Permit • CITY OF TIGARD - PLUMBING PERMIT
AA DEVELOPMENT SERVICES PERMIT #: PLM2001 -00364
Ail 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 08/15/2001
SITE ADDRESS: 15125 SW 107TH TERR PARCEL: 2S110DA 08700
SUBDIVISION: ERICKSON HEIGHTS ZONING: R -3.5
BLOCK: LOT: 048 JURISDICTION: TIG
CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS: 1
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: SEWER LINE: ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Irrigation backflow pevention device.
FEES
Owner:
Type By Date Amount Receipt
RENAISSANCE CUSTOM HOMES PRMT CTR 08/15/2001 $36.25 27200100000
1672 SW WILLAMETTE FALLS DR SPOT CTR 08/15/2001 $2.90 27200100000
WEST LINN, OR 97068
Total $39.15
Phone 1: 557 -8000
Contractor:
MOODY ENTERPRISES INC
PO BOX 713
ESTACADA, OR 97023 REQUIRED INSPECTIONS
Phone 1: 503 - 630 -5532 Final Inspection
Reg #: LIC 5973
PLM 11717
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 may obtain copies of these rules or direct questions to OUNC by calling (503) 246 -1987.
Issued By: &A �r��/`( Permittee Signature: ey1
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
i`1S 7 - ,'D e7
Plumbing Permit Application
- gib..; -} I City of Tigard
Date received: fi Permit no. ; /- 0036,
A- ' l Sewer permit no.: Building permit no.:
Address: 13125 SW Hall Blvd, Tigard, OR 97223
City of Tigard Phone: (503) 639 -4171 Project/app1. no.: Expire date:
Fax: (503) 598 -1960 Date issued: By 325 Receipt no.:
Land use approval: Case file no.: Payment type:
TYPE OF PERMIT
4 1 & 2 family dwelling or accessory ❑ Commercial /industrial U Multi- family ❑ Tenant improvement
New construction ❑ Addition/alteration/replacement ❑ Food service ❑ Other:
JOB SITE INFORMATION FEE SCHEDULE (for special information use checklist)
Job address: , 2 C ,s, 0/ , /c 7i re,tx , 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: 'i I Block: I Subdivision: SFR (2) bath
Project name: ,E4 f i .s- Ile.. Pr SFR (3) bath
City /county: i f a ✓ I ZIP: 97 2 23 Each additional bath/kitchen
Description and location of work on premises: 5011 1 Site utilities:
Catch basin/area drain
Est. date of completion/inspection: Drywells/leach line/trench drain
PLUMBING CONTRACTOR Footing drain (no. lin. ft.)
Manufactured home utilities
Business name:
0Jct ifNf2 /4„ '7' vc, Manholes
Address: Y0? 4, 7/3 Rain drain connector
City: FSfRCa 4 I State: (/ I ZIP: 7 70 23 Sanitary sewer (no. lin. ft.)
Phone: a "d.T 6,7o-5 2 I Fax:'q.zic I E -mail: Storm sewer (no. lin. ft.)
CCB no.: /17/7 I Plumb. bus. reg. no: 5-V73 Water service (no. lin. ft.)
- City /metro lic. no.: Fixture or item:
-
Contractor's representative signature: j 0, ie /,/Pf Absorption valve • 7 Back flow preventer
Print name: /7. Q /c,, ;, r" /1/ hx. / Date: 7 3'1 a Backwater valve
CONTACT' PERSON Basins/lavatory
Name: ( Clothes washer
/l� of 1 Dishwasher
Address: f e, ll 7 /3 Drinking fountain(s)
City: Z S'7 c ice I StatelD/< I ZIP: 9-7 °2,3 Ejectors/sump
Phone: f2'7 - Cfv -S"4"' . Fax: S"7,.//r E -mail: Expansion tank
OWNER Fixture/sewer cap
Name (print): 0,041/Pt t7,4 If J4 Floor drains/floor sinks/hub
g t �1 L W ILL fin, f /� ap
Ga rbage disposal
Mailin address: Hose bibb
City: W [ U' A j i j I State: �I ZIP: IM Q Ice maker
Phone f . *PQp I Fax: I E -mail: Interceptor /grease trap
Owner installation/residential maintenance only: The actual installation Primer(s)
will be made by me o e •ntenance and repair made by my regular Roof drain (commercial)
employee on the p I wn as per ORS Chapter 447 Sink(s), basin(s), lays(s)
Owner's signature: Date: 1 87 I Sump
Tubs/shower /shower pan •
Name: Urinal
Water closet
Address: Water heater
City: I State: I ZIP: Other:
Phone: I Fax: I E -mail: Total
Not all jurisdictions accept credit cards, please call jurisdiction for more information. Minimum fee $ 3 6 , 25
Notice: This permit application
o Visa 0 MasterCard Plan review (at %) $
expires if a permit is not obtained 9
Credit card number: / Ex it / within 180 days after it has been State surcharge (8 %) .... $
a
p TOTAL $ 39, /5
Name of cardholder as shown on credit card accepted as complete. $
Cardholder signature Amount
440 -4616 (6/00/COM)
. \
to /tea./ ' ea�n�rc�
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s ��i/� /2L� G✓ Oyu' -4-) ,{ �fJj
(7/f (
Subject: Erickson Heights et ,,, b " % 'i / /
ag - 6930
Following is a list of the plumbing permits issued for irrigation backflow devicet that are being voided and 80% of
the permit fee will be refunded to the plumbing contractor, Moody Enterprises Inc.
