Permit CITY OF TIGARD
PLUMBING PERMIT
" ° COMMUNITY DEVELOPMENT PERMIT #: PLM2008 - 00070
TIGARD, 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
DATE ISSUED: 2/26/2008
PARCEL: 2S 103RD - 09300
SITE ADDRESS: 12991 SW 116TH PL ZONING: R - 4.5
SUBDIVISION: HUNTER'S WOODLAND LOT: 005 JURISDICTION: TIG
PROJECT: MCCOLLUM
Project Description: BATH REMODEL
CLASS OF WORK: ALT 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
VAWN MCCOLLUM
12991 SW 116TH PL Description Date Amount
TIGARD, OR 97223 [PLUMB] Permit Fee 2/26/2008 $72.50
[TAX] 12% State Surch 2/26/2008 $8.70
Phone : 971-221-6011 Total $81.20
Contractor:
NORTHWEST CENTRAL PLUMBING
2870 SE 75TH AVE #206
HILLSBORO, OR 97123 REQUIRED ITEMS AND REPORTS
Contact # : PRI 503 -642 -2067
FAX 503 -624 -5954
Reg #: LIC 72253
PLM 34 -197PB
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.
.:02/28/2008 09:18 FAX (1 002 /003
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• Plumbing Permit Application,
Building Fixtures
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I r City of Tigard Eli ' . pondBY ei j57"7 P4171 No wt/ '— ,...• ' --7,0, + ': � r" a 13125 SW Hall Blvd , Tigard, OR 97 p u e , Y
r,t � � m , Phone: 503,639,4171 Fax. 503.59�/ �1�91fi0/��, i 9 lyf _ u
Outer Perm¢ No.
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• a t,AR , .rw D: Inspection Line: 503.639,4175 ' bale RcadyrBy tuns IEI Sce Pnge 2 for
. - .' Inial1C1 wwv, .tigard -ur gov LELDINP n"lf" Nonfied /Method Supolementnl information
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❑ New construction ❑ Demolition Fur special information use checklist
Descri,tion .ft . Ea 'total
i'! Addition /alteration /replacement ❑ Other: New 1- 2- family dwellings (includes 100 R. for each utility connection)
CA'ff3R CIF GibNS$RUCIION SPR (1) bath 240.20
IIIJ 1- and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 350,00
-
E] Accessory building ❑ Multi- family SFR (3) bath 399.00
Each additional bash /kitchen 45 00
j] Master builder ❑ Other; "� ,
Fire sprinkler ( sq, tt.) Page 2 I
' JOB SITE 1:1}TOIYIV)'AT 3N''iiiND ltOCAt,ON Sire utilities -- _._....
-- ......_. I 1'i 1 5Lt) l oco% 11. — .. Jub site address: Catch basin or area drain 16,60
City/State/Z1,, »2 / 7?', Dr Icach line, or trench drain 16.60
Suite /bldg. /apt, no Project name: ! w� CoI L &ia Footing drain (no linear 11.. ) Page 2
Manufactured home utilities IIII 1 10.00 IM
Cross street /directions to joh site
..... - _ -M._• ._ Manholes 16.60
Rain drain connector 16.60
Sanitary' sewer (no smear A. _ ) Page 2
Storm sewer (no. linear 13.: _ ) Page 2
• Water service (no linear ft.' ) MEV
Subdivision; Lot no _—.
Fixture or item
Tux map /parcel no.:
—
Absorption valve 16 60
4 ';' l l #Q' i'Q- -i ' 4 I r ,. ,, ((
, lt; ;I r,lp;!,I „ ,.' �! Pi'S1 ) : i' i� ili • "" _ ' C :IIt)j ^, il , )l , in''lil 13aekflowpreventer Page
,�" tl
IP .A . i Backwater valve 16,60
Clothes washer 16 60
Dishwasher � 16.60
'''';.1 , Drinking fountain 16 60
►= b! K X IiOVJR l b , ^ il• : t rl F?l� i'
F /sump 16,60
Nam e• VA Mc.. CO 1..4)KA y �, Expansion rank 16 60
Address: i D.PA r! Slf) 1 1 (o - no 1° , , Fixture /sewer cap 16,60
—
City/State /ZIP: " ' y �N[,t /op. ( e - » _.— Floor drain /(lour sink /hub 16 60
Phone, ( 1) > I (�� Fax: ( ) Garbage disposal ■ 16 60
r ,�.�. Huse bib 16,60
„
Ij; , , ,Cl'.41 LLC,r�NT'' ,, '' • I ;', ',i. "' 'CAj?�',`, ,,,T'; F,,, .ON ,
Ice maker MEM 16.60 -
Business name: f"'•
- -- - -., ...... ..._.....•, _. - _ Interceptor /grease trap 16.60 -
Contact name: _ Medical gas (value: 5 _ ) Page 2
Address: Primer 16.60
—
•
City/State/ZIP: Roof drain (commercial) 16 60
Phone; ( ) - -- Fax.. ( )
sink/basin/lavatory 1660
Tub /shower /shower pan 16 60 4*
E.-mail: Urinal 16 60
„ „ .. .,.1, i „ ,.COP'II,', „�94,;,h.„ J' ,.,,, ... "Il,r " Water closet 16.60
Business name: Northwest Central Plumbing Co. Water heater 16.60
-
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Address: 2870 SE 75 Avenue, Suite 206 Dther:
City /State /ZIP: Hillsboro /OR/97123 Subtotal l(p, !Oa
Minimum perinu fee; 472.50 -/..,, 95
Phone: (503) 642.2067 Fax: (503) 642.5954 Residential backtlow minimum permit fcc: 536.25 /
CCB Lic.: 72253 PI robing Lic. no.