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Permit CITY TIGARD PLUMBING PERMIT u'l DEVELOPMENT SERVICES PERMIT #: PLM2002 - 00400 ` _°'' ` r 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 11/19/02 SITE ADDRESS: 15205 SW 74TH AVE PARCEL: 2S112DB 00600 SUBDIVISION: ZONING: BLOCK: LOT: JURISDICTION: CLASS OF WORK: NEW GARBAGE DISPOSALS: MOBILE HOME SPACES: TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS: OCCUPANCY GRP: B FLOOR DRAINS: 3 TRAPS: STORIES: WATER HEATERS: 1 CATCH BASINS: FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS: SINKS: 2 URINALS: 4 GREASE TRAPS: LAVATORIES: 5 OTHER FIXTURES: 7 TUB /SHOWERS: SEWER LINE: ft WATER CLOSETS: 4 WATER LINE: ft DISHWASHERS: RAIN DRAIN: ft Remarks: Building fixtures: 5 lays, 3 2" floor drains, 2 sinks, 4 urinals, 4 water closets, 1 water heater. Other fixtures: 4 hose bibbs, 3 primers. FEES Owner: Description Date Amount DENNY MEYER 7340 SW LANDMARK LANE [PLUMB] Permit Fee 10/22/02 $448.20 TIGARD, OR 97223 [PLUMB] Permit Fee 10/22/02 $0.00 [PLMPLN] Plan Review 11/4/02 $96.11 [PLMPLN] Plan Review 11/4/02 $0.00 Phone 1: 503- 620 -2086 [TAX] 8% State Tax 10/22/02 $35.86 Contractor: [TAX] 8% State Tax 10/22/02 $0.00 (additional fees not shown here) COLUMBIA MECHANICAL INC 1702 DIKE RD Total $1,044.31 WOODLAND, WA 98674 REQUIRED INSPECTIONS Phone 1: 360-225-5761 Water Service Insp Top - out Insp Reg #: LIC 151122 Final Inspection PLM 37 -451PB This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 0001 -0010 through OAR 952 - 0001 -0100. You may obtain copies of these rules or direct questions to OUNC by calling (503) 246 -6699. i /1 Ai i(011 By: • ,o, Jj' / , -_ , /1 Permittee Signature: 1 vi /U,CC) Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day -l/ (�6 tJ t1 l • _ : a r , Building Fixtures , R . . - O- — o o DPI, -'' `� _ OF FICE L'S O \L1' Plumbing Per A pp li ca t ion _ _. Date received: /0 - 1 (o-OZ Permit no.:PL�/h, 0 �0 0? I& r t ' Ci of Tig�rard u i L `\ 'L -.. . �� b Sewer permit no.: Building permit no.: Address: 13125 SW Hall Blvd, Tigard, OR 97223 Ex ire date: City of Tigard Phone: (503) 639 -4171 OCT roject/appl. no.: p Fax: (503) 598-1960 � l ��' Date issued: Bel) Receipt no.: a, ;S' a I ~`J,I LI Case file no.: Payment type: -) L and use approval: r -^ � ,,.. - ---..- - - , -- - . ' TYPE OF PERNI1T It � I ❑ I & 2 famil y dwelling or accessory )I�Commercial/industrial 0 Multi - family O Tenant improvement 4 ./ 0 New construction 0 Addition/alteration /replacement 0 Food service 0 Other: JOB SITE INFORMATION FEE SCHEDULE (for special information use chec ist) Description Qty. Pee(ea.) Total Job address: r Q 1 S t�, 7 t . New 1- and 2- family dwellings only: Bldg. no.: I Suite no.: (includes 100 ft_ for each utility connection) Tax map /tax lot/account no.: SFR (1) bath Lot: `Block: I Subdivision: SFR (2) bath E. Project name: /1 ei o f 5, 1,/1 SFR (3) bath City/county: / ,",,,,,,; ,4_.. ZIP: Each