Permit CITY TIGARD PLUMBING PERMIT
pi r 'I DEVELOPMENT SERVICES PERMIT #: PLM2001 -00360
I 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 08/15/2001
SITE ADDRESS: 10677 SW LADY MARION DR PARCEL: 2S110DA 08100
SUBDIVISION: ERICKSON HEIGHTS ZONING: R -3.5
BLOCK: LOT: 042 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 INC PRMT CTR 08/15/2001 $36.25 27200100000
1672 SW WILLAMETTE FALLS DRIVE 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: 4d , Permittee Signature: f}��•
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
/'1,.c - 4 . 0" yoP_5
Plumbing Permit Application
- Date received: /z /)/ Perm it no.:A/12{1D /461 ,
,..ry City ®f Tigard � ;.
x11.1. _ y . Sewer permit no.: Building permit no.:
CiryojTigard Addres : 13125 SW Hall Blvd, Tigard, OR 97223
Phone: (503) 639 -4171 Project/appl.no.: Expire date:
Fax: (503) 598 - 1960 Date issued: ByA56 Receipt no.:
Land use approval: Case file no.: Payment type: •
. I P1. OF 'PERMIT
O j,& 2 family dwelling or accessory ❑ Commercial/industrial Cl Multi - family 0 Tenant improvement
ie'New construction Cl Addition/alteration /replacement Cl Food service Cl Other.
JOB SITE INFOKM I.I I St'11t 1)1_!1, (I or ' peci d inh rntat un use dii tkhsl) '
Job address: /Q 77 S, t'i' L a L v7id,� /A, ��don [s ] Total
Bldg. no 1 Suite no.: l�ew 1- and 2- y wellings only: ,
Tax map/tax lot/account no.: (Includes 100 ft. for each utility connection)
SFR (1) bath
Lot: 1 -j 2 Block: 1 Subdivision: SFR (2) bath I 1
Project name: r4Z / /rye 4, /i 6 ) e 16)//7/5 — SFR (3) bath
City /county: - 7 -- / .9 a/7 a 1 ZIP: 77 22.1 Each additional bath/kitchen
Description and location of work on premises: Sp., n / e 4 r - • Siteutiikies:
Catch basin/area drain
Est. date of completion/inspection: DrywelIs/leach line/trench drain
•
PLUM VG CON >I K C li' OK Footin: drain (no. lin. ft.)
Manufactured home utilities
Business name:. , �, e/i /r rs `e,' ti4 • l fanholes
Address: Pc>, , < 7/3 Rain drain connector
City: E.: S 1i74 der 1 State: (/ 1 ZIP: 7 70 23 Sanitary sewer (no. lin. ft.)
Phone:4 - (y3v -� . j' 2. 1 Fax:C4c-ric 1E-mail: Storm sewer (no. lin. ft.)
CCB no.:1/7/7 1 Plumb. bus. reg. no: 5-1 73 Water service (no. lin. ft.)
City /metro lie. no.: Fixture or item:
Contractor's representative signature: / Q, i, �fl" , , .. Absorption valve
�� - Back flow preventer
Print name: ,n, t t / a , Ai e /1"/ / , Date: 7 - i 0/ Backwater valve -
. -' ° (t)N 4)N1 .1t Er P1JtSON- Basans/lavatory
Name:
Clothes washer
if ( 8 Q , ;V e . ,410, �t ,�+ Dishwasher
-
Address: 0, 4 7 /3 / .
S tate�� 1 ZIP: 9723 Drinking fountain(s)
City:
47S'S'c'et dq , Ejectors/sump __I
Phone: o 3. - 6,5•0.4 21', Fax: s c E - mail: Ex' anion tank
OW NI. . Fixture/sewer ca
f Floor drains/floor sinks/hub
Name (print): . J i . `
Mailing address: ' .� Hose be dis .sal
g c..a'�'�" ' :�3�( ►. r. Hose bibb
City: IN/ . i 1 • State: , w ZIP: 0 ' �'' Ice maker
Phone. • ' i i ' P 1 Fax: 1 E -mail: Interceptor /grease trap
Owner installation/residential maintenance only: The actual installation Primer(s)
will be made by me o e • • tenance and repair made by my regular Roof drain (commercial)
employee on the p t I . w $ as per ORS Chapter 447. Sink(s), basin(s), Iays(s)
Owner's signature: Date: • 1 el ump
Tubs/shower /shower pan
„I11.GINl :�t It ` P
Urinal
Name: Water closet
Address: Water heater
City: 1 State: 1 ZIP: Other:
Phone: 'Fax: 1E-mail: Total 1
'Not all jurisdiedans accept csedit cards, please call jurisdiction for more information, Minimum fee $ .36. • 2S
Visa— Q.MasterCard Notice: This permit application
— expires'if a permiris not - obtaine d Plan rev (at __ `9c) $
—
O
Credit card number: • / L_ w ithin 180 days after it has been State surcharge (8%) .... $ eZ , 9 d
Expire: TOTAL $ 29, LS
Name of cardholder as shown on credit card accepted as complete.
S
Cardholder signature Amount , 440 - 4616 (6/OOICOM)