PAID
j l
,Tl -2 U ' 2-C) 42, 1 l /7�'
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t5UILUIINU Ut-eA I i`rIL'i`1 t, I IIJP101Lr r()
PLUI`ABI►NG PERMIT
L
„
ho:- ;-,- of a valid p!umbiny contractors license is hereby
auth rued to cas usa plumbing work herein noted to be installed in accordance with the plumbing code of
Tigard. Such installatic s raqul.e inspection by the City Inspector who shall be notified not less than four
(4) huurs prior to the time the insta,Ilations are read•, for inspection. City of Tigard Business License required
for all contractors and Subcontractors.
` Date /_
NUh13F.R Oe TOTAL PER h11r No.'s
7YI'S OF pER?Alr ITEMS FEE ON EACH AHIOLINT (Office Use Only)
R 9 S 10 tV - --
Sinali Family-1 bath-each _ — _� 25.00 _
Ougle,c-each 1 bash unit _ _ 25.00__
t` -- 10.00_
Additional h It oumt-aach —
htobile Home spa.a __-each15.00
INDIVIDUAL FIXTURE_F_EES_ — —
to 5o Fixtures in 1 build r; -each - 3.00
i
51 to 100 Fix-mes in I buildir„-enc`+ _ 2.50
1 I0I to :00 Fixtures in I b101 ir.Cuearil �— ' _ 2'_00
-1 - ----- --
_201 or more Fix:,;re. in I SuilrEA -gir-h— _ _ — —. 1.50
MISCELLANEOUS
Buildin; 5a.var -Ist 50 ft. 10.00— _—
Sewer-each ed•:i,on:.l 100 ft. 10,00
� —— 00
Water S-trvic�r to buIding 5.
—
Privatt% 3rRrSy2tems etch 100 ft_ -__-_ _ 10.90
Other (SoecIM:
PEB orr _ �: ��1 For?lur•tbinq in:.r,.:; :i Mmrv?639,4111
o State Plumbing Contractor By ►/
i ---- __ �
i - ' C)CJ RECEIPT NO. Iss.:ed By _ c .
BUILDING PERMIT APPLICATION 11T TIGARD DATE once
9
OF
THE UNDERSIGNED HEREBY APPLIES FOR APERMIT FOR THE WORK HEREIN INDICATED BUILDER RHONE_
OR AS SHOWN AND APPROVED IN THE ACCJMPANYING PLANS AND SPECIFICATIONS. OWNERPHONE
LOTNO-__---
OWNER ri. F) r.ons JOB ADDRESS io
15760 Swrnet HOME ADDRESS
ARCHITECI
ENGINEER
BUILDER ADDRESS DESIGNER
CIREP;IIR ORENEWAL []FIRE DAMAGE CIDEMOLITION
STRUCTURE 0 N-EW 0RvmnDEL OADDITION
0 RESIDENCE OCOMM CIEDUCATIONAL OGOV'T CIRELIGIOUSOPATIO [jCAR PORT EIGARAGE C1 STORAGE EISLAB OFENCE
OBOND 0MOVING OCONDITIONAL USE OLIESIGN REVIEW EICOUNCIL APPROVED [3SIGNS
OCCUPANCY-----' LAND USE ZONE-- BLDG,TYPE W FIRE_ZONE PLAN CHECK BY—'. HEAT-----..,
With ettaehud �,arajrz
3 badroom - 1 Usth
J&"Uq alt jtj4,7 KjMbfRrjy - hturage 240 gars6w
40 20 2440
$TOR SEA--_--ND VALU
BUILDING DEPARTMENT SETBACKS FRONT REAR LEFT SIDE RIGHT SIDE
Permit
PHIS
BUILDING CODE, ZONING
HIS PERMIT IS ISSUED SUBJECT TO THE REGULATIONS CONTAINED IN T
Plan Check REGULATIONS AND ALL APPLICABLE CODES AND ORDINANCES, AND 11 IS HEREBY AGREED THAT THE
WORK WILL BF DONE IN ACCORDANCE WITH THE PLANS AND SPECIFICATION',AND IN COMPLIANCE W!TH
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
State Tax LICENSE. SEPARATE PERMITS REQUIRED FOR SEWER, PLUMBING AND HEATING.
Total
BY APPLICANT OR AGENT
Approved Receipt No
DATE INSP. TYPE INSPECTION REMARKS PLUMBING DATE
^;��� I• ���„ _ _ � _ Contractor n
• `V�/ Permit No. / 6,
Ct l Rough-in
Fixture
�y 7b i31.r
(('J Final
HEATING
Gs �— Contractor
2 ' - '�„t�L — z
Permit No.
