Permit CITY OF TIGARD
PLUMBING PERMIT
COMMUNITY DEVELOPMENT PERMIT #: PLM2008 - 00401
�GD' 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 10/10/2008
T AR
PARCEL: 1S135BC-00201
SITE ADDRESS: 10765 SW GREENBURG RD ZONING: C -
SUBDIVISION: LOT: JURISDICTION: TIG
PROJECT: 7 -11
Project Description: Relocating water line for sink.
CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: M FLOOR DRAINS; TRAPS:
STORIES: WATER HEATERS: CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: URINALS: GREASE TRAPS:
LAVATORIES: 1 OTHER FIXTURES:
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Owner:
FEES
BELANICH, ROGER M
BY SOUTHLAND CORP Description Date Amount
PO BOX 711 [PLUMB] Permit Fee 10/10/200E $72.50
DALLAS, TX 75221
[TAX] 12% State Surch 10/10/200E $8.70
Phone : Total $81.20
Contractor:
APOLLO DRAIN & ROOTER SERVICE
2208 NW BIRDSDALE #8
GRESHAM, OR 97030 REQUIRED ITEMS AND REPORTS
Contact # : PRI 503- 239 -8801
FAX 503- 669 -9568
Reg #: LIC 49418
PLM 26 -533PB
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 or 1.800.332.2344.
Issued By: / ji ` Permittee Signature: /G4oj./
Call 503.639.4175 by 7:00 a.m. for an inspection that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
,Oct. 10. 2008 12:52PM1 No. 4858 P. 1
JJ
, 1'111rribinc Permit Application
Building Fixtures
RECE1') ,., � FOR or FIC E u se olvi;r :
4, ' � City of TiElyd Rec.,; eil n
re „ait x,,.: /"
,1 n 13125 SW Hall Blvd.. Tigard, OR 97223 OCT 1 0 2003 " "'e „ 'y . �� A) i1 677-- a ( -'U (
! � Plan Review
d , Phone; 503.639,4171 Fax: 503.598.1960 ry Other Permit No.:
CITY OF TIGA i'�i
m Inspection Line: 50:3.639.4175 lfitc Rc,uly /uy harts fa See Pa 2 for
:1 hite inet: wwwtti nrd -or. ov
' g� g j i mined/method: . Supplemental Information
TYPE OF „ ILDING D IVISII
FEE. SCIiEDIJLT
❑ New construction El Demolition For speciallnfornrallon use checklist
- - .._....... .. Description Qty. 1 r __.... ru 1 Total
L Addition/aitcration /replacement ❑ Other: New 1- 2- family dwellings (includes 100 II. for cacti utility connection)
CA•i'ECORY OF (:ONSTRUCTiON SFR (1) hush 249.20
❑ 1- and 2- family dwelling ,KCommereiallindustrial SFR (2) bath 350,00
-- _- SFR (3) bath 399.00
Accessory building ❑ Multi-family
Each additional bath/kitchen 4S.00
❑ Master builder ❑ Other: ....
Firc sprinkler (___, sq. 0.) Page 2
J013 SITE 1NFOR,alATION AND l.O(.•ATiON
Site utilities
lob site address: 1 ` 4^1I'�
lQ „� .,�W ` � / /� ��uY(} �1, ._-- Cinch basin or urea drain 16.60
City/State/ZIP: C -� z
I or _ C�� Dr wall, leach {we or trench drain 16.60
� Dry
well,
no.: I Project 1111Mc:
Footing drain (no linear tl.: ) Page 2
- Manufactured home utilities 110.00
Cross street/directions to job site: -
- -- ___..... Manholes 16.60
Rain drain connector 16.60
Sanitary sewer (no, linear fl.: _) Page 2
Storm sewer (nu. linear R.: _) Page 2
Subdivision: 3.of no : Winer service (nu. linear ft.' _ ) I Page 2
- Fixture Fixture nr ileru
Tax map /parcel no.: Absorption valve 16.60
J S(RIPfION OF WORK • Dac prev enter l.ltoev prcvntcr Page 2
. ' J .P .aL - (,c>a• _yf'i( i / a4iLJJ,i' Back valve 16,60
V ..). Clothes washer 16.60
Dishwasher 16.60
Drinking fountain 16.60
❑ PROPERTY OWNER I ❑ - 1 :NAN'
-
- Ejectors /sump 16.60
Nam: firpuosion tank 16.60
Address: - Fixture /sewer cap 16.60
City/State/71P; Floor drain/floor sink/hub 16.60
Phone: ( ) f ,x; ( ) Garbage disposal 16.60
Hose bib 16.00
XAPPL1CA.V'1' ❑ (:ON't'ACT PERSON -
Ice maker 1(00
Business name: ) t v t yn� _ .
_ . -......... / , i/ V IC,C1/ r .e � 4Gr'r't � Interceptor/grease trap 16.60
Contact name: Medical gas (value: S ,) Page 2
Address: Printer 16.60
City/State/ZIP: drain (commercial) 16.60
Cam. 90 // 1%n� . - Sink /basin /lavatory I 16.60 R (
Phone (9- e) 90 - /100 - 1 Fax: : ( )
'lab/shower/shower pun 16.60
E-mail: - _- __.. -....
- ....... , Urinal 16.60
CONTRACTOR Water closet 0
1GG
Business name: - ^ .Y /0 tii_./ r Water heater 16.60
Address: r it Other:
Cily/Stnte/7TP - ,� • . 0) . _... 5 S 2
•t
- .__ _ vfioi permit tee: 572 >0
Phone: (r,-02) - )
"- Fax: (Gi ) C • r! G Residential backilow minimum permit Ice; S36,25 72'
CCB T,i .: Z.-, l Plumbing Lic. no.: » -» Plan review (25% of pernllt fee)
State surcharge (12 %of permit fee) i ,70
Authorized sigi attire: � O -
/./ �- . �C ( _ TOTAL PERMIT FEE j
... .... . ...
Print name: ` k. F)l - / v _
tc.10 v I This permit application expires 11 permit is not obtained within
-- -. - f .. .--
}� f " L - 2p,1e. 180 days after it has been accepted as complete,
l( *Fee methodology set by Tri County Building Industry Service Board.
t'. tnuakiiroramit5 \ruttF- I4n nitA IA, do,• 17/7.7/06 .1:a 6167(I0c2 /CUMfWE11)
CITY OF TIGARD
BUILDING DIVISION PERMIT #: RI M20r)fs 00401
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 10/10/2008
Phone: (503) 639 -4171 l A,
Inspection Requests (24 Hrs.): (503) 639 -4175 ,_'.. °, iiI
INSPECTION WORKSHEET FOR DATE: TIME: PAGE:
10/17/2008 7: 02AM 22
SITE ADDRESS: 107f�� SW URE81�lBtJRG RD
OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: J..11
DESCRIPTION: Relocating Water Tine for :ink,
OWNER: E;I LANI( ti, ROGER M, PHONE #:
CONTRACTOR: APOLLO DRAIN & ROOTER SERVICE PHONE #: 603_-)39.. 8+301
Inspection Request Scheduled For: Date 10/1707008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
399 Plumbing final 076853 -01 503.233. 8801 N
Corrections /Comments /Instructions:
Oaf-e_ c0 L/CA. Le--st 94A
ly(PASS ❑ PARTIAL APPROVAL ❑ CANCEL fI NO ACCESS
fl FAIL n CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: \ \\Ya►- - Date: 1 -1 1"1 t ' Phone #: (503) 718-
1