Permit CITY TIGARD PLUMBING PERMIT
di ll DEVELOPMENT SERVICES PERMIT #: PLM2002 - 00412
c 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 10/28/02
SITE ADDRESS: 14680 SW 76TH AVE 088 PARCEL: 2S112BD 00100
SUBDIVISION: ZONING:
BLOCK: LOT: JURISDICTION:
CLASS OF WORK: OTR GARBAGE DISPOSALS: 1 MOBILE HOME SPACES:
TYPE OF USE: MF WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: R1 FLOOR DRAINS; TRAPS:
STORIES: WATER HEATERS: CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: 1 URINALS: GREASE TRAPS:
LAVATORIES: 1 OTHER FIXTURES:
TUB /SHOWERS: 1 SEWER LINE: 0 ft
WATER CLOSETS: 1 WATER LINE: ft
DISHWASHERS: 1 RAIN DRAIN: ft
Remarks: Replace plumbing fixtures.
FEES
Owner:
Description Date Amount
WASHINGTON CO. HOUSING AUTHORITY
111 NE LINCOLN ST [PLUMB] Permit Fee 10/28/02 $99.60
#200 -L, MS63 [PLUMB] Permit Fee 10/28/02 $0.00
HILLSBORO, OR 97124 - 3082 [TAX] 8% State Tax 10/28/02 $7.97
[TAX] 8% State Tax 10/28/02 $0.00
Phone 1: 503- 846 -4794 [PLUMB] Investigation 10/28/02 $99.60
Contractor: [PLUMB] Investigation 10/28/02 $0.00
ALBERTA PLUMBING Total $207.17
LEWIS TRANER
PO BOX 55031
PORTLAND, OR 97238 REQUIRED INSPECTIONS
Phone 1: 503-331-0657 Rough - Insp
Final Inspection
Reg #: LIC 96782
PLM 26 -707PB
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 -0100.
You y obtal opies of these rules or direct questions to OUNC by calling (503) 246 -6699.
Iss d By: / � _ f% �/ / , � Permittee Signature: _
Call (503) 639 -4175 by 7:00 P.M. for an inspection need:. e next business day
Building Fixtures
Plumbing Permit Application
OFFICE USE ONLY
3 1 ' , U U U L- D ate received: C o - 2- Permit no.: A ,,, . --efj 43,
� ij� City of Tigard Sewer permit no.: Building permit no.:
Address: 13125 SW Hall Blvd, ' faTd, OR 9723
City of Tigard Phone: (503) 639 - 4171 4 ' 0 LUUC Projecdappl. no.: Expire date:
Fax: (503) 598 -1960 L-' L.,.�' y,4,r ' Date issued: By: ? Receipt no.:
Land use approval: Case file no.: Payment type:
5 ' <',: TYPE .OF PERMIT
❑ 1 & 2 family dwelling or accessory ❑ Commercial/industrial ❑ Multi- family ❑ Tenant improvement
❑ New construction ❑ Addition /alteration/replacement ❑ Food service ❑ Other:
' JOB SITE INFORMATION ' , ..', FEE SCHEDULE (for special information use checklist)
Job address: Description Qty. Fee(ea.) Total
.„,' b -Ph �� a New 1- and 2- family dwellings only:
Bldg. no.: Suite no.: (includes 100 ft. for each utility connection)
Tax map /tax lot/account no.: SFR (1) bath
Lot: Block: Subdivision: SFR (2) bath _
Project name: SFR (3) bath _
City /county: ZIP: Each additional bath/kitchen
Description and location of work on premises: Site utilities: ■ -.
Catch basin/area drain
Est. date ofcompletion /inspection: Drywells /leach line /trench drain —
4 ' —= F• Footing drain (no. lin. ft.) _
` " ' _'PLUMBING CONTRACTOR;
�' . Manufactured home utilities 1��
Business name: 4 , � � , . � Manholes _
Address: _ . ill' ��,..,,•• � Rain drain connector _
41 III mig, i rzgrai „„
L9 //gym Sanitary sewer (no. lin. ft.) I
mo
Phone: _ O — Storm sewer (no. lin. ft.) _—
CCB no.: at • I. Plumb. bus. reg. no: - _ 07 ' ; . Water service no. lin. ft.) .1.
City /metro lic. no.: Fixture or item: ■ -.
Absorption valve
Contractor's representative signature: _j� _ _ . Back flow preventer _
Print name. ate: i - - O L Backwater vg - Mill
s 4"-;, ±.` CONTACT- PERSON Basi '' ava • -' i
Clothes washer ME
"`�,' �l ' Dishwasher Mil
Address: Drinking fountain(s) - --
d
!_ / � ZIP: " 2 Ejectors /sump —
Phone
r E-mail: Expansion tank _
. ! / .. O r m VVNER , - , Fixture /sewer cap • ' F ax: ma
Name (print): Floor drains /floor sinks/hub M
Garbage disposal no
Mailing address: Hose bibb MN
City: State: ZIP: Ice maker —
Phone: Fax: 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 Ro.- drain (commercial) _
employee on the property I own as per ORS Chapter 447. /:. - it:), basin(s), lays(s) II.
Owner's signature: Date: Sump —
EN Tubs /shower /shower pan fa
- Urinal ME
Name: Water closet
Address: Water heater
City: State: ZIP: Other: MI
Phone: Fax: E -mail: Total —
Minimum fee $ W1bt9
Not all jurisdictions accept credit cards, please call jurisdiction for more information. Notice: This permit application
O Visa 0 MasterCard $
_
expir if a permit is not has been Plan review (at %) State surcharge (8 %) $
Credit card Dumber: within 180 days after it has been `/-
Expires TOTAL $ l O7
Name of cardholder as shown on credit card accepted as complete. 14 FL✓ v
Cardholder signature Amount eCt
A 8. /'