Permit CITY TIGARD • PLUMBING PERMIT
i DEVELOPMENT SERVICES PERMIT PLM2001-00354
n f1 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 08/15!2001
SITE ADDRESS: 10537 SW LADY MARION DR PARCEL: 2S110DA -07500
SUBDIVISION: ERICKSON HEIGHTS ZONING: R -3.5
BLOCK: LOT: 036 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
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: 503 - 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: G , � Permittee Signature: Ty, a ,.E.
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
H-Sj ;O / -. oaa !o
Plumbing Permit Application .
Date received: r f z - 0/ Permit no.: A GH250 / % 03 5 -
•� City of Tigard
4.. __ emu: Sewer permit no.: Building permit no.:
Address: 13125 SW Hail Blvd, Tigard, OR 97223
City of Tigard Phone: (503) 639-4171 ProjecUappl.no.: Expire date:
Fax: (503) 598 -1960 Date issued: t��'�J Receipt no.:
Land use approval: Case Fite no.: Payment type:
I YPE. 01~`PERMIT : _
0 2 family dwelling or accessory 0 Commercial/industrial 0 Multi- family 0 Tenant improvement
I c New construction 0 Addition/alteration/replacement 0 Food service 0 Other:
.jolt SUIT INFORM/1'1'10N' ' IiIt S('i_ I (1w special inlontiation st a <lie.khst)' •
; Job address: /0577 7 - W .1 qd Akil /e/v nn, Descri}oti ®n l Total
Bldg. no.: SGite no.: New 1- an 2 -famlly dwellings only:
Tax map/tax lot/account no.: (includes 100 ft. for each utility connection)
SFR (1) bath
Lot: 96
BIock: Subdivision: SFR (2) bath
Project name: 2 ,. /ice 4. hie o'* // /,s SFR (3) bath IIIII
City /county: '1`1 can a , ZIP: .77 2 z y Each additional bath/kitchen -_
Description and location of work on premises: 5 p., , .t / / 2 Site utilities: !
Catch basin/area drain 1
Est. date of completion/inspection: DrywelIs/leach line trench drain i
CON Pootinc drain (no. lin. ft.)
H I LtiIVIRIN(, 1 RAC" Y'OK, ,; • Manufactured home utilities -
Business name: �, J L. t r A/ 1e� i, � pir: s t,' "r4/„.• - Manholes
Address: EL; t 7 / Rain drain connector MIIIII_
City: F$1LciG4 c C[ State:O r ZIP: 17'70 2. 3 F : ' :.- c ( • i t.) ■
Phone: j0Y- (y3c).-� S 1 I Fax:5 yrc I E -mail: Storm sewer (no. lin. ft.)
CCB no.: 1 /7 /7 1 Plumb. bus. reg. no: 5"5? 3 Water service (no. lin. ft.)
II
City /metro lic. no.: Fixture or item:
Contractor's representative signature: e, „ Back flow k valve
�� �' , ., Back preventer
Print name: n, fj' /,.;,�;J 4! ,,../ /Date: 7 „i i c/ Backwater valve III
(ON I :1t I PERSON Basins/lavatory
Name: 8 4.,',. /�lvo
Clothes washer
III
Address: J b 4 t? 8 ' 7 /3 Dishwasher
Drinking fountain(s)
City: S 0 4'c'cit` c StateC f ZIP: ' ' Ejectors /sum. i
Phone: o'-&' Fax: - I - et :a e E-mail: - xpansion tank N�
t1% %NEIL Fixture/sewer cas Ell
Name (pant) t + �. f Floor drains/floor sinks/hub
�' a dis ..sal ■-
Mailing address: MM � i'�;( ,r� r ' Hose bibb
City: 1 I State: ; s� ZIP: ' r► ' Hose L
Ice maker IIII
Phone: • , / / •° I Fax: I E 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 "l I i w • as per ORS Chapter 44 Sink(s), basin(s), lays(s) II
Owner's signature: • Date: . '' # I Sump MONNIIII {
l n(.INFI 1i Tubs/shower /shower 'an
Urinal 1.111111111111
Name. Water closet I
Address:
Water heater
City: j State: I ZIP: Other:
Phone: Fax: I E -mail: Total ,
Not all jurisdicdana accept credit cards, please call jurisdictton for more information. Minimum fee $ 36 r ZS
Notice: This permit application Plan review (at _ %) $
-o Visa— Q.MasterCard expires if permit
Credit card number: / / within 180 days after it has been State surcharge (8%) .... $ `
Expires accepted as complete. TOTAL ... $ 9 . /s ^
Name of cardholder as shown on credit card
Cardholder signature Amount 440 - 4615 (M/00/COM)