Permit CITY TIGARD PLUMBING PERMIT
DEVELOPMENT SERVICES PE
DEVELOPMENT PLM2001 -00355
'— 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 08/15/2001
SITE ADDRESS: 10555 SW LADY MARION DR PARCEL: 2S110DA -07600
SUBDIVISION: ERICKSON HEIGHTS ZONING: R -3.5
BLOCK: LOT: 037 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 97062
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.
Issued By: e ��� Permittee Signature: crn / . 2 , 1 12 7 ,61L 9
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
%1.1 o 00 — D /
A lio
Plumbing Permit Application . : f , 2,-',,', , '
Date received: c7Z O/ Permit no.://-itOe / - 'a iS
� � City of Tigard
. --41-.1
_ _ , , Sewer permit no.: Building permit no.:
City of Tigard Addres : 13125 SW Hall Blvd, Tigard, OR 97223
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:
j .
1 ti PI o>H .1 Ii nl I li g
O _.& 2 family dwelling or accessory ❑ Commercial /industrial Cl Multi - family O Tenant improvement
et construction Ci Addition/alteration/replacement O Food service 0 Other. _ _
4011 Si I I ` INFORMNA7 lON , - I:6' St IIE titiI I (lot speital inlonuatiou usi. rliuklnt)
Job address: t Grca I• L✓r 4o• At! 'p,,U On
Dese lion s Total
Bldg. no.: uite 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: Block: Subdivision: SFR (2) bath M
Project name: - 4. t k. 4, Nz /6 ' /j f ,5' SFR (3) bath
City /county: -17e7... ag a I Z IP: '7 7 2. 2 3 Each additional bath/kitchen
Description and location of work on premises: 5-' ,9., , , v4'/ e its Site utilities: i
Catch basin/area drain !
I
Drywells/leach Line/trench drain
Est completion/inspection: date of
PLimitWt, ((i1V I KAt I OR Footin_ drain (no. lib. ft.)
r
Manufactured home utilities
Business name : . t', Oc ii ' .t-7c , /i/�t ,s`:', v,4`• Manholes
Address: N fie 7/7 Rain drain connector
City: E, rte( 4 47 I State:CP, ZIP: 776) 2.3 Sanitary sewer (no. Iin. ft.)
Phone:0,?- 031)..1 Z I Fax:C' E -mail: Storm sewer (no. lin. ft.)
CCB no.: /1 Plumb. bus. reg. no: 5''y Water service (no. lib. ft.)
City /metro lie. no.: Fixture or item:
Contractor's representative signature: / �;, ' / -n' Absorption valve i
�n Back flow preventer
Print name: r.:): ei 4.-4.,' a✓e ,/ Date , . i i a! Backwater valve
4'CO':1 I 1( t PERSON Basins/lavatory
Name: l , i ' j
� d ( Clothes washer
Dishwasher
Address: R; e, 8( ?,3 Drinking fountain(s)
City: jS erc'ciC. c State' -4 ZIP: ' J23 Ejectors /sump
Phone: O 6 fo • 4s7 Fax: -ret.../fr E -mail: -x .anion tank
t1�YNIR Fixture /sewer cap
Floor drains/floor sinks/hub
Name •tint). s"z i - Garbage disposal
Mailing address: nix , i. T ► "�
City: t ' :: '�' ' State :. $ ZIP: • r` I s maker
Phone.... • , . i [ Fa x : E -mail: , Interceptor /grease trap
Owner installation/residential maintenance only: The actual installation Primer(s)
will be made by me o a 1.: 'ntenance and repair made by my regular Roof drain (commercial)
employee on the p la I w f as per ORS Ch.pter 447. Sink(s), basin(s).1ays(s) ( I
Owner's signature: • Date: 1 ' OP - _ — Sump
r,,,,-
iINGI I I it f Tubs/shower /shower pan )
Name: Urinal
Water closet
Address: Water heater
City: State: I ZIP: Other.
I Phone: ] Fax: E -mail: Total
Not all jurisdictions accept credit cards, please call jurisdiction for mote information. Minimum fee -36 • 2
Notice: This permit application
-0Viisa 0 - MasterCard Plan review (at %) $ _
expires - if a permit - -
Credit card number: / / within 180 days after it has been State surcharge (8%) .... $ 2 � 0
Name of cardholder as shown on credit card Expires accepted as complete. TOTAL $ 7 ' IS
S
Cardholder signature Amount 440 -4616 (6,00/COM)