Permit CITY T I G A R D PLUMBING PERMIT
r DEVELOPMENT SERVICES PERMIT #: PLM2001 -00362
`�' 13 125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
DATE ISSUED: 08/15/2001
SITE ADDRESS: 10733 SW LADY MARION DR PARCEL: 2S110DA -08300
SUBDIVISION: ERICKSON HEIGHTS ZONING: R -3.5
BLOCK: LOT: 044 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: 2 � �� � Permittee Signature:
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
/7S72/ -DOO/
Plumbing Application
Datereceived: ' D� rf /y o/ Permit no.PLNigooi 80.36, 7., ">Tir City of Tigard /
Sewer permit no.: _ Building permit no.:
Address: 13125 SW Hall Blvd, Tigard, OR 97223
City of Tigard Phone: (503) 639 -4171 Project/appl. no.: Expire date:
Fax: (503) 598 - 1960 Date issued: ByQ8 Receipt no.:
Land use approval: Case file no.: Payment type:
TYPE OF PERMIT .
Li 1 & 2 family dwelling or accessory ❑ Commercial /industrial ❑ Multi- family O Tenant improvement
C> "New construction O Addition/alteration /replacement U Food service O Other:
`' JOB•SITE INFORMATION FEE SCHEDULE (for special information use :checklist)
Job address: 0 2 .S' , , . ', .1, Description Qty. Fee(ea.) Total
New 1- and 2- family dwellings only:
Bldg. no.: Suite no.: (includes 100 ft. for each utility connection)
Tax map /tax lot/account no.: SFR (1) bath
Lot: it Block: Subdivision: SFR (2) bath .
Project name: SFR (3) bath
City /county: I , ,e• `, ZIP: 2 Each Each additional bath/kitchen
Description and location of work on premises: i Site utilities:
Catch basin/area drain
Est. date of completion/inspection: Drywells/leach line /trench drain
• Footing drain (no. lin. ft.)
PLUMBING CONTRACTOR Manufactured home utilities
Business name:, Manholes
Address: 'L:; /, 7/3 Rain drain connector
City: Er q4 de: BEM ZIP: q 2. 3 Sanitary sewer (no. lin. ft.)
Phone: d_r- 6. ,7c)• -. 3 Fax:5°'.yic E -mail: Storm sewer (no. lin. ft.)
CCB no.: 1/7 7 Plumb. bus. reg. no: 5773 Water service (no. lin. ft.)
City/metro lie. no.: Fixture or item:
Contractor's representative signature: sib Absorption valve
Back flow preventer
Print name: fl, I42,-:d e /1.1 ' Date: 7 _J /' 0/ Backwater valve • '
•
CONTAC .: PERSON Basins/lavatory
�7
Name: p 1. ;1, ,41 „di. Clothes washer Dishwasher
Address: • , 6 A • 7 /3
IIEMBEINMEMIM State:C %� ZIP: 02y Drinking fountain(s)
Ejectors /sump
Phone: ,p y- C,fc7..s r°9 , Fax: -rei.. fe E -mail: Expansion tank
.OWNER Fixture/sewer cap •
„ Floor drains/floor sinks/hub
Name (print): 0, 7 Garbage disposal
Mailing address: (r �. 1 / - • Hose bibb
■
ZIP:11 0 '/ Ice maker
Phone. i u Fax: E -mail: Interceptor /grease trap
Owner installation/residential maintenance only: The actual installation Primer(s)
will be made by me o e oi and repair made by my regular Roof drain (commercial)
employee on the p �, , I , as per ORS Chapter 447. Sink(s), basin(s), lays(s)
Owner's signature: a Date: 4 : I # I " Sump
ENGINEER • . Tubs/shower /shower pan
Name: Urinal
Address: Water closet
Water heater
City: State: ZIP: Other:
Phone: Fax: E -mail: Total •
Minimum fee $ <36 , ZS
Not all jurisdictions accept credit cards, please call jurisdiction for more information. Notice: This permit application
o Visa 0 MasterCard Plan review _(at_ %¢)_$_
Credit card number: expires if a permitis notobtained State surcharge (8 %) .... $
�.9
Expires within 180 days after it has been TOTAL $ 9 ,IS
Name of cardholder as shown on credit card accepted as complete.
$
Cardholder signature Amount
440-4616 (6/00 /COM)