Permit CITY TIGARD PLUMBING PERMIT
.6 ' I DEVELOPMENT SERVICES PERMIT #: PLM2002 -00132
�•� DATE ISSUED: 4/22/02
� ° - ' ;�i -`- 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS: 10975 SW 79TH AVE PARCEL: 1S136CA-02300
SUBDIVISION: FRIENDLY ACRES ZONING: R -4.5
BLOCK: LOT: 026 JURISDICTION: TIG
CLASS OF WORK: OTR GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: R3 FLOOR DRAINS: TRAPS:
STORIES: WATER HEATERS: CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES:
TUB /SHOWERS: 1 SEWER LINE: ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Replace tub /shower valve.
FEES
Owner:
Type By Date Amount Receipt
MCDONALD, KEITH A ADELE V PRMT CTR 4/22/02 $72.50 27200200000
10975 SW 79TH AVE 5PCT CTR 4/22/02 $5.80 27200200000
TIGARD, OR 97223
Total $78.30
Phone 1:
Contractor:
CROWN PLUMBING
5429 SE FRANCIS
PORTLAND, OR 97206 REQUIRED INSPECTIONS
Phone 1: 503 - 771 -9449 Rough -in Insp
Final Inspection
Reg #: LIC 42671
PLM 34 -70PB
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 -0080.
You m. • • .. in copies of these rules or direct questions to OUNC by calling (503)246 -1987.
Iss ' d By �� 4 , - l it Permittee Signature: 1 i It, I .. t
Call (503 .39-4175 by 7:00 P.M. for an inspection needed the next business day
APR -19 -2002 05:07 PM CROWN. PLUMBING 503 771 9454 P. 01
-
Plumbing Permit Application
Datereceived: y /9 09- :: 9t E ® Sewe Addres133 12SW Hall Blvd. Trd 2 3 no.: E
City of Tigard Phone: (503) 63944171 � ProJecilappl. no.: Expire date:
503 (
Fax 960 A PR `' ` . 7 A ‘
(503) 598 -1 Date issued: $y: Receipt no.:
Land use appr&val CI", � 01' 11 : Case file no.: Payment type:
14i iiiiL8 l +gbY B01-
111'I' t)1, I').
J & 2 family dwelling or accessory ❑ Commercial /industrial ❑ Multi - family ❑ Tenant improvement
❑ New construction AtAddition(alteration /replacement CI Food service ❑ Other:
Milli SI1I.:INIOItI\1,1't'ION 1.1.:1'. St' 111 1) 1' 1, 1..( i or special intotirationasethcciclistt
Job address: I l • 7 5 Ll) '19 Desert . tion 1 Fee ea. Total
Bldg. no.: Suite no.: ew - an , -f , ly dwellings only:
Tax mapltax lot/at count no.: (includes 100lt. for eadtutllltyconnectton)
SFR (1) bath
Lot: [Block: 1 Subdivision: _ SFR i (2) bath
Project name: IsA e.. o t^ t c7 ' SFR (3) bath '
City /county:' ;1qq 0.sr /, ZIP: ct q 3 Each additional bath/kitchen
Description and Ideation f work n premises: Site utilities:
• • I . i .. . . P �.. Catch basin/area drain
Est, d • • of completion/inspection: wells /leash iiiiatrench drain
Fo onn drain (no. lin. ft. _
Manufactured home utilities
Business name: r d w v`, u m' .... Manholes
Address: $ gal '5E Fro,. vt e i` _ Rain drain connector
City: cr v - f 4 ayS I State: Q2 [ ZIP: Q'1 a.o Ir, Sanitary sewer (no. lin. ft.)
Phone: WO 1 -q W Li 9 I Fax: ? - 911641 E �- Storm sewer (no. lin. ft.)
CCB no.: 4 A 1 I Plumb. bus. reg. no: 3 14-?1) p8 Water service (no, lin. ft.)
City /metro tic. no.: Fixture or item:
Abso .lion valve
Contractors representative signatu Minifffillffifell, Back flow preventer
Print name: e, l 0a r cf di Date: - / 9' Backwater valve
('ON'l'A('I PERSON Basins/lavato
Name: 0 S w ; : r
Dishwasher
Address: Drinking fountain(s)
City. State: ZIP: Ejectors/sump ,
Phone: Fax: E -mail: Expansion tank
OW NI '.It Fixture/sewer ca
Floor , Name (print): )�d211 NI C, disposal a-1 c� _ ins sinks/hub
Mailing addnsss: ar
v% II. fiose bibb
Cit State: ZIP: Ice maker
Phone: , y' - . S OM E-mail: — Interceptor/grease trap
Owner installation/residential mai enancc only: The actual installation ' Primer(s)
will be made by me or the maintenance and repair made by my regular Roof drain (commercial) ,
employee on the property I own as per ORS Chapter 447. Sink(s), basin(s), lays(s)
Owners s ature: Date: Sum
Tubs/shower /shower pan .
Urinal
Name: Water closet
Address: - Water heater
City: I State; ZIP: , Other: •Nt_r)i 2P g t _ I i to.,i i io
Phone: I Fax: I I E-mail: Total
No all Jurisdictions accept raedit card'. please WI Jurisdiction fur more tafonnattan. Notice: This permit application Minimum fee $ 7�. �0
Plan review (at qt) $
vlea ❑
expires if a pertn►t is not obtained S tate o surcharge (89) .... $ 5.'80 —
ctit card nu . f s 1 quota within 180 days after it has been
• - , � r accepted as complete. TOTAL $ 78.30
.
af . 7{7,, a' Wf -. =edit own
i��4w�i 7 — ..id- S Amount e4o- 46t6 (610alCOM)