a
Refund calculations: 1) $36.25 @ 80% = $29.00 refunded to applicant 5.3
2) $36.25 @ 20% = $7.25 retained by City of Tigard for administrative costs
3) $2.90 state surcharge is non - refundable.
L
0
Site Address Permit # $ Refunded $ Non-refundable
10888 SW Kable St. PLM2001 -00389 $29.00 $10.15 No �S1
10856 SW Kable St. PLM2001 -00337 29.00 10.15 9 20o0'3f y r
3 ' 10832 SW Kable St. PLM2001 -00338 29.00 10.15 slit' P
- / 4 10810 SW Kable St. PLM2001 -00339 29.00 10.15 5/1 f
. 8 10852 SW Kable St. PLM2001 -00340 29.00 10.15 actor- /3 P
10630 SW Kable St. PLM2001 -00341 29.00 10.15 ft P
1 10600 SW Kable St. - 29.00 10.15 aao0 -S3'' F
d ir 10559 SW Kable St. - 29.00 10.15 Avo r'5
3 10510 SW Hoodview Dr. PLM2001 -00342 29.00 10.15 i2ooi -.1/7 Z
1 10501 SW Naeve St. PLM2001 -00343 29.00 10.15 2000 -ko/ F
20) 10503 SW Naeve St. ' PLM2001 -00344 29.00 10.15 .loon - .25/ T
1 10505 SW Naeve S PLM2001 -00345 29.00 10.15 40o1- T
2 10507W Naeve St. PLM2001 -00346 29.00 10.15 aoo0-5(4 P
28 15210 SW 107 Terr. PLM2001 -00347 29.00 10.15 /49 /
v 29' 15190 107 Terr. PLM2001 -00348 29.00 10.15 6401 -3t V
o¢ 15156 SW 107 Ten. PLM2001 -00349 29.00 10.15 74 Z
15160 SW 107 Ten. PLM2001 -00350 29.00 10.15 gaol -30 T
1508$ SW.107` Ten. PLM2001 -00351 29.00 10.15
`' 34 ‘ 1066 SW Lady Marion Dr. PLM2001 -00352 29.00 10.15 1
a000 - /17
35 10654 SW Lady Marion Dr. PLM2001 -00353 29.00 10.15 ,1yo P
' 36 10537 SW Lady Marion Dr. PLM2001 -00354 29.00 10.15 Goal - to !%
e I A 10555 SW Lady Marion Dr. PLM2001 -00355 29.00 10.15 1//y 1
8 10599 SW Lady Marion Dr. PLM2001 -00356 29.00 10.15 2.000 -71 Y
V 39 10635 SW Lady Marion Dr. PLM2001 -00357 29.00 10.15 y5g f
40 10651 SW Lady Marion Dr. PLM2001 -00358 29.00 10.15 .Zoo/ -ii 3 1
4 41 10669 SW Lady Marion Dr. PLM2001 -00359 29.00 10.15 a 4 G
.s , 42 10677 SW Lady Marion Dr. PLM2001 -00360 29.00 10.15 Moo -1I5 P
-.7% 43 10693 SW Lady Marion Dr. PLM2001 -00361 29.00 10.15 .200 i -/ f y t
44 10733 SW Lady Marion Dr. ' PLM2001 -00362 29.00 10.15 ,2401 -111 P
e ___,A.7 15101 SW 107 Ten. PLM2001 -00363 29.00 10.15 07000 -1% 1-
48 15125 SW 107 Terr. PLM2001 -00364 29.00 10.15 a000 -24.2. P
j4 9 15159 1 107 Ten. PLM2001 -00366 29.00 10.15 31/7 F
(3 152 107 Ten. PLM2001. -00367 29.00 10.15 _ f
C ' 158 SW Kable St. PLM2001 -00387 '29.00 10.15 aoof -LW S
56 10859 SW Kable St. PLM2001 -00368 29.00 10.15 ,ao /9/ C
10889 SW Kable St. PLM2001 -00386 29.00 10.15 .vo MST
of'A Y1/ 365
c i 53 e,AIRI e k4 or4 /E r Pcti . ..14::.c__ F s d2 2
C i : 1/
L6-Ts ' NI aT - /V = 3
n,tt A l c�1■ I Nor/+ --r1 x11.1 S .2 W
BUP - Buildirrg Permit ELC - Electrical Permit
4 Inspection Description Date Passed • By • 4 Inspection Description Date Passed By
Footing /Setback Underground cover
Foundation walls Wall cover
Footing drain Ceiling cover
Waterproof bsmt walls Electrical rough -in
