Permit s ,
CITY TIGARD PLUMBING PERMIT
DEVELOPMENT SERVICES PE
DEVELOPMENT PLM2001 -00511
.." 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 10/31/01
SITE ADDRESS: 09870 SW VENTURA CT PARCEL: 1S125DD -05600
SUBDIVISION: WASHINGTON SQUARE ESTATES NO. ZONING: R -4.5
BLOCK: LOT: 064 JURISDICTION: TIG
CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS: 1
OCCUPANCY GRP: 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: Install landscape back flow preventer
FEES
Owner:
Type By Date Amount Receipt
SODERQUIST, DAVID R + PAMELA E PRMT CTR 10/31/01 $36.25 27200100000
9870 SW CT 5PCT CTR 10/31/01 $2.90 27200100000
OR 972
TIGARD, OR 97223
Total $39.15
Phone 1:
Contractor:
MIKE PATTERSON PLUMBING
15028 S MITCHELL LANE
OREGON CITY, OR 97045 REQUIRED INSPECTIONS
Phone 1: 632 -7374 RP /Backflow Preventer
Reg #: LIC 81746
PLM 3 -359PB
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: AP, i ' 4 Permittee Signature
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
•
Plumbing Permit Application
Datereceived: /O Petmitn... - .� -
..,',, City g
Cit of Tigard � �! `J Sewer permit no.: Building permit no.:
Address: 13125 SW Hall Blvd, Tigard, OR 97223
City ofTigard Phone: (503) 639 -4171 Project/appl. no.: Expire date:
Fax: (503) 598 -1960 Date issued: By: Receipt no.:
Land use approval: Case file no.: Payment type:
TYPE OF PERMIT
❑ 1 & 2 family dwelling or accessory ❑ Commercial/industrial ❑ Multi- family ❑ Tenant improvement
❑ New construction 121 Addition/alteration /replacement ❑ Food service 0 Other:
JOB SITE INFORMATION FEE SCHEDULE (for special inforn ation use checklist)
Job address: 9 8 1 7 0 ( IA) / EN T / . ( kA CT., 7 42p, ant l 753 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.: A• P : I $ 12 S D D - OSb )0 Acr: Rz 3 agv3
SFR (1) bath
Lot: (, (Block: — I Subdivision: w it - rA - r 5 A- SFR (2) bath
Project name: Tr)E SODEf2 W S-r £F/YIODEL p/2OJ1 c7 SFR (3) bath
City /county: -T/ ( W As µ . I ZIP: 9 7 9-2- 3 Each additional bath/kitchen
Description Wjocation of work on ppremises: UPS'rA,121 a rr,On) Site utilities:
k(3tlJt f f 0/ D //V F) W e fO OrnE OrF /cE
/'rV/ b eu i y 73 Fx - r. n .K id H , Catch basin area drain
Est. date of completion/inspection: II - 3 b - 0i Drywells/leach line/trench drain
PLUMBING CONTRACTOR Footing drain (no. lin. ft.)
Manufactured home utilities
Business name: !71I l(E PA- TEi&SOt3 1 Pl /Ai& Manholes
Address: /5 2.? S. Pt /Tell ECL CANE Rain drain connector
City: O(Er5OA) C / I State: OR I ZIP: 9701/S- . Sanitary sewer (no. lin. ft.)
Phone: 9lio - ayift, I Fax: ( -.51,4A E -mail: Storm sewer (no. lin. ft.)
Plumb. bus. re no: Water service (no. lin. ft.) - - — --
CCB no.: 817y�o I g• 3 -359 Pa
City/metro lic. no.: 5 /(2 e mE-2o� Alxture or tam ' "
Contractor's representative signature: Absorption valve ``
Back flow preventer / ierA N
Print name: TA Ike PA - rTER.SOK) Date: aBackwater valve • /
CONTACT PERSON 131ItinS laKstory
Name: CGUd - i3ti'n ad Az°.Q6tU-
Clothes wasnetr _ '; i`'
Dishwasher
Address: . Drinking fountain(s)
City: I State: I ZIP: Ejectors/sump
Phone: Fax: E -mail: Expansion tank
OWNER Fixture/sewer cap
Name (print): DA V r D Ant D ( r So RDu / sT Floor drains/floor sinks/hub
Mailing address: c g 7O s W VENTURA Cr: Garbage disposal
Hose bibb
City: -r76-m2.2. I State: Die I ZIP: 17g? 7g? 3 Ice maker
Phone: aye -S346 'Fax: ?N / - 76SYo I E - mail: S DP/42r Ali Interceptor /grease trap
Owner installation/residential maintenance 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 pro rty wn r O Chapter 447. Sink(s), basin(s), lays(s)
Owner's signature: Date: /0-3 -a/ Sump
Tubs/shower /shower pan
Name: T3.ERR NORDLJAJ6 " J& W INC l
Watteer closet
Address: W(cD Sul CDR(3ETT flVl7✓UE Water heater
City: POR7L/l a I State: ex I ZIP: 9 7e20 / Other:
Phone: aa7 -7783 I Fax: 9.27-778y1 E -mail: Total -
Not all jur ards
isdictions accept credit c, please can jurisdiction fo mo
r re inrotmatiaa Notice: This permit application P l ni evi fee $
O Visa O MasterCard expires if a permit is not obtained Plan review (at _ %) $
Credit card number: / / within 180 days after it has been State surcharge (8 %) .... $
Expires TOTAL $
Name of cardholder as shown on credit card accepted as complete.
$
Cardholder signature Amount 440-4616 (6100/COM)