Permit CITY TIGARD PLUMBING PERMIT
DEVELOPMENT SERVICES PERMIT #: PLM2001 -00353
+ E - 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 D ATE ISSUED: 08/15/2001
SITE ADDRESS: 10654 SW LADY MARION DR PARCEL: 2S110DA -07400
SUBDIVISION: ERICKSON HEIGHTS ZONING: R -3.5
BLOCK: LOT: 035 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 5PCT CTR 08/15/2001 $2.90 27200100000
WEST LINN, OR 97062
Total $39.15
Phone 1:
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: • 1:, /Lk' Permittee Signature: "yj
1
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
• /vST;2_oop?
Plumbing Permit Application '
Date received: € 9/2-/0/ Permit no "Pmgoo 1
'.404,„,, ty a City of Tigard ,
3,�. _ -� Sewer permit n o.: Building permit no.:
Address: 13125 SW Hall Blvd, Tigard, OR 97223
City ojTigard Phone: (503) 639 -4171 Project/appl. no.: Expire date:
Fax: (503) 598 -1960 Date issued: By&A Receipt no.:
Land use approval: Case file no.: Payment type:
0 11 & 2 family dwelling or accessory O Commercial/industrial 0 Multi - family O Tenant improvement
lB New construction D Addition/alteration /replacement 0 Food service 0 Other: 1
_ :l 0R SI I I' INF0RMA'I ION • i ._ St Ill DI A LE. (for speunl uS.. 4 wt t stA)
/ O65 y S, iv. L4 f14Nt, / P/1 a�z a Total
Job address: Den ■ lio •
Bldg. no.: Suite no.:
New 1- and 2- family dwellings only:
Tax map /tax lot/account no.: (includes 100ft. for each utility connection) i
SFR (1) bath
Lot: 35 B Subdivision: SFR (2) bath
Project name: pock:
j'SG 4, / , c //f 5 SFR (3) bath
City /county: 7 a /7 a ZIP: ' 7 2 2 3 Each additional bath/kitchen 111111111 j
1
Description and location of work on premises: - Spr, 1 44/ e iz s" Site utilities:
Catch basin/area drain t
Est. date of completion/inspection: Drywells/leach line/trench drain
' - PLlUM BINt CONI 11A( FOR Footin_ drain (no. lin. ft.)
Manufactured home utilities M
Business name:. ,, - c 1,1 25.4, edlit a 's ' -rt, , • ' oles
Address: v, . 7 / ' l Rain drain connector
City: Ertge4c l/ State:0 f; ZIP: 770 2. Sanitary sewer (no. lin. ft.) -1
Phone:-3).-5f3' z Fax:S"y ".yrc E -mail: Storm sewer (no. lin. ft.)
CCB no ": 1/7/7 _Plumb. bus. reg. no: 5-y73 Water service (no. lin. ft.)
City /metro Ho. no.:
Fixture or item:
Contractor's representative signature: , /! r, , 0 g valve
- ' Back ack flow preventer
Print name: f) , ,6S' /;., ":., e A Y J Date: '/ I a/ Backwater valve
,t ON'I i �t I Pt'�RSON ■
Bas ins/lavatory
Name: 8 4 e ,1Ge t � " Clothes washer
Address: , 6, 8 7 /3 / Dishwasher
City: 1 (StateC,1 ZIP: %74'13 Drinking fountain(s) 1
YS' c�ae> c( E'ectors/sump 1
Phone: a C,fr✓ - 4 ' . Fax: Sr.//r E -mail: xpansion tank
OW1`I• tt;' Fixture/sewer ca• 1 1
(print): i " Floor drains/floor sinks/hub IIIII Name (p —__
i r,
Cuba- dis•+sal MI
Mailing address: �' : ` l ■ ±, . ' : Hose bibb ��_
City: I Stat .. • ZIP ' � ' Ice maker M�
Phone • ., "�.i a ( Fax: (E -mail: Interceptor /grease trap ff
Owner installation/residential maintenance only: The actual installation Primer(s)
will be made by me o • and repair made by my regular Roof drain (commercial)
employee on the p rai I >,wn as per ORS Chapter 447 Sin (s), basin(s), lays(s)
Owner's signature: Date: * 1 P Sum• Ell
s _ Li Clitii Lti ` ; — ° - Tubs/shower /shower tan
Name: Urinal
Water closet
Address:
Water heater
City: ( State: ZIP: Other
Phone: Fax: E -mail: Total j
( Not ail jurisdictions accept credit cards, please call jurisdiction for more information, i Minimum fee 3�
Notice: This permit application
o Visa a astercard expires -if-a- permit-is not-obtained Plan review (at _— %) $
M _
Credit card number: / / State surcharge (8`90) .,,. $ - Sa
Expires within 1 SO days after it has been TOTAL $ 3g /5
Name of cardholder as shown on credit card accepted as complete.
S
Cardholder signature Amount 4u) -46i5 (6ro3 /COM)