Gas or Oil
R o-igh•in
Final
SEWER
Final ZZ
G�f�
DRIVEWAY
--- Final
�- Storm Drainage
(Rain Drain)Final
Sidewel k
Curb&Street Final
Approach _
BLDG. DEPT.FINAL, TtMPORARY --� CERTIFICATE OCCUPANCY Final
CERTIFICATE OCCUPANCY —
Landscaping
Zoning Final
CITY 1 iC ��.RD DATE_ /�•---- ----• 19._� N2 )'B
BUILDING PLRMIT APPLICA TION OF
NSIGNE D HEREBY APPLIES FOR A PERMIT FOR THE WORK HEREIN INDICATED LIU DER PHONE_
Lir A SHOWN AND APPROVED IN THE ACCOMPANYING PLANS AND SPECIFICATIONS. - VNcRPHONE
LOT NO.
en
BD
ADRESS ---1 HOME
ARCHITECT
C� ENGINEER —y
F DESIGNER
RE- 'vEWDR.MODEL ❑ADDITION_I[RLPAIR^� ❑RENEWAL ❑FIRE DAMAGE - ❑DEMOLITION
]\; r NSE L] _(AMM I�EDUCATION_AL ❑_GOV'T-ORELIGIOUSOPATIO �J_CAR PORT ❑GARAGE ❑STORAGE OSLAB ❑FENCE.
/ \ ND MOVING, ❑CONDITIONAL USE LJDLSriGN_REVIEW ❑COUNCIL APPROVED ❑SIGNS
_ _
-D USE ZONE r -BLDG TYPE — FIRE 70NE� PLAN CHECK BY _ HEAT
r - --
P .�r_� 11._K4.@EtJR99 _�AL41J`- G?
HUiLDING DEPARTMENT SET BACKS FRO Nt REAR �, LEFT SIDE RIGH"t SIDE J
'r e•rmit7 c!'Z
-- THIS PERMIT IS ISSUED SUBJECT TO THE REGULATIONS CONTAINEU IN THE BUILDING CODE, ZONING
Flan Check (J 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
Suh 10tal7 ��" ALL APPLICABLE CODES AND ORDINANCES. THE ISSUANCE OF THIS PERMIT DOES NOT WAIVE
__---- _ _E aL-,3•• RESTRICTIVE COVENANTS CONTRACTOR AND SUB CONTRACTORS TO HAVE CURRENT CITY BUSINESS
`tate LICENSE SEPARATE PERMITS REOUIRED FOR SEWER, PLUMBING AND HEATING.
10181 .. Z. Z� ';1-
Fly _ APPS iCANT 0R AG NT ----- —�–y-- ----
- Receipt No.
a
A
Uf4 SEWER PERMIT NY1 5946
Unified Sewerage Agency
of Washington County CITY OF Tigard rd DATE6-13-78
_
OWNER : Jerwin Construction PHONE :
OWNER 'S ADDRESS: �Se4E�Yg�rnean it
TYPE OF INSTALLATION :
❑ BUILDING SEWER ❑ BUILDING SEWER AND SIDE SEWER
TYPE OF OCCUPANCY,
L] NEW I� SINGLE FAMILY ❑ COMMERCIAL_
❑ EXIST. (PRIOR TO 7- 1-70 ) ❑ MUI_T. RES. ❑ INDUSTRIAL_
FIXTURE UNITS_ _ DWELLING UNITS ],_
ADDRESS OF STRUCTURE : __1 ,r17i fl I;[-irPna ( t. __
PERMIT CONDITIONS: THE APPLICANT AGREES TO COMPLY WITH ALL RULES AND
REGULATIONS OF THE UNIFILD SEWFRAGE 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 .
FEES:
PERMIT FEE $ 25.
CONNECTION CHARGE 600.
SIDE SEWER INSTALLATION _ _ D_ rnhArf, on _
OTHER ISSUED BY
TO T AL--,, $ 625.
--
! APF L_IDA N F. DATE
KDE
_QCNAWILT, BECL"IIFOR TNIo
PER it.
SEWER PERMIT N° 15946 :
ADDRESS OF STRUCTURE ) l,7 ,n Se-Lua Lt.
TAX MAP TAX LOT — SYSTEM Fanno Creek
LOT 15 BLOCK _ OF --
T Llal din 6-�3=7�_�
APPROVED BY DATE ISSUED BY DATE
U . it . ' S 1 REMARKS Bldg. #2136