Permit C ITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT PERMIT #: PLM2008 - 00286
TIGARD' 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 7/7/2008
PARCEL: 2S 114BC -04500
SITE ADDRESS: 10496 SW BONANZA WAY ZONING: R -7
SUBDIVISION: RIVERVIEW ESTATES NO. 2 LOT: 082 JURISDICTION: TIG
PROJECT: DIXON
Project Description: Relocating plumbing fixtures. Other fixture: ice maker.
CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: SF WASHING MACH: 1 BACKFLOW PREVNTRS:
OCCUPANCY GRP: R3 FLOOR DRAINS; TRAPS:
STORIES: WATER HEATERS: CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: 2 URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES: 1
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Owner: FEES
KENNETH & DIXON
10496 SW BONANZA WAY Description Date Amount
TIGARD, OR 97224 [PLUMB] Permit Fee 7/7/2008 $72.50
[TAX] 12% State Surch 7/7/2008 $8.70
Phone : 503 -624 -5609 Total $81.20
Contractor:
OWNER
REQUIRED ITEMS AND REPORTS
Contact # : PRI
Reg #:
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: ' Permittee Signature: �.
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.
Plumbing Permit Application -
Building Fixtures
61\ � F l:Ol2 OFF ICE USE O I l
_ .
C of Ti and Rece ived permit No.:
11111 `, g Date/By: ff . Y / •____ ; a
n 13125 SW Hall Blvd., Tigard, OR \ _ . �CO Plan Review
Other Permit No.:
Phone: 503.639.4171 Fax: 503 8.. '60 % Date/By:
\
`I Inspection Line: 503.639.4175 �� , lit Ready /By: luris: 0 See Page 2 for
T1G -,., i Internet: www.tigard or.gov J� ® ft ��G 't otified/Me[hod s Supplemental elemental Information
TYPE' OF WORK G\`'( � ,%cs For FEE* SCHEDULE
❑ New construction ❑ D For spectral information use checklist
Description 1 Qty. 1 Ea. 1 Total
® Addition/alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (1) bath 249.20_
® 1- and 2- family dwelling ❑ Commercial/industrial SFR (2) bath 350.00
❑ Accessory building ❑ Multi - family
SFR (3) bath 399.00
Each additional bath/kitchen 45.00
❑ Master builder ❑ Other:
Fire sprinkler (_ sq. ft.) Page 2
JOB SITE INFORMATION AND LOCATION • Site utilities
Job site address: 10496 SW Bonanza Way Catch basin or area drain 16.60
City /State /ZIP: Tigard, OR 97224 Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: I Project name: Dixon Kitchen Footing drain (no. linear ft.: ) Page 2
Manufactured home utilities 110.00
Cross street/directions to job site: SW corner Riverwood and Bonanza Way
Manholes 16.60
Rain drain connector 16.60
Sanitary sewer (no. linear ft.: ) Page 2
Storm sewer (no. linear ft.: ) Page 2
Subdivision: Riverview Estates 1 Lot no.: Water service (no. linear ft.: ) Page 2
Fixture or item
Tax map /parcel no.:
Absorption valve 16.60
DESCRIPTION OF WORK Backflow preventer Page 2
Relocate plumbing for sink, refrigerator, washing machine. Backwater valve 16.60
U 'c v • S _ �, Clothes washer 1 16.60 /6,, &
(� l t�(V� Dishwasher 16.60
Drinking fountain 16.60
" ❑ •PROPERTY OWNER I ❑ TENANT
� \ Ejectors/sump 16.60
Name: E (Q 6 `j%3 (Q Expansion tank 16.60
Address: t L( c SW ppN w t "1 Fixture /sewer cap 16.60
City /State /ZIP: T1 6 O( 71 ZZ (f Floor drain/floor sink/hub 16.60
Phone: 6 ,2.,-( — Stdq Fax: ) 6 - - ,,1,2L3- Garbage disposal 16.60 • Hose bib 16.60
❑ APPLICANT ❑ CONTACT PERSON
Ice maker / 16.60 !6, L I)
Interceptor /grease trap 16.60
Contact name: Medical gas (value: $ ) Page 2
Address: Primer 16.60
City /State/ZIP: Roof drain (commercial) 16.60
Phone: ( ) ( ) Siri asin/lavatory V�r IE/44,_ 16.60 )�
Fax:
ub /shower /shower pan " 16.60
E -mail: Urinal 16.60
CONTRACTOR Water closet 16.60
Business name: <Xu ATC,r— Water heater 16.60
Address: Other:
Subtotal
City /State /ZIP:
Minimum permit fee: $72.50
Phone: ( ) Fax: ( ) Residential backflow minimum permit fee: $36.25
CCB Lic.: Plumbing Lic. no.: Plan review (25 %ofpermit fee)
State surcharge (12% of permit fee)
Authorized signature:
��,�� � /\ "� Wit, TOTAL PERMIT FEE I.d- L)
Print name: lG ( (YON) Date:7 /7/0? This permit application expires if a permit is not obtained within
180 days after it has been accepted as complete.
