Permit CITY TIGARD PLUMBING PERMIT
A 'Altili t DEVELOPMENT SERVICES PERMIT #: PLM2002 - 00410
1 3125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 10/28/02
SITE ADDRESS: 14620 SW 76TH AVE 051 PARCEL: 2S112BD 00100
SUBDIVISION: ZONING:
BLOCK: LOT: JURISDICTION:
CLASS OF WORK: OTR GARBAGE DISPOSALS: 1 MOBILE HOME SPACES:
TYPE OF USE: MF WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: R1 FLOOR DRAINS: TRAPS:
STORIES: WATER HEATERS: CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: 1 URINALS: GREASE TRAPS:
LAVATORIES: 1 OTHER FIXTURES:
TUB /SHOWERS: 1 SEWER LINE: ft
WATER CLOSETS: 1 WATER LINE: ft
DISHWASHERS: 1 RAIN DRAIN: ft
Remarks: Replace plumbing fixtures.
FEES
Owner:
Description Date Amount
WASHINGTON CO. HOUSING AUTHORITY
111 NE LINCOLN ST [PLUMB] Permit Fee 10/28/02 $99.60
#200 -L, MS63 [PLUMB] Permit Fee 10/28/02 $0.00
HILLSBORO, OR 97124 -3082 [TAX] 8% State Tax 10/28/02 $7.97
[TAX] 8% State Tax 10/28/02 $0.00
Phone 1: 503- 846 -4794 [PLUMB] Investigation 10/28/02 $99.60
Contractor: [PLUMB] Investigation 10/28/02 $0.00
ALBERTA PLUMBING Total $207.17
LEWIS TRANER
PO BOX 55031
PORTLAND, OR 97238 REQUIRED INSPECTIONS
Phone 1: 503-331-0657 Rough - Insp
Final Inspection
Reg #: LIC 96782
PLM 26 -707PB
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 ► . • • , • copies of these rules or direct questions to OUNC by calling (503) 246 -6699.
Issue. By: `�� �„ - Permittee Signature: AI - _
7
Call (503) 639 -4175 by 7:00 P.M. for an inspection neede he next business day
Building Fixtures
K Plumb Perm t�pplicat OFFICE USE ONLY
e
,� City of Tigard l
Date received: /d 'W Permit no.: 1 L // �a /0
31- n�jl : C� ' ,. Sewer permit no.:
� 1 Building permit no.:
Address: 13125 SW Hall Blvd, Tigard, OR 7223 " ' _
City of Tigard Phone: (503) 639 -4171 OCT roject/appl. no.: Expire date:
Fax: (503) 598 -1960 I 2 r 20112 Date issued: MI Receipt no.:
..., r,
U a 1L ,, Case file no.: Payment type:
Land use approval: _ . -,-n �� . �� _�' ,
• v TYPE OF PERMIT . -
0 1 & 2 family dwelling or accessory 0 Commercial /industrial 0 Multi- family ❑ Tenant improvement •
0 New construction 0 Addition /alteration/replacement 0 Food service ❑ Other:
4'; ' . f JOB' SITE :INFORMATION ;` -a'. =` =: FEE SCHEDULE (for special information use checklist •
Job address: `ll -:. . Description Qty. Fee(ea.) Total
Bldg. no.: Suite no.:
New 1- and 2- family dwellings only:
(includes 100 ft. for each utility connection)
Tax map /tax lot/account no.: SFR (1) bath
Lot: Block: Subdivision: SFR (2) bath _
Project name: SFR (3) bath _
City /county: ZIP: Each additional bath/kitchen
NM
Description and location of work on premises: Site utilities: ■ - .
Catch basin/area drain
Est, date of completion/inspection: Drywells /leach line /trench drain _
Footing drain (no. lin. ft.) - NM
„ k „ M
PL CO Manufactured home utilities
Business name: Al Manholes _
Address: _ ♦ o. Rain drain connector N
j r'►�I. Ma /� Sanitary sewer (no. lin. ft.)
Storm sewer (no. lie. ft.) ..1
CCB no.: • A., Pl r r • r r I. t....707„. ' Water service no. lin. ft.
City/metro lic. no.: Fixture or item: ■--
Absorption valve
Contractor's representative signature: _-j- , • _ _ , Back flow preventer _
„AP Pent name: a te O Z Backwater alve
0 .,';:l . ,: „, �,; { � " ' _ ° ` CONTA CT PERSON = ;�;,; -, Bast . vato
IIM
11121_11.51111FRIA Clothes washer Mil
Dishwasher VA
Address: Drinking fountain(s) _ --
D. , filt i ZIP:' rw Ejectors /sump - --
Phone ' r • / ' Fax: E-mail: Expansion tank _
'" "..7 r r .. i ''• OWNER' • d', Fixture /sewer cap I
Name (pent):
Floor drains /floor sinks/hub
Mailing address: Hose Garbage bibb disposal ��
City: State: ZIP: Ice maker _
Phone: Fax: E -mail: Interceptor /grease trap _
Owner installation/residential maintenance only: The actual installation Primer(s) _
will be made by me or the maintenance and repair made by my regular Roof drain (commercial) Ell
employee on the property I own as per ORS Chapter 447. MP.), basin(s), lays(s) Iffil
Owner's signature: Date: ump I
ENGINEER Tubs /shower /shower pan V
Urinal
Name: Water closet
Address: Water heater MN
City: State: ZIP: Other:
Phone: Fax: E -mail: Total 111 1
Minimum fee $ �/
Not all jurisdictions accept credit cards, please call jurisdiction for more information. Notice: This permit application $
❑visa ❑ Mastercard Plan review (at o /o)
expires if a permit is not obtained State surcharge (8 %) $ .Q 7
Credit card number: / / within 180 days after it has been
Expires TOTAL $ / 01 • al
Name of cardholder as shown on credit card accepted as complete.
$ 3/1/ fee . 114, 100
Cardholder signature Amount COtvf)
• • A07,17