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Permit ' CITY OF TIGARD PLUMBING PERMIT DEVELOPMENT SERVICES PERMIT #: PLM2005 -00639 DATE ISSUED: 11/17/2005 + - 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 PARCEL: 2S114BA - 12200 SITE ADDRESS: 09565 SW MILLEN DR ZONING: R -7 SUBDIVISION: COPPER CREEK STAGE 3 LOT: 087 JURISDICTION: TIG Project Description: Replace water service. CLASS OF WORK: OTR GARBAGE DISPOSALS: MOBILE HOME SPACES: TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS: 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: 50 ft DISHWASHERS: RAIN DRAIN: ft Owner: FEES KENNETH GARRISON 9565 SW MILLEN DR Description Date Amount TIGARD, OR 97224 [PLUMB] Permit Fee 11/16/200`. $72.50 [TAX] 8% State Surcha 11/16/200E $5.80 Phone : 503- 639 -5070 Total $78.30 Contractor: WOLCOTT PLUMBING CONTRACTORS 1075 W COLUMBIA RIVER HWY TROUTDALE, OR 97060 REQUIRED ITEMS AND REPORTS Phone : 503- 667 -1781 Reg #: LIC 23847 PLM 26 -208PB This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 0001 -0010 through OAR 952 - 0001 -0100. You may obtain copies of these rules or direct questions to OUNC by calling 503 - 246 -6699 or 1- 800 - 332 -2344. Issued By: LeLcz„ Permittee Signature: 55 Call 503 - 639 -4175 by 7:00 a.m. for an inspection that business day. V, This permit card shall be kept in a conspicuous place on the job site until completion of the project. Approved plans are required on the job site at the time of each inspection. .- , � §�� :: `�t t` �z F UrFTCL UST' U!'Ll' _ � y YT e �.9�1Zo.' ]FlumtAno Permit A Nicatiola .... E, ,. ;. \ ' �,/� City of Tigard �V ED Roceivad / ) 717)5— Permit No " r 1`1 G.O S 6 639 Dwa Plan Review I3125 SW Hall Blvd., Tigard, OR Urte/B . Other Permit No.: Phone: 503.639,4171 Fax 503. 98,1960 4 T�;;�I� ` � 1 �,�. lhtc Reid lB . 65 Sec pone 2 for 24- Hour Inspection Line: ,503.639, i T 7.+ n`; 0 05 ...s Y Y� ' / Supplemental Information - Internet: www,ci,tigard.or.uS 1 �` o U if Notificcl /Mothod; ` � FEE' sC I;EDI7I.E G ��I�, F ors a ©al In otmariox rase Checklist. El New construction at AWING �J ° icm description pre Ea. Total Other: New 1- 2- family dwellings (includes 100 ft. ibr each utility connection) Addition /alteration /replacement ❑ _ 249.20 CATEGORY OF CON$TRT.PC'TION SFR (1) bath 350.00 �1 -and 2 tbinily dwelling ❑ Commercial/industrial SFR (2) bath _ 399,00 SFR (3) bath ❑ Accessory building ❑ Multi- family Each additional bath/kitchen 45.00 ❑ Master builder [] Other; - giro sprinkler (,___ sq, ft.) [ 1 Page 2 JOR SITE INFORMATION AND LOCA.TiON gltc utilities Joh site address: �7`� 1 r , :.r Catch basin or area drain 16,60 ��// TJrywoll, leach line, or bench drain 16.60 City /Statc / / �L Footing drain (no, linear ft.: ) Page 2 Suite/bldg./apt. /apt. no.: I Project name: (/ _ lvl ti 110.00 - - anufacturcd home utilities Cross street /directions to job site: Mnnlmica i6.60 J / , -� / Rain drain connector 16.60 . Sanitary sewer (no. linear ft.: ) Pagc 2 _ Storm sewer (no. linear fl.: , ) Page 2 _ Water service (no, linen ft � " Page 2 65:-- Subdivision: Lot nn.: Fixture or item Tax map /parcel nn. Absorption valve 16.60 DESCRIPTION OF WORK - Ea ckflow pr evcntcr Pagc 2 / pj , 4 f ` , j q/ ! ) .,• f • , / it ; ackwnter valve 16.60 - i •�v Clothes washer 16,60 _ Dishwasher ME 16.60 - Drinking fountain 16.60 - /1 PROPERTY OWNER [] TENANT Ejectors/sump 16,60 Name: i WIPJI ►� / Expansion tank 119111 16.60 Address: G�j6745— LL.. j/44 J Fixture/sewercap Floor drain /floor sink/hub 16.60 City/State /ZIP: j f /, /// / -7 / Garbage disposal 16.60 Phone; ( ' /- / ■sd—.. *Er" ' ) _ 16,60 Hose bib _ 5 AFFLTC. ,>NT ❑ C ONr:C<T rLR.yoN �Icc maker 16.60 Business name; Woicoti Plumbing dim Jack Hawk rlu bldg interceptor /grease trap 16.60 S. / P % , Medical gas (value: $ ) Page 2 Contact name: / , Address: 1.075 W Historic Colombia River Hwy Primer 16.60 Ttoofdrnin(commercial) 16. _ City/State/ZIP: Trnatdnle, OR 97060 _ Sink/basin/lavatory 16.60 Phone: (503) 235 -8784 ,Fax:: (503) 491 -2432 Tub /shower /shower pan 16.60 E-mail: - - Urinal 16.60. Water closet 16.60 13usiness name: Wolcott Plumbing, dba lack Hawk Plumbing Wstcr heater 16.60 Other. Address: 1075 W Historic Columbia RiverHwy = �- Su• * °t City /State /Z1P; Troutdale, OR 97060 Minimum permit f $72.5 - Phone: (503) 2354784 Fax: (503) 491 -2932 Residential backflow minimum permit fcc: '.36,25 7, j� Ph,mbin g Lie. no.: 26 -205 TB Plan review (25% of permit fee) CCB Lie.: 23847 State surcharge (S% of permit fcc) Authorized signature; * . ./A; / - TOTAL PERMIT FEE 1W ',;. ; ��e Pr it Date: /(05 Thin permit application expires if n permit i3 dot eb - , Print name; /J �� _ [[ 180 days after it has been accepted RS Complete. *Fee methodology act by Tri- County Bui1din' Industry Service Board - 7 Y '