Slab Electrical service
Crawl drain Electrical final
Underfloor insulation
Post/beam structural
Shear walls /anchors ELR - Restricted Energy Permit
Roof nailing 4 Inspection Description Date Passed By
Firewall Low voltage
Tilt -up panel Electrical final
Masonry /Reinforcement
Framing
MFG - Structure set -up MEC - Mechanical Permit
Insulation
Drywall nailing 4 Inspection Description Date Passed By
Post/beam mechanical
Suspended ceiling Gas line
Engineered soils Mechanical rough -in
Welding Lab Final Fire damper
Concrete Lab Final Duct work
Bolting Lab Final Smoke detector
Structural observation Mechanical final
Fireproofing Lab Final
Final inspection
PLM - Plumbing Permit
4 Inspection Description Date Passed By
BUP — Fire Protection System Permit Plumbing underslab
4 Inspection Description Date Passed By Crawl drain
Sprinkler underfloor /slab Post/beam plumbing
Sprinkler rough -in Plumbing top -out
Sprinkler final RP /backflow preventer
Fire alarm final Rain drain
Storm drain
Water service
SIT - Site Permit Sanitary sewer
4 Inspection Description Date Passed By Culvert/catch basin
Footings Pump /fill septic tank
Foundation walls Plumbing final /0/. f/0/7
Sprinkler supply lines
Sprinkler underfloor /slab
Catch basin /Manhole SWR - Sewer Permit
Engineered soils 4 Inspection Description Date Passed By
Engineering acceptance Sanitary sewer
Final inspection Final inspection
Inspection Record - BUP, PLM, SWR, ELC, ELR, MEC, SIT Permits
i : \dsts\ forms \InspRecordBUP. doc 04/17/01
CITY OF TI GA R D
PLUM-SING PERMIT
t DEVELOPMENT SERVICES PERMIT #: PLM2001 -00364
- 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 08/15/2001
SITE ADDRESS: 15125 SW 107TH TERR
PARCEL: 2S 110DA -08700
SUBDIVISION: ERICKSON HEIGHTS ZONING: R -3.5
BLOCK: LOT: 048 JURISDICTION: TIG
CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS: 1
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: SEWER LINE: ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Irrigation backflow pevention device.
FEES
Owner:
Type By Date Amount Receipt
RENAISSANCE CUSTOM HOMES PRMT CTR 08/15/2001 $36.25 27200100000
1672 SW WILLAMETTE FALLS DR SPOT CTR 08/15/2001 $2.90 27200100000
WEST LINN, OR 97068
Total $39.15
Phone 1: 557 -8000
Contractor:
MOODY ENTERPRISES INC
PO BOX 713
ESTACADA, OR 97023 REQUIRED INSPECTIONS
Phone 1: 503 - 630 -5532 Final Inspection
Reg #: LIC 5973
PLM 11717
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. to
Specialty Codes and all other applicable laws. All work will be done in accordance with approved plan
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 may obtain copies of these rules or direct questions to OUNC by calling (503) 246 -1987.
Issued By: ZC L i'11 Permittee Signature: j5yi
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day