Correspondence CITY ®F. TIcARD
BUILDING DIVISION PERMIT #: PLiv12C)07- 0011 &i
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 7/2/2007
Phone: (503) 639- 4171�'
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 7/5/2007 TIME: 7:03AM PAGE: 26
SITE ADDRESS: 09180 SW 6GTH AVE CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: BEATY
DESCRIPTION: Replace approx 150' water service.
OWNER: BEATY, ROY E, PHONE #:
CONTRACTOR: 3 MOUNTAINS PLUMBING PHONE #: 503- 925 -1342
Inspection Request Scheduled For: Date: 7/5/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
330 Water service 051474 -01 503-925-1342 N
Corrections /Comments /Instructions:
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Care
X PASS ❑ PARTIAL APPROVAL n CANCEL ❑ NO ACCESS
❑ FAIL n CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: L1µ✓ Date: 7/< 7 Phone #: (503) 718-
07 -09 -2007 0B:04 3 MTNS PLUMBING 5039259104 PAGE1
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QTY OF TIGARD
COMMUNITY DEVELOPMENT
ric,A °;inn 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
Plumbing Signature Form
IMPORTANT PERMIT NOTICE
3 MOUNTAINS PLUMBING
SHERWOOD, OR 97140
Permit #: PLM2007- 00275
Date Issued: 7/2/2007
Parcel: 1 S125DA -00602
Site Address: 09180 SW 66TH AVE
Subdivision:
Lot:
Jurisdiction: R-4.5
Zoning: TIG
Project Name: BEATY
Description: Replace approx 150' water service.
Your company has been indicated as the plumbing contractor for the permit referenced above. In order for the
plumbing permit to be valid, please have the appropriate individual from your company sign below and return this
Plumbing Signature Form prior to the start of the work. Please mail the form to: City of Tigard, Building Division,
13125 SW Hall Blvd., Tigard, OR 97223, or you may fax the form to: 503.624.3681.
If you have any questions please call 503.718.2433.
No plumbing inspections will be authorized until this completed form is received
OWNER: PLUMBING CONTRACTOR:
BEATY, ROY E 3 MOUNTAINS PLUMBING
9180 SW 66TH AVE „P.D -BOX 386 .2 0 . 5 `!r 5 f a c ' G`. �f�Y # �� 3
TIGARD, OR 97223 SHERWOOD, OR 97140
Phone #: Phone #: 503- 925 -1342
Reg #: 1.IC 169499
PLM PB99
AN INK SIGNATURE IS REQUIRED ON THIS FORM
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Signature of Authorize lumber Name (printed)