additional bath/kitchen ,_, Description and location of work on premises: Site utilities: ii/z. tv- (or151 frti* e. 415 C Catch basin/area drain Drywells/leach line /trench drain O Est. date of completion/inspection: Footing drain (no. lin. ft.) : , PLUMBING CONTRACTOR Manufactured home utilities Business name: Cp /vrr, f.,`a, /rlrc/cn� .L i'-. Manholes ' ' Address: / 78J 0, II, c le 6, Rain drain connector (/` City: {il/GC /kr, ii- l State: I ZIP: /J'b 7 iii Sanitary sewer (no. lin. ft.) Phone:3(rC-0) - S 'S76/ Fax:' d-Yf.J/T4 E- mail: .,7,--/-?-. Storm sewer (no. lin. ft.) Water service (no. lin. ft.) CCB no.: f S j / Plumb. bus. reg. no: J y S / -4�� Fixture or item: t City/metro lie. no.: 6,�y y Absorption valve \_ Contractor's representative signature: � .e,es.k Back flow preventer � Print name: p e i dk J6, X 5914 ,- Date: '6" �✓� I' Backw valve ) P ,: Basins/lavatory ! 0 16. _ CONTACT PERSON - Ciothes washer Name: 5"e„-„,- _ Di s h was h er Address: Drinking fountain(s) _ City: I State: ! ZIP: Ejectors /sump Phone: Fax: E -mail: Expansion tank - O1S;'NER, Fixture/sewer cap - . " ' Floor drains/floor sinks/hub 3 (6.4e - Name (print): Garbage disposal Mailing address: Hose bibb - `' 46.60 City: I State: I ZIP: Ice maker Phone: I Fax: [E-mail: Interceptor /grease trap _ Owner installationfresidential maintenance only: The actual installation Primer(s) 3 , - will be-made by me or the maintenance and repair made by my regular Roof drain (commercial) employee on the property 1 own as per ORS Chapter 447. Sin s ), basin(s), lays(s) . 16. be ,Owner's signature: Date: Sump ENGINEER • Tubs/shower /shower pan —/ Urinal q (4.41' Name: Water closet 'i . 16 • 667 Address: Water heater / f 6 •6C City: 'State: 'ZIP: Other. Phone: ( Fax: 1E-mail: Total Minimum fee $ /7 20 "(vis all jurisdictions accept edit duds please call jurisdiction for mac information. Notice: This permit application Plan review (at %) $ ' `/ j i 205 q� visa C] MasterCard expires if a pccmit is not obtained. ;State surcharge (8 %) $ 3 / 7 '?► • � / Credit card number. F� Expires within 180 days alter it has been TOTAL $ O/ accepted as complete. s '6, 11 Name of cardholder as shown on credit card S 440 -4616 (NONCOM) Cardholder signature mount 7 .�. )/) 1 •d /3 dST :TO aO 91 400 Al E Y E s .16N ISOMh' Q pON►ES WATE,k • 3,1 L 1, 1 3fy 6� \ • yp , .rp.4) cz:i Bi& �`'� / • "---..„,,,,,,, i • •••■ r ) i � 31,,` � `'�" 5��✓K �I rotl,O r,..„, l ��.' VA/ LAW \ r NEnT�R ! [., 3/ . .,, w • BI 13 V6. •fi .� • . •:"� �L✓ ' Pa • fs.3 � v�y,v4, 1 TOILET , ' 0 tffi s •• ••• ••• • ••• Cll � • • • • • • • • O I l V : • : 0 0 : : : i"--s, O ( h • / • • • • • • • • • r / �_.. . I' G w 1- . tw • / / I M�1 Al l- •• • • • • • • Si: ;`lFL� +) • • • • • • • • • • Y c ,5 U • • • • •• • • ••• O • • • • • • • • • • (,�j.'g o i • • • • • • • ••• ••• ••• •• • • i 1 /Lib . o �� i 0 0 ig n N � 0 0 ELEO cA.. 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