Permit r • ti�
CITY T I GA R D PLUMBING PERMIT
Alip to
41 &., DEVELOPMENT SERVICES
PERMIT #: PLM2001 -00338
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 08/15/2001
SITE ADDRESS: 10832 SW KABLE ST PARCEL: 2S110DA -04200
SUBDIVISION: ERICKSON HEIGHTS ZONING: R -3.5
BLOCK: LOT: 003 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 prevention device.
FEES
Owner:
Type By Date Amount Receipt
PRMT CTR 08/15/2001 $36.25 27200100000
5PCT CTR 08/15/2001 $2.90 27200100000
Total $39.15
Phone 1:
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.
. „' �2, P Signature: e / ,
Issued By: ,�� ^ �i�- �� i/�il //l Permittee Si � ( , T �� • / ' ,..._
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
.. , JT�oa,o -dc P
A . Plumbing Permit Application
Date received: P Z a / Permit no.: / 0a3f
s City of Tigard
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: By • Receipt no.:
Land use approval: Case file no.: Payment type:
TYPE OF PERMIT •
❑/l & 2 family dwelling or accessory 0 Conunercial /industrial 0 Multi - family 0 Tenant improvement
i1 New construction 0 Addition/alteration /replacement 0 Food service 0 Other:
JOB SITE INFORMATION FEE SCHEDULE (for special information use checklist)
Job address: l Q ' 3 2 5, (r1/ /fir ‘-e7 S - 1 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.: SFR (1) bath
Lot: 3 Block: I Subdivision: SFR (2) bath
Project name: e".. 5' oN // /rAir SFR (3) bath •
City /county: l -1 G /gGl ZIP: 9'7 2 2 ? Each additional bath/kitchen
Description and location of work on premises: 5 'frt./ s✓,f /e 2 s Site utilities:
Catch basin/area drain
Est. date of completion/inspection: Drywells/leach line /trench drain
PLUMING CONTRACTOR Footing drain (no. lin. ft.)
Business name: Manufactured home utilities
�, t ?G Uiv��/ ✓l rs`r'�ti'� Manholes
Address: P✓, is , 7 / 3 / Rain drain connector
City: ES'AC- �rcfc:/ State:OR ZIP: 770 2 3 Sanitary sewer (no. lin. ft.)
Phone: f dY- (,,3t). -. T'' Z Fax:'.. e E -mail: Storm sewer (no. lin. ft.)
CCB no.: 1/7/7 I Plumb. bus. reg. no: 5'17 3 Water service (no. lin. ft.)
City /metro lic. no.: Fixture or item:
Absorption valve
Contractor's representative signature: / 0, ef, r726_ —/ Back flow preventer
Print name: f l , ,e4- ;, e /11 ' Date: 7 .7//10/ Backwater valve
CONTACT PERSON Basins/lavatory
Name: Clothes washer
r v /� ��` Woe d , / Dishwasher
Address: -/? 12 f) r 7/3
City: Ly I StateCIj ZIP: 9-lazy Drin
s/s f u o m untain(s)
J P
Phone: ..f - CYO-56"/ Fax: ses. E -mail: Expansion tank
OWNER Fixture /sewer cap
Name (print): asop trlep/hE Floor drains/floor sinks/hub
g ``0 wt t !with Hosbage disposal
Mailin address: Hose bibb
City: W T U ij tJ I State: P—I ZIP: �I1 d rife Ice maker
Phone s 004 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 pr•, , I .wn as per ORS Chapter 447 Sink(s), basin(s), lays(s)
Owner's signature: a Date: � ® 0 PI . Sump
Tubs/shower /shower pan
Name: Urinal
Address:
Water closet
• Water heater
City: I State: ZIP: Other:
Phone: I Fax: 1E-mail: Total
Not all jurisdictions accept credit cards, please call jurisdiction for more information. Minimum fee $ .j . 2.5
Notice: This permit application
0 visa 0 MasterCard expires if a permit is not obtained Plan review (at %) $
Credit card number: - Ex ire/s within 180 days after it has been State surcharge (8 %) .... $ Z , 9 O
p accepted complete. TOTAL $ 3 9 . /5
as cam
Name of cardholder as shown on credit card P P
$
Cardholder signature Amount
440-4616 (6(00 /COM)