Permit CITY TIGARD PLUMBING PERMIT
DEVELOPMENT SERVICES PERMIT #: PLM2001 -00358
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 08/15/2001
SITE ADDRESS: 10651 SW LADY MARION DR PARCEL: 2S110DA -07900
SUBDIVISION: ERICKSON HEIGHTS ZONING: R -3.5
BLOCK: LOT: 040 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: 4. � 0 /` Permittee Signature: )l
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
., gg e0 / — e).0 //3
Plumbing Permit Application
Date received: d 2- o/ . Permit no.:pu 1 • i l - &%E''
�, �.t ' Cit o f Ti ' '
= . t . t . -�� �l Sewer permit no.: Building permit no.:
CiryoJTi anti Addres : 13125 SW Hall Blvd, Tigard, OR 97223
8 Phone: (503) 639 -4171 Project/appl.no.: Expire date:
Fax: (503) 598 -1960 Date issued: IONA Receipt no.:
Land use approval: Case file no.: Payment type:
1
O l 2 family dwelling or accessory O Commercial/industrial O Multi - family 0 Tenant improvement
New construction 0 Addition/alteration/replacement 0 Food service 0 Other.
JOR SUIT INFORMATION IION . , . t , , I I?I S( IILUUI h ,(tor sKeial ►tton use check114)
Job address: /O‘ 57 S ki, . - s,ci e j• pv Allill Desert don I .- Fee(ea.) Total
Bldg. no.: Suite no New 1- and 2- family wellings onl
Tax map /tax lot/account no.: (Includes 100 ft. for each utility connection) !
SFR (1) bath I
Lot: l/e Block: Subdivision: SFR (2) bath
Project name: 1 t i-S6 4v He I'4' /t/.5- SFR (3) bath
City /county: '7` an g a ZIP: ? 7'2 2 3 Each additional bath/kitchen
Description and location of work on premises: Spn , 4/41 r 4S Site utilities:
Catch basin/area drain
Est. date of completion/inspection: Drywells/leach line/trench drain
YLiJ111 131N(, (UNI ItAGtUI; „y Footin: drain (no. lin. ft.)
' Manufactured home utilities III
Business name:. C cf C y t / / /il,s'�s' _ y4 Manholes
Address. 1 ( 7 / 1 Rain drain connector IIIII
City: FS'g4s7414 State:0 \ ZIP: 9 70 23 Sanitary sewer (no. lin. ft.) =MIN_
Phone: fe,r -63 ). -. f"' 2 Fax:s'y.sic E -mail: Storm sewer (no. lin. ft.) 111111
CCB no.: /17 7 Plumb. bus. reg. no: 5 '73 Water service (no. lin. ft.)
City /metro lic. no.: Fixture or item: I
Back f
Contractor's representative signature: LP j! , //1;_'p err .
B tion valve
Back flow preventer
Print name: fl. fc 1,, , A/,, /Date: r u/ Backwater valve . 1 I
(,ilN1;AC I PLNSON . Basins/lavatory
Name: >I 8 q, v e „4/0,- cit./
C othes washer
Address: d ; 8 , 7 /3 / Dishwasher
��^,,.�C =yeer Drinking fountain(s) I i
City: l%S / f /C tate� { ZIP: 11023
( i SC Ejectors/sump !
Phone: a y -6,re. S s",' Fax: Se / t, E -mail Expansion tank IIIII —
'OWNER Fixture/sewer ca. • • Name (print): +, . Floor drains/floor sinks/hub IIIII
> ^� I _ - .. Garb: :e die • •sal
Mailing address.: "�` i(/ T l ll r . r, I Hose bibb
City:. 1 State:.' r gi Ice maker M
Phone. � ' i U i ' Fax: 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 • I w. as per ORS Chapter 447. 1 Sink(s), basin(s), lays(s)
Owner's signature: • Date
*; 1 P I Sump
_` -'° c ' • Tubs/shower /shower pan '
Urinal
Name: Water closet i
Address: Water heater
City; State: ZIP: Other
Phone: I Fax; E -mail: Total
Not ail jurisdictions accept credit cards, please call jurisdiction information. iction for more infoation. Minimum fee $ ( ZS
Notice: This permit application
_D_viiea —R MasterCard — expires if a pemniris norobtained Plan review (at _ `70) $
Credit card number: / / State surcharge (8%) .... $ .2.-96
Expires within 180 days after it has been TOTAL $ 3 S • Ls
Name of cardholder as shown on credit card accepted as complete.
$
Cardholder signature Amount 44o -4616 (6ro3/COM)