Permit ripi 'l. CITY OF TIGARD PLUMBING PERMIT
-' . COMMUNITY DEVELOPMENT PERMIT #: PLM2006 -00561
`� x= DATE ISSUED: 11/17/2006
TtcnRD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
Y' °` ' w PARCEL: 2S104DB -04400
SITE ADDRESS: 13130 SW ROCKINGHAM DR ZONING: R -4.5
SUBDIVISION: AMESBURY HEIGHTS LOT: 044 JURISDICTION: TIG
Project Description: Installation of water heater.
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: 1 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
Owner: FEES
ERIC DUFORT
13130 SW ROCKINGHAM DR Description Date Amount
PORTLAND, OR 97223 [PLUMB] Permit Fee 11/17/200E $72.50
[TAX] 8% State Surcharl 11/17/200E $5.80
Phone : 503 -524 -2443 Total $78.30
Contractor:
COLUMBIA CONTRACTING SERVICES INC ,
38197 SE HUDSON
SANDY, OR 97055 REQUIRED ITEMS AND REPORTS
Contact # : PRI 503- 225 -0774
FAX 503- 668 -3701
Reg #: LIC 103764
PLM 3 -505PB
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.
Per mittee S i natur • - flI 6 (c."---...___, Issu d By: k i g / /
v
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.
p . 1
- . .
Plumbine Permit Application i(»; i)1 iv I. I :
• City ofTigard Recci.cd
Delay: / /1 1 14/ rtrmit Na.: Litt RD6-665 1
1 , 1 • . 12, SW IUD Blvd.. Tiprd, OR 97223 Plaa Rorizoi
: 11
Phone 503.639.4171 Fax 503598.1960 c/By: Other Permit tio:.
. Inspection Line: 503.639.4175 -
Motif:War ; ' ES see Pages for
1) wane: www.dvird_arvw No660i/harthod: So manna Informed=
" .:t •if.::. -3..c-T;A:•. 4- ...::..;;,.. . :.:t.4-7..-: '.:tq.
13 New construction 0 Demolition Far ;pedal lafennation asc checklist
Description 1 Qty. 1 Es, 1 Total •
• M Adding:a/alteration/replacement 0 Other. New 1-2-family dwelliags (includes 100 A. for each utility comnection)
A:. .i. SFR ( tee' NM 24920 1
PM1r 0 Conunercialfindustrial SFR (2) bath 350.00 . .
0 Accessory banding 0 Multi-family SFR (3) bath 399.00
Each additional bath/kitchen 45.00/
0 Master budder CI Cttbcr:
ire? sprinkler ( sq. ft) Page 2
' 1: • .
, ,..7.: 17.: w.:;!- ... ...... •. ,. • • ..- • ;•..- - • • ...., .• ,- - ..- .)..; sae obliges
Job situ addl: /..1/2 ,...c4C... 49 CZ hA.4Y40 ." Catch basin or area drain 16.60
City/State/ZIP: Zhi .e_ Drywell, leach line, or trench drain 16.60
Footing dab (no. linear it: _,) Page 2
SUite/bMg./apt. no.: 14 name:
Manufactured home utilities 110.00
• Cross stront/directioas to jab site:
Manholes 16.60
Rain drain commetor 16.60
Sanitary sewer (no. linear I: _) Page 2
Storm sewer (no. linear ft: ) Page 2
SubdiviSiOn: I Lot t10.: Water service (no. linear ft.: __)
Page 2
• roan or item
Tax map/parcel no.:
....„ , ., , es .„. „. .. Absorptioo valve 16.60
" j! ‘ :`.": : ;$.', : :: ; • ; :: - .'": . `J,'. 1 t.....16 3 .3 " W#0 0 ***..:*** 1 0*.* : : :. " :t e'kti . . 4 : : •:4'•'• i.. J. %allow peventa IIM
. 2 ■ 4 ` i TeX__ / 1 7 / . 0 %e - Backwater calve 16.60
Clothes washer 16.60
bib waaho- 16.60
.:.:i :•;...,..-.:;' ',;;;
:
' -... ; 16.60
. Drinking fountain
' • EjectotrJramp 16.60
Name: 11 Expansion tank 16.60
Address: Fixture/sewer cap 16.60
City/State/ZIP: Flom drain/floor sink/hub 16.60
Phone: ( ....;;? _ c:?5,,
Fax: ( ) Garbage dispo®I 16.60
..4:;..
.. „. Rom bib 16.60
Ice maker 16.60
Business mune:
hacrceptor/gresse trap 16.60
Contact name: Medical gas (valuer S ) Pap 2
Address: Primer 16.60
City/StatrjaP: Roof dram (cormacreia)) 16.60
Phone: ( ) Fax: ( ) Sink/basin/lavatory 16.60
t :
Tub/shower/shower pan 16.60
E-mad : Urinal 16.60
.•,; -,•••• : : --.• f: -'... :::... - ..fy,:tikithirnaCriii,.... :;• a ...':. . M ::::'....:"... •
16.6a
Business name: 1./ / CepAec _ ...24/ Water heater / 16:60
Address: „....?:7 ....---- eAd.5". ,Z Other:
City/Stan/ZIP: 544.( p,e___ .e.,5 Sebtotat
Minimum permit fee: S72.50 ..... -)
Phme: ( Wl 5 2 777 Fax: ( )66d59 Residential backtlow minimum . - it fee: S3625 1 4 •
CC:B LiC.; /,&e., 76 Plumbing tic. no. :?5 fiaa roview (25% of permit fee)
State sunhat ge (11% ofpermit fee) 5 8'0
Authorized signature: do o. . .4•‘-r.......... .....r...c.-...-.------.--
TOTAL PERMIT
Print name •-,/,0 &"-- dg Diaci.,/-/7-e7Z This permit applicatioa opiates If a permit is not obtailied within
gga days after it has been accepted as complete.
"Poe methodology set by Tri-County Boa ding Industry service Board.
Vskiterm 06121106 1{646161(IGAWC0MIW59)