*Fee methodology set by Tri -County Building industry Service Board.
I \ Building \ Permits \PLMF- PermitApp.doc 12 /27/06 440- 4616T(10 /02/COM/WEB)
Information Notice to Property Owners About
Construction Responsibilities Statement
Oregon Law requires residential construction permit applicants who are not licensed
with the Construction Contractors Board to sign the following statement before a
building permit can be issued. [ORS 701.055 (4)]
This statement is required for residential building, electrical, mechanical and plumbing permits.
Licensed architect and engineer applicants, exempt from licensing under ORS 701.010(7), need
not submit this statement. This statement will be filed with the permit.
Please check the appropriate box and complete the foliowing statement:
own reside in or will reside in the "completed structure and my; general contractor is:
Name CCB# Expiration' Date
I will instruct my general contractor that all subcontractors who work on the structure must be
licensed" with the Construction Contractors Board.
or.
I will be performing" work on property 1 own; -a residence that 1 reside in or a residence that 1 will
reside in. If 1 hire subcontractors, 1 will hire only subcontractors licensed with the Construction
Contractors Board. If I,change.rny Mind and hire a general" contractor, .I will contract with a
contractor who is licensed with' the CCB and will immediately notify the office issuing this building
,permit-of the name of.the contractor.
I have'read and understand the information Notice to Property Owners about Construction
'Responsibilities contained on these two pages and I hereby, certify that the information checked and
Completed above is correct and accurate.
Print "name of permit applicant" Signature of permit applicant
7 o Pi
Date
'7E bb = vc)3
Permit #: EZ.C.A 1) 00,3M/ 4 - WDo8ro
This form is supplied to building ( 0 - / . 76. � �� w�U�i/2a �
permit offices by the Oregon ; Address: I /
Construction Contractors Board, i�`;te� « ►k':
as required by ORS 701.055 (6) :. '
7 � 7 B
Issued by: � � Date: U Rv
This copy to issuing permit office
CITY OF TIGARD .
BUILDING DIVISION PERMIT #: Pl.M2008- 00286
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 7/7/2008
Phone: (503) 639 -4171
Inspection Requests (24 Hrs.): (503) 639 -4175 rrll�
INSPECTION WORKSHEET FOR DATE: 8/25/2008 TIME: 7:00AM PAGE: 23
SITE ADDRESS: 10496 SW BONANZA WAY CLASS OF WORK:
SUBDIVISION: RIVF_RVIEW ESTATES NO. 2 LOT #: 082 TYPE OF USE:
PROJECT NAME: DIXON
DESCRIPTION: Relocating plumbing fixtures. Other fixture: ice maker.
OWNER: DIXON, KENNETH & KIM(3ERLEE PHONE #: 503.6245609
CONTRACTOR: OWNER PHONE #:
Inspection Request Scheduled For: Date: 8/25/2008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
320 Plumbing rough -in 074588 -02 150.362 -4560 N
Corrections /Comments /Instructions:
Nt PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector( Date: l Uri Phone #: (503) 718-
.
CITY OF TIGARD -
BUILDING DIVISION PERMIT #: PLM2008.002F36
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 7//12008
Phone: (503) 639 -4171'
Inspection Requests (24 Hrs.): (503) 639 -4175 '' L.
INSPECTION WORKSHEET FOR DATE: 8/21/2008 TIME: 7:02AM PAGE: 27
SITE ADDRESS: 1¢186 SW BONANZA WAY CLASS OF WORK:
SUBDIVISION: RIVF_RVIEW ESTATES NO. 2 LOT #: 082 TYPE OF USE:
PROJECT NAME: DIXON
DESCRIPTION: Relocating plumbing fixture'.. Other fixture: ice maker.
OWNER: DIXON, KENNETH & KIML3ERLEE PHONE #: 503- 624 -5609
CONTRACTOR: OWNER PHONE #:
Inspection Request Scheduled For: Date: 8/2112008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
320 Plumbing rough -in 074456.01 360.852 -6890 N
Corrections /Comments/ Instructions:
" b I -CC -e✓c,/
❑ PASS ❑ PARTIAL APPROVAL ❑ CANCEL I NO ACCESS
FAIL IX CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: d ry - .j% \ 111M2- Date: gtZ\ `D C, Phone #: (503) 718-