Permit •
C ITY OF TIGARD �i�� PLUMBING PERMIT
DEVELOPMENT SERVICES PERMIT #: PLM2006 -00056
I
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 2/3/2006
PARCEL: 2S114BC -00300
SITE ADDRESS: 10085 SW RIVERWOOD LN ZONING: R -4.5
SUBDIVISION: PICKS LANDING NO.1 LOT: 058 JURISDICTION: TIG
Project Description: Replacement shower: valve & drain.
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: 1 SEWER LINE: ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Owner: FEES
STEVE & VI BLACHLY
10085 SW RIVERWOOD LN Description Date Amount
TIGARD, OR 97224 [PLUMB] Permit Fee 2/3/2006 $72.50
[TAX] 8% State Surcha 2/3/2006 $5.80
Phone : 503 -524 -7904 Total $78.30
Contractor:
CROWN PLUMBING
5429 SE FRANCIS
PORTLAND, OR 97206 REQUIRED ITEMS AND REPORTS
Contact # : PRI 503 -771 -9449
FAX 503 -771 -9454
Reg #: LIC 42671
PLM 34 -70PB
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: - 11 Permittee Signature: ___20
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.
PAGE 02
02102/2006 11:12 5 otIVE t�R CROWN PLUMBING
Flux . d ling Permit &pp at o s , � ,,� .
City t Tigard 1 2006 ': r c1R n 1 l I CI I < { ,
13125 ; N Ball Blvd.. Tigard, OR 97223 DatciBy;� - v. .1 Permit a.• Ih - ' , �v01-/
Phone: !10:.639.4171 Fax: 503,598,,oY OF TIGARD plan ' • b
24- Hon B It spection Line: 503.639. 1 LD I N G D VISION �s.:..' t" {t'l1I I , Date/12y: Other Permit No„
Internet: w Hw.ci.tigard.or,us '.•: --:. . Date Ready/Br 1unx; Sts Page 2 for
Nogtied/Method.• , Supplemental Information
TYPE OF WORK .
. FEE* SCHEDUI:E i ct, ' „;':
n New 1 NI Del volition :.; ,:•
❑ Far s pec i al information use checklist
Addis on' alteration/replacement "- Description Qty, Ea. Total
❑ OE cr:
CATEGORX OF CONSTRUt' Y7ON - New 1- 2bfamlly dwellings (includes 100 II. for each utility connection)
SFR (1) bath 249.20
® 1- and 2- amily dwelling $ p Co:. rmercial/induatrial SFR (2) bath
0 Acces .or , building ti-family
350.00
S ❑ Mu: i SFR (3) bath
399.00
0 Master bt ilder Each additional bath/kitchen 45.00
❑ Utt. ;r:
JOB SITE INFORMATION AND ':I ,OCATION Fire sprinkler L_ sq. ft.) Page 2
S utilities
Job site at iirt ss: 10085 SW RIVEKWOOD LANE
Catch basin or area drain 16.60
City /State .:I) TIGARD, OR 97224
Drywcll. leach line, or trench drain 16.60
Suite bldg 'a; t. no.: I Project name: Fooling drain (no. linear I<.: _ ) Page 2 -
Cross sYre< rid irections to job site: - Manufactured home utilities 110.00
Manholes 16.60
Rain drain connector 16.60
Sanitary sewer (no, linear 11.: ) Page 2
Storm sewer (no. linear 8.: ) Page 2
Subdivisio is Lot taro,; Water service (no. linear tt.T
3 Page 2
Tax map/p; : ref d no.' Fixture or item
-
DESCRIPTION OF WORM Absorption valve 16.60
REPLACE !17I :NT SHOWER: VALVE and DRAIN Backilow prcventer Page 2
Backwater �� aekwater valve 16.60
- Clothes washer 16.60
Dishwasher 16,60
.PROPERTY' OWNE 16.64
❑ TENANT Drinking fountain
Name: STE X AND VICTORIA ELACHL7' Expanss /Sump 16.60
Address: 10 u8; SE RIV)ERWOOD LANE - _ Expansion tank _ 16.601
City /State/Z P: TIGARD, OR 97224 -' Fixttrrc/sewer cap 16.60
Floor drair✓t)oor sink /hub 16.60
Phone: ( ),..5-2.$/- 7 � / Fax: ( ) Garbage disposal
7 APPLICANT !6,60
0 CONTACT PERSON Hose bib _ 16.60
•
Business vat e: CROWN PLUMBING Ice maker 16.60
Intercept
Contact nom ,: I ENNI UNDERWOOD, DISPATCHER or /grease trap 16.60
Address: 5429 SE FRANCIS STREET r
Primer !gas (value: S ) Page 2
Primes _ 16.60
City/State /21 ": PORTLAND, OR 97206 Roof drain (commercial) -
•
16.60
` Phone: (503) '171 9449 I Fax; : (50:1) 771 -9454 Sink/basin/lavatory 16.60
E-mail: Tub/shower/shower pan /4 16 ��
Urinal
CONTRACTOR , . 16.60
Business earn a: t :ROWTf PLUMBING Water closet 16.60
_Water heater 1 6.60
Address; 1429 SE FRANCIS STREET •
- Other.
City /State/ZIT : P DR'CLAND, OR 97206
Subtotal
Phone: (503) 71.9449 .Fax; (503) "71-9 Minimum hermit foe: $72.50
Residential backflow minimum permit fee: $3625 J
CCI3 Lic.; 426 ;11 Plumbing I.:. no.: 3 70PB _
Plan review (25% of permit fee)
State
Authorized sit la1 are: e surcharge (8% of permit fee)
�1� S .
Print name: Dr un Is Underwood
1
• TOTAL PERMIT FEE "d+
-
Date: 02/202006 j 1 - This permit application expires 1f a per„iit is not obtained within
180 days after It has been accepted as complete.
1. \F3uilding■Ptrrnits■Pl :N.i'aulii 1pp.Cpc 12/03 * Fee methodology set by Tri- Coutlty Building Industry Service Board.
4 40 - 1616T(16 /02JCOny W gD)