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Permit CITY TIGARD PLUMBING PERMIT ^ b. DEVELOPMENT SERVICES PERMIT #: PLM2001 -00366 f 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 08/15/2001 SITE ADDRESS: 15159 SW 107TH TERR MODEL HOME PARCEL: 2S110DA 08800 SUBDIVISION: ERICKSON HEIGHTS ZONING: R -3.5 BLOCK: LOT: 049 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 pevention device. FEES Owner: Type By Date Amount Receipt RENAISSANCE CUSTOM HOMES PRMT CTR 08/15/2001 $36.25 27200100000 1672 SW WILLAMETTE FALLS DR SPOT CTR 08/15/2001 $2.90 27200100000 WEST LINN, OR 97068 Total $39.15 Phone 1: 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: �� �� Permittee Signature: 1; 1/ Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day Plumbing Permit Application Date received: j/7i/0 / Permit no.:Pjf 200 f9 3( ;� City of Tigard A Address: 13125 SW Hall Blvd, Tigard, OR 97223 Sewer permit no.: Building permit no.: City of Tigard Phone: (503) 639 -4171 Project/appl. no.: Expire date: Fax: (503) 598 -1960 Date issued: Byje6 Receiptno.: 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 ❑ Addition/alteration/replacement ❑ Food service ❑ Other: JOB SITE INFORMATION FEE SCHEDULE (for special information use checklist) Job address: l S l I9 5, U', 107,4 7 /In , 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: L g 'Block: I Subdivision: SFR (2) bath Project name: F ; rh'Sa,. i /s SFR (3) bath City /county: 7 ail 4 I ZIP: q 7 2 23' Each additional bath/kitchen Description and location of work on premises: _ SPa %.//r /e, - Site utilities: Catch basin/area drain Est. date of completion/inspection: Drywells/leach line/trench drain PLUMBING CONTRACTOR Footing drain (no. lin. ft.) o Manufactured home utilities Business name: L, d c u r/ti/e It , s C' .7 Manholes Address: PO f t, 7 /3 / Rain drain connector City: ES fge /G/ I State:OR I ZIP: 7702.3 Sanitary sewer (no. lin. ft.) Phone:p,r- 63()•- 1".f7j' z I Fax:A 4.14c I E -mail: Storm sewer (no. lin. ft.) CCB no.: 117 /7 I Plumb. bus. reg. no: 6-y 73 Water service (no. lin. ft.) City /metro lic. no.: Fixture or item: Absorption valve Contractor's representative signature: f_(,), e1 ,-',4' Back flow preventer [ Print name: f 7 ; 4 /Q,-,, e /lived Date: 7 ,-•> I u / Backwater valve • CONTAC r PERSON Basins/lavatory Name: , 8 q,:v e 41e,cc'�/ Clothes washer Address: i 6 er 7 /, Dishwasher City: L ^S'7 'c�rc/'cq I StateOi I ZIP: 9702y E ectors/s J P Phone: re, '• -6,re 4"6"' . Fax: -rei../it E -mail: Expansion tank OWNER Fixture/sewer cap Name (print): g ltje, I/4 Floor drains/floor sinks/hub g 10 w e Garbage disposal Mailing address: Hose bibb City: WT U� I I State: v�l ZIP: G Ice maker Phone j b . 00 I Fax: I E -mail: Interceptor /grease trap Owner installation/residential maintenance only: The actual installation Primer(s) will be made by me o e 'ntenance and repair made by my regular Roof drain (commercial) employee on the p t,i; I'. w as per ORS Chapter 447. i Sink(s), basin(s), lays(s) Owner's signature: a Date: • i AP 1 Sump Tubs/shower /shower pan Name: Urinal Address: Water closet Water heater City: State: I ZIP: Other: Phone: I Fax: I E -mail: Total Not all jurisdictions accept credit camels, please call jurisdiction for more information. Minimum fee $ .34 • Z5 Notice: This permit application ❑Visa 0 MasterCard Plan review (at _ %) $ expires if a permit is not obtained Credit card number: / / .... State surcharge (8 %) $ .2 , 9d Expires within 180 days after it has been as complete. TOTAL $ , /S acce ted lete. Name of cardholder as shown on credit card P P $ Cardholder signature Amount 440-4616 (6N0/COM)