Permit ~: CITY OF TIGARD
PLUMBING PERMIT
I DEVELOPMENT SERVICES PERMIT #: PLM2002 - 00408
`' ��' J) 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 10/28/02
SITE ADDRESS: 14620 SW 76TH AVE 052 PARCEL: 2S112BD
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: Replacement of 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 - • stain copies of these rules or direct questions to OUNC by calling (503) 246 -6699.
/ , . t . - s
�'� 1 / .i P ermittee Signature _ r v,/ (y,/
lss ed By: • . •il...'4l%1�/� . r' .1A A. .4 A.,
Call (503) 63t -4175 by 7:00 P.M. for an inspection needed next business day
Building Fixtures
,
Plumbing Permit Application • oF FICEIJSE ONLY
Date received: /p 0 b 0P-- Permit no.: , ,r./ , • , Z - g
t i i ii. ; City of Tigard r u �/ I ,
A ,,. f) i;� I I. Sewer permit no.: Building permit no.:
Address: 13125 SW Hall B!lvc( 9 .7- 223
City of Tigard Phone: (503) 639 -4171 Project/appl. no.: Expire date:
Fax: (503) 598 -1960 OCT 2 3 2002 Date issued: rIM Receipt no.:
Land use approval: ( .l h v a_l +K N.e tt .•k, i?' h Case file no.: Payment type:
IT', i? •tv r 'Rom , r,ra -z a
'..1',"1,,'.:q: - , . \V l M
a
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. TYPE OF PERMIT •
+
❑ 1 & 2 family dwelling or accessory ❑ Commercial /industrial ❑ Multi- family ❑ Tenant improvement
❑ New construction ❑ Addition /alteration/replacement ❑ Food service ❑ Other:
' ANA ,�''' s . t . ' .' JOB'SITE INFORMATION. - FEE`SCHEDULE {for spe information use checklist) , : - id
t 20 60 -7 (p p� Z Description Qty. Fee(ea.) Total
Job address: (
� 7 ! New 1- and 2 -family dwellings only:
Bldg. no.: 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
Project name: SFR (3) bath
City /county: 1 ZIP: Each additional bath/kitchen
Description and location of work on premises: Site utilities:
Catch basin/area drain
Est. date of completion/inspection: Drywells /leach line /trench drain
" *a " ''' '
I i n ; , ' .PLUMBIG: CONT , x Footing drain (no. lin. ft.)
., N
: . -, " '' "" Manufactured home utilities
Business name: , • MI M M� Manholes
Address: _ Rain drain connector C
/� Ma 9 izriii Sanitary sewer (no. lin. ft.)
Phone: _ o — — _ y l, Storm sewer (no. lin. ft.)
Z Plumb. bus. reg. no: 2 _ 7Q 7 ; Water service (no. lin. ft.)
CCB no.: ®q �C �� Fixture or item:
City /metro lic. no.: _ 4=Qa-- Absorption valve
Contractor's representative signature:+,, ,.,,0,.,,.■ Back flow preventer
Print name: ate: , o Z Backwater valve
5 >' ' � 5 '1 z: - .CONTAC 1 ' '
�=- Basin vato
Clothes washer
er %
Address: Drinking fountain(s) ;
City: !;•, ., a Stateav ZIP: # s Ejectors /sump
Phone: ' ■ • / '` ;, Fax: E -mail: Expansion tank
1 ; w c � ': t , ' ` a- . r ., Fixture /sewer cap
Floor drains /floor sinks /hub
�. Name me (print): . Garbage disposal
Mailing address: Hose bibb
3 City: State: I ZIP: Ice maker
Phone: Fax: I 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 t e •` in (commercial)
employee on the property I own as per ORS Chapter 447. �� , basin(s), lays(s)
/
Owner's signature: Date: ump
' - ° . ENGINEER - Tubs/shower/shower pan
�"
Name: Water closet f
Address: Water heater
City: I State: I ZIP: Other:
Phone: 'Fax: E -mail: Total -
Minimum fee $ .LoO
Not all jurisdictions accept credit cards, please call jurisdiction for more information. Notice: This permit application $
o Visa 0 MasterCard Plan review (at _ %)
expires if a permit is not obtained State surcharge (8 %) .... $
Expires +
Credit card number: / p within 180 days after it has been TOTA $ i (7 i e!
Name of cardholder as shown on credit card accepted as complete. qw ho
$ I
Cardholder signature Amount 616 (6/00 /CO