Permit CITY TIGARD PLUMBING PERMIT
Its DEVELOPMENT SERVICES PERMIT #: PLM2002 -00325
+ . - II 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 8/21/02
SITE ADDRESS: 14625 SW 89TH AVE PARCEL: 2S111AD -04000
SUBDIVISION: PINEBROOK TERRACE ZONING: R -4.5
BLOCK: LOT: 037 JURISDICTION: TIG
CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS:
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: 25 ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Installation of 251f interior water line.
FEES
Owner:
Type By Date Amount Receipt
CINDY MAAS PRMT CTR 8/21/02 $72.50 27200200000
14625 SW 89TH 5PCT CTR 8/21/02 $5.80 27200200000
TIGARD, OR 97224
Total $78.30
Phone 1: 503 - 639 -3835
Contractor:
CROWN PLUMBING
5429 SE FRANCIS
PORTLAND, OR 97206 REQUIRED INSPECTIONS
Phone 1: 503 - 771 -9449 Water Line Insp
Reg #: LIC 42671 Final Inspection
PLM 34 -70PB
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: Permittee Signature: jjyi a y-L7
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business ay
AUG- 19- 2002 12:43 � P + M CROWN. PLUMBING 503 771 9454 P. 01
i... .01.9 RILIA,5l- I � 4 x PIA t It en-. 1'o' ,4th.. 4 5/4•t° - S / 4,
• PlumbingPernnitApplicat[on • •
.. / 1 . � i '• r;• .yip s�;•: -.,* x.,.,.. • wr,.. i"' u 0 Datereceived: `d �2 /-6 2.. P ?Lli1 - 00 � •
• • Sewer per no.' Building permit no.:
Ad dress:13123 SWHa11, Wd, Tigard, OR 97223 ,
CilY ofTigard . (503) 63914111'' ' "' Projeet/appl, no.. Expire date.
Hrpt: (503) 598 -1S60 . , Date issued. By: .?,3 I Rec•fptno.:
.. - .. Land -use approval: . - � rile no.: ; • Payment type:
11 ] 1'L 01` 1110111'
1111 I'
®1 2 family dwelling or accessory ' O CommeicIa1/industrla1 ,,,.-__,- ,- .2.1...O Multifamily Cl Tenant improvement
O New construction 02, Addition /alteration/rreplacement, 1, 0 Food service 0 Other.
.)Uli1III. Itil-U14I11A1HON 1 sr'111.:1) 111 .1' ;(lorspecialiut'orutaliunuu• checklist)
Job address. 1)-4- 6 IS c .s.. 1 .. Descri•don Qty. Fee(ea.) Total
Bldg. no.: r • * . ''Suite no.: y 4, : -J -19 ! ' .' rr'l dweWugs only:
(i�ad r 100il.foreachutiWycoauectlou)
Tax map/tax lot/account no.: • _ SFR i bath, '
1.-ot: Block: ' I Subdivision: '- • ) . , , .
Proje ame: CI\ • 1 : r. , ; .
fr SFR (3 bath
City /countyr�; r 4 p.I ZIP: ( f Each additional bath/kitclutr
_ _
Descri'tion to I ation work a r t 'rmi.4e _ Site utilities:
_ ! Catch basin/area drain
Est. date of completion/ins • - 7 . on:. • .4- ... . :�J..:< ;I;'•-:• !'• ` 1• - -. • we ls/icach Line/trench drain
F.. : • rain (no. lin. ft.
!'Lt I11111NC: (.ON•I'ItA(:•1'OR • : u ac • - utilities
Business name: a vqcs ti. v. P{ v.v,r.ii ._• 1.•""• 1 • ••-• Manholes i
c 0
Address: S r'4 Z9 S Fro_ v's ef • • . • , _ . • . Rain drain connector
C l t y : " P o -1 I o . c ) . State: ZIP: • • ',yet,, • an! • sewer (no. Gn. ft.)
Phone: II 1 _ 60)41 ' Fax:'1'll•-9 4 Sif 1 B•mail: • • _ .. Storm sewer o. lin. ft-) •
CCB no.: t.0.49 i LPlumb. bus. reg. no: std: ?D log II star sere cc no. tn.
City/metro lie, no.: Lt 55 , F F utter. or item:
Contractor's . • - , tative si _nature: bao on valve
ow • reverter
' Print name: . EA) d r J • D0/x '• --0 Q : ackwater v ve
(•ON'l'A( 1'1'.lttiON Basins/lav: •,
•
Name: 3 (bm 'e.,..P J : { . i w W '
Address: .. -••- . - • • • . -
• ill. ♦ . . • a
City: ;..... St c .:... .., g' - .. , sum •
Phone: ? Fax ! E- mull: • a _ .. , . tank
OIl \I Ii " • SOWN ca•
Name (print):...(, t ,n A r VYl am, 5 -: nor • us/floor sink /herb _ _ .
Mail! ' - address: . .. ...._. • • - ....., .. ' • . - .. bb s . •
_ —
City: - State: - • ZIP: • loo maker •
Phone: . ' - . S Fax: '!- E-mail: . - nterce• •rftra. .
Owner installatiott/residcrt = • • . tenance only: The actual . urination 7 • a ,
• will be made by me or the m»inteuance and repair made by my regular Roof drain (commercial)
employee on the property I own aa,per ORS Chapter.447. ; -_ Sink(s), basin(s), lays(s)
Owner's 51:. attire: - Data; = Sum •
EINGINl•;FIt 'M• o , a .wer . S
i Fri
Name: Water closet .
Address: Water heater
City; State: ZIP: Other: . o - ea
Phone: Fax: , E - • __
11a s �, , ... gar , . ,,,: . ., . Miairrrrrrn fee $ , • Zs
1• ii ""• c4pi 71 1 N ot i ce: Thi perm spptivation
1�s• O MasterCard � expires 1f a permit it twt obtained Plan review (at _ %) S •
end i .apnotir - 0 ' - —T! - la /0 within ISO days after it has been State sutatargo (8%) $ r
y TOTAL $ r" I `%�^• •- , aealr s accep as cot
• moult 440.4616 (. • • • • Kt