Permit CI TY OF TIGARD PLUMBING PERMIT
A l4ID �"1 DEVELOPMENT SERVICES PERMIT #: PL /15/20 -00356
e 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 08/15/2001
SITE ADDRESS: 10599 SW LADY MARION DR MODEL HOME PARCEL: 2S110DA -07700
SUBDIVISION: ERICKSON HEIGHTS ZONING: R -3.5
BLOCK: LOT: 038 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 prevention 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: , _ __ _ _w Permittee Signature:
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
//Sraoa 2 Doo77 •
Plumbing Permit Application ,
Date received: P'2 0/ Permit no.:PLly0D1. ,0035(0
`+ City of Tigard
,4 Sewer permit no.: Building permit no.:
Address: 13125 SW Hall Blvd, Tigard, OR 97223
City of Tigw
Phone: (503) 639 -4171 Project/appl. no.: Expire date:
Fax: (503) 598 -1960 Date issued: By;B� Receipt no.:
Land use approval: Case file no.: Payment type:
, • FYPI OF Pi RMI'C
L1 .1,& 2 family dwelling or accessory 0 Commercial /industrial C3 Multi - family 0 Tenant improvement
te'New construction 0 Addition/alteration /replacement 0 Food service 0 Other.
;' . ,. JOB, S UEFA N FOR MA1H)N .. I Fir St'IILUUI:I'(tor s,eual information u. atom:Wiry
Job address: 1 5' S, We I.4• yv el /t: Ai 04 Description Qty. Fee(es.) Total
Bldg. no.: 'Suite no.: New 1 and 2 family dwellings only:
Tax map /tax lot/account no.: (includes 100 ft. for each utility connection)
SFR (1) bath
Lot: plock: ( Subdivision: SFR (2) bath
Project name: 2 / f s. ti Nz ,'�' /p f " SFR (3) bath 1
City /county: 7`j. an a : '77 2 23 Each additional bath/kitchen
Description and location of work on premises: .S pr, , 44/ e as- Site utilities: l
Catch basin/area drain
Est. date of completion/inspection: Drywells/leach line/trench drain • F'hlil♦iltl E:OM1'I Foottn: drain (no. lin. ft.)
' anu actured home utilities
Business name: , 0 C �� t /i//'!,s' 7......414;:, Manholes
.
Address: /1 7 /' Rain drain connector
City: 5 1c44 dq , State:()/ 1 ZIP: 9 702,3 Sanitary sewer (no. lin. ft.)
Phone: 103- (r,3c).' .fy Z Fax:C'yr.sie E -mail: Storm sewer (no. lin. ft.)
CCB no.:117/7 Plumb. bus. reg. no: 5-'y7 3 Water service (no. lin. ft.)
City /metro lic. no.: Fixture or item:
Contractor's representative signature: 1 „ l ' r .
s,• •lion valve
r
Back B Sack flow preventer
Print name: fl, ./s' /u; ;J e / Date: 7 , ; /' o / Backwater valve
• ' (ON i AC t PERSON Basins/lavatory
Clothes washer t
Name: l 8 q,:' Woo 4� ----- ---- --
Address: p, d, eY 7 /. Dishwasher ��
StateC/Z 1 ZIP: VOZ3
Drinking um ptains) }
City: �S'��r'C'ciG�lr( Ejectors/sump
Phone: 07-6,fv 3 . Fax: .5 i t E -mail: Ex • ansion tank
OWNER � r'. Fixture/sewer cap •
Floor drains/floor sinks/hub
Name (print): l / I Garba:e dis • •sal
Mailing address: I rj ; r + WI Hose bibb �M
City: 1 State :'
is ZIP: ' •• ' Ice maker
Phone. ' :T • ' ,,,,,;/', Fax: E -mail: Interce •tor /Irease trap
Owner installation/residential maintenance only: The actual installation Primer(s)
will be made by me o , e 1 tenance and repair made by my regular Roof drain (commercial)
employee on the p AM I w as per ORS C apter 447. Sink(s), basin(s), lays(s)
Owner's signature: `M' • Date: ' 9 1 . Sump
7 = • A , `? Tubs/shower /shower •an
Urinal I
Name: Water closet
Address: Water heater
City: State: f ZIP: Other:
Phone: Fax: I E -mail: Total I -
Not all jurisdictions accept credit cards, please call jurisdiction for more infozmation. Minimum fee 34, ZS
Notice: This permit application Plan review (at _ %C) $
-❑ isa —O- MasterCard expires -ifa-permit not-obtained
Credit card number: / t within 180 days after it has been State surcharge (8%) .... $ Z.90
Expires
Warne of cardholder as shown on credit card
as complete. TOTAL $ 3 9 • 1
$
Cardholder signature Amount 4404616 (6/00 /COAT;