Permit CITY TIGARD PLUMBING PERMIT
,11 DEVELOPMENT SERVICES PERMIT #: PLM2001 -00359
4,� W 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 08/15/2001
SITE ADDRESS: 10669 SW LADY MARION DR PARCEL: 2S110DA -08000
SUBDIVISION: ERICKSON HEIGHTS ZONING: R -3.5
BLOCK: LOT: 041 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 97068
Total $39.15
Phone 1: 503 - 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: • , _ 1 �� Permittee Signature: /f y1
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
' .t i
57 / —O(3 e , /02--)
Plumbing Permit Application ,
` � y FM � l
Date received: / /Z /D/ ' Permit no.:/ js-
A , 0, t ' City Tigard
'' .` y O 'Tigar Address: 13125 SW Hall Blvd, Tigard, OR 97223 Sewer permit no.: Building permit no.: 1
City of Tigard Phone: (503) 639 - 4171 Project/appl, no.: Expire date:
Fax: (503) 598 - 1960 Date issued: 1 By:, Receipt no.:
Land use approval: Case file no.: Payment type:
I%P,I�. PLI4M1T
i
0 IA 2 family dwelling or accessory ❑ Commercial/industrial 0 Multi - family 0 Tenant improvement
l New construction 0 Addition/alteration /replacement (2 Food service 0 Other:
, JOIR SI FL INEORMA I�ION IT U; S( DIE UU1 T (16i s ricial'itilhirm.it,ou use checklist)
Job address: /0 w�o q Description Qty. Fee(ea.) 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: Li j ploek: 1 Subdivision: SFR. (2) bath
Project name: 4 ( f"So �Z,'CI ///,5 SFR (3) bath
City /county: 7 a/7 a 71P: q 7 2 z 3 Each additional bath/kitchen i {
Description and location of work on premises: , v / t•,' U s Site utilities: I
Catch basin/area drain
Est date of completion/inspection: Drywells/leach line /trench drain
,, z " ootin * drain (no. lin. ft.) 1111111111111.11 1111111111111.11 P1 1-"L‘"`' ,,,,,,v-,4,,,,,, ' Manufactured home utilities
Business name: tv 0c , "ivl - ft ,s s' ' ,7 anholes NM — j
Address: {':'t%, 1 ,r 7 / Rain +rain connector Ell
City: E dt<ic State:0 . E Sanitary sewer (no. Iin. ft.) 1
Phone: aY- 6;20.. fy 2. Fax:C4cl ic Storm sewer (no. iin. ft.)
CCB no.: /17/7 Plumb. bus. reg. no: 5y 73 Water service (no. lin. ft.)
City /metro lic. no.: Fixture or item: i
Contractor's representative signature: / J:. j,� , �/'' Absorption valve I �' Back flow preventer I
Print name: n. ei..r,- /r • ,4f, :;J Date: 7/7 r o/ Backwater valve
`t ON I A(C PE RSON `- Basins/lavatory
{ I
Name At Q 4, -trC. /l'I(,a� Clothes washer
/
Address: Re 8,,,7/3
f Dishwasher
: StateC f I ZIP: �j' " Drinking fountain(s) Cit
City: I=5'�y' <�c��;�c( Ejectors/sump .;
Phone: o 650 4e Fax: sei ?/e E-mail: Ex .anion tank Mr
0%1. NF It L , Fixture/sewer cap
Floor drains/floor sinks/hub WM
Name (print): ! , ;� i s -
address: �r ► Garba_e dis• sal
Mailing e�. r.'_; .. > Hose bibb 1.1.= — 1_1
DEM ' . , y ` ZIP 111.1i All I ce maker 11111
Phone ",fir o;'a [,l Fax: E -mail: Interce • torl: cease tra •
Owner installation/residential maintenance only: The actual installation • 'mer(s)
will be made by me o e •- ' ntenance and repair made by my regular Roof drain (commercial)
employee on the p • • I as per ORS C apter 447. Sink(s), basin(s), lays(s)
Owner's signature: • Date: 10 I r i . Sump
uNidN[`.I it Tubs/shower /shower • an , •
W t al
II
Name:
Address: a er closet I
Water heater
City: [ State: [ ZIP: Other:
Phone: - _ Fax: E -mail: Total �{� ■
• Not all jurisdictions accept credit words, pima call jurisdiction for more informattoo, Minimum fee $ • Z_ S
N ot i ce: Th is permit application Plan review (at „ %) $
o visa a MasterCard expires a permit-is not-obtained a2. /7!
Credit card number: / / within 180 days after it has been State surcharge (8%) .... $
Ex TOTAL $ 39 • /S
Name of cardholder as shown on credit card accepted as complete.
S
Cardholder signature Amount aao 44046:6 (6roo /COM)
i.