Permit C ITY OF TIGARD PLUMBING PERMIT
s DEVELOPMENT SERVICES PERMIT #: PLM2001 -00425
s `� = I � 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 9/7/01
SITE ADDRESS: 16125 SW 72ND AVE BLD.B PARCEL: 2S113AB -00600
SUBDIVISION: FANNO CREEK ACRE TRACTS ZONING: I -L
BLOCK: LOT: JURISDICTION: TIG
CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: B 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: Installation of back flow preventer.
FEES
Owner:
Type By Date Amount Receipt
PACIFIC REALTY ASSOCIATES PRMT CTR 9/7/01 $72.50 27200100000
15350 SW SEQUOIA PKWY #300 -WMI
5PCT CTR 9/7/01 $5.80 27200100000
PORTLAND, OR 97224
Total $78.30
Phone 1: '
Contractor:
POWER PLUMBING CO
P BOX 23144
TIGARD, OR 97281 REQUIRED INSPECTIONS
Phone 1: 244 -1900 RP /Backflow Preventer
Reg #: LIC 52378 Final Inspection
PLM 34 -150PB
EXPIRED
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR.
Specialty Codes and all other applicable laws. All work will be done in accordance with approved plans.
This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more
than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility
Notification Center. Those rules are set forth in OAR 952 - 0001 -0010 through OAR 952 - 0001 -0080.
You may obtain copies of these rules or direct questions to OUNC by calling (503) 246 -1987.
Issued By: e � ,� ��/ A" _ Permittee Signature: ja
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
SEP 04 2001 10:17flM POWER PLUMBING CO. 503 244 8825 p.l
4 • Plumbing A 1 W. ti on
City Date received: ? Permit no. / _o / _ 07 cgs
.,....1,1-` I' , . CiCity of Tigard
' _I I!, Sewer permit no.: Building permit no.:
Address: 13125 SW Hall Blvd, , gard, OR 972 .
City of Tigard Phone: (503) 639 -4171 Project/appl. no.: Expire date:
Fax: (503) 598-1960 Date issued: By /46 1 Receipt no.:
Land use approval: Case file no.: Payment type:
. 0 1 & 2 family dwelling or accessory ommercial/industrial 0 Multi- family 0 Tenant improvement
0 New construction 0 Addition/alteration/replacement 0 Food service 0 Other
.10B SITE INFORMATION FEE SCIIED(JLE (for special information use checklist)
Job address: !(o f2 5 t$&)'; / Q,(j-e_.- Description 0 Total
Bldg. no 1 Suite no.: New 1- and 2- family dwellings only
Tax map/tax lodaccotmtno.:
(Includes 100 ft. for eath utility connection)
SFR (1) bath
- Lot: 'Block: Subdivision: SFR (2) bath -.
Project name: Th L(`�/) SFR (3) bath
City/county: 776,4-en(74)At j/ (.ZIP �� (�
: 9 � Each additional bath/kitchen
)1 ( ti n and location o Q C premises: s ii
Catch tch b fare.a drain
Est. date of completion/inspection: Drywells/leach line/trench drain
PLUMBING CQ1 "f RACTOIt Footing drain (no. lin. ft.)
Manufactured home utilities
Business name: Po e F grirfrip 0 Manholes
r . Address: / / / q4/ ? Rain drain connector
City: & I State: ZIP: Q1 U Sanitary sewer (no. lin. ft)
`� Phone: 24'4 —/q pQ Fax: a Q- E -mail: Storm sewer (no. lin. ft.) -
CCB no.: S'2 !Plumb. bus. reg. no: 3/-4- 150 Water service (no. [in ft.)
City/metro lic. no.: 14L02.— F bsor a or item -
Contractor's representative signature:` `stwao ,, Absorption valve
Back flow preventer I •.J( U
Print name: / ST/ D Date: Backwater valve
Basins/lavatory
i� Clothes washer
Name: �J [ Dishwasher
Address:. /j _ /j �� ��t Drinking fountain(s)
— :5ty: g j . `; State: Or ZIP. d' 7,aD • its/sum
phone._ — - 4 Oa I2214 E -mail: Expansion tank
O\%N Jt Fixture/sewer -: .
Name (print): ( 0 h / Floor drains /floor sinks/hub
Mailing address: / (p t.2_5 £ '7 X d � Garbage disposal
T! Nose bibb r V ��t k r, y - ,�
CRY:
( / � ) ESQ: r I 91 e Lf Ice maker " ---- P , r !NI
Phone: I Fax: I E -mail: 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 propetry I own as per ORS Chapter 447. Sink(s), basin(s), lays(s)
Owner's signature: Date:. Sump
ENGINEER Tubs/shower/shower pan
Urinal
Name: Water closet
Address: Water heater
City: 1 State: ZIP: Other. - .
Phone: 1 Fax: 1E-mail: Total ' 1 4 .AtU /
Na all jwisd Cr
ctions accept edit cards. Please can jurisdiction fa man infnnnario• Minimum fee $ 1.2. 5 _
Notice: This permit application plan review (at %) $ -
O Visa 0 MasterCard expires if a permit is not obtained
Credit card number / / within 180 days after it has been State surcharge (8%) .... $ S�
Expires TOTAL $ - r7{ 3 O
e.
Naroe of cardholder as ahowo oo credit card accepted as c y� �/l D
4
Cardholder signature Amount * On C2 O�/ V V --V f / a)^- 4464616 (6 O/COM)
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