Permit „_,
A-. C OF TIGARD PLUMBING PERMIT
PERMIT #: PLM2002 -00485
,jy; DEVELOPMENT SERVICES DATE ISSUED: 12/17/02
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS: 14055 SW PACIFIC HY
PARCEL: 2S1 10AA -02800
W
SUBDIVISION: ZONING: C -G
BLOCK: LOT: JURISDICTION: TIG
•
CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: FLOOR DRAINS: TRAPS:
STORIES: WATER HEATERS: CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES:
TUBISHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LINE: 2 ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Repair broken water service.
FEES
Owner:
Description Date Amount
DANNA BROTHERS PROPERTIES
9800 SE STARK ST [TAX] 8% State Tax 12/17/02 $5.80
PORTLAND, OR 97216 [PLUMB] Permit Fee 12/17/02 $72.50
Total $78.30
Phone :
Contractor:
MIKE PATTERSON PLUMBING
15028 S MITCHELL LANE
OREGON CITY, OR 97045
REQUIRED INSPECTIONS
Phone : 632 - 7374 Water Line Insp
Final Inspection
Reg #: MET 5242
LIC 81746
PLM 3 -359PB
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 -0100.
You may obtain copies of these rules or direct questions to OUNC by calling (503) 246 -6699.
f �
Issued By: : ! / _ — Permittee Signature: o4.7 /570/2z. / c�7.70
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
Thursday, December 12, 2002 9:54 AM MIKE PATTERSON 503-632-5647 p.02
U7/11/ZUUZ 11:Z4 FAX 5035981900 CITY OF TIGARD (J002
•
, \ • • Building Fixtures
PlumbingPermitApplication OFFICE LSE Ci \ I.N
. • Date 'received: /Z/
City of Tigard 17/ Noah no.:PL/42X2150q5 •
Sewer permit no.: .Building permit no.:
Address: 13125 SW
Cil o f Trgard Phone: (503) 639-41 e. 11 714e TVE °
Ci t • cr/eppt. no.: Expire date:
•Fax: (503) 598-1960 Date knit& ' By rifet Reel* no.: •
• ,
Land use approval: ;DEC 1 2 2002 Case file no.: Payment type: .
O 1 gi 2 family dwelling or accessory QM 0 Multi-family 0 Tenant improvement
0 New construction ditionfalterationircpIacement 0 Food service 0 Other
JOR SITE IN FEE SCHEDULE (lor special infon alion use checklist)
Jab address: 05 tA) MIP ts) . Descri — on Qty. Fee(ea.) Total
Bldg. no.: Suite no.: • New I - and Z-Lenttly dwellings only:
(includes 100 ft. foreach utility connection)
Tax map/tax lot/account no.: • SFR (1) bath
Laic . Block: Subdivision: SFR bath
Pro'ect name:, &"-- eS I it Li A/ SFR (3) • alb ,
City/county: • .. „211/111 ZIP: ' 2.Z- Esc additional bath/lcitchcn
P
- ription and I. •no of wor on premises: • • SiteuttIties:
i ,... 4 ;" be.s w . s4 Catch basin/area drain
Est. date of completion/ins. ction: t../(4 lc, . I each line/trench drain
PLINIBI NG CONTRACTOR ooting drain (no. to • .)
I
•
. - .„. e,e0.,, I - je,‘ , . Anommunam2m.m.m...m 11 =I. ore u i Ines
Business name '
Address: f 50.16' ' " 11._% LAN.. e Rain drain ccuinector
City: Ore. 4" C-: ' State: ic, ZIP: • • . sewer (no. lin. ft.)
Phone: r- - ‘52 . 134 LEMEMNEI E-mail: Storm sewer (no. tin. P.)
Water servIce no. lin. ft. • .2. IrwlarM .a
COI no.: $ I tAio 621 Plumb. bus. reg. no: - 151 ? G.
City/metro lic. no.: 6 , .4 7.- /IMO Facture or Han:
Abso . ..... valve
Contractor's representative signature: ' _
Back flow • reventer .
PliDt138Me: (WO! - 7 - 1,..,,..\ Z Date: •l 1- 61 ' Backwater valve • •
COI PERSON 11==.11.111111.1.11.111.111111
Name: Clothes washer
Dishwasher
Address: •
Drinki , • fountain(s)
Ci : ' State: 21P: Ejectors/ ., • • .
Phone: Fax: E-mail: . elision tank
OWN utrure/sewer e .
Name (prim): • . t . • • oar sinks/bub
• a_ e • ' • • sal
Mailing address: . Hose bibb • '
•
State: ZIP: lee n3aker •
Phone: Fax: 1=311111111:
Owner installation/residential maintenance only: The actual installation Primer(s)
will be made by me or the maintenance and repair made by my regular Roof. • in commercial)
employee on the property I own as per ORS Chapter 447. Sink(s), bashi(s , lays(s) •
Owner's signature: • Date;
EtitiINFIR IICIZa==r1
Urinal
Name: • •
Water closet
Address: Water heater ..
City: State: ZIP: • er
Phone: Fax: E-mail: Total • r 03
5 q. 1 • °
Wet ittljediertclietes eccepe credit tants. Plena call Aigiaktign Rig Om latbfamilegl: 40tica 'Mb pewit apprkati,,,, Minimum fec
sa XtitneerCind expires if a pennit is not obtained Plan review (at ____
0 vi %) S
Crwie cord re:ether, 5e e- (Ade.' sksiS / / widan 180 days atter is has bom State surcharge (8%) $ CI
am,. TOTAL $
0
luxeptecl as compkte.
masa of cards:dear is ,owe ea amen eye S
Canlhelder *mom Amount ) 440.4616 (6/00/C014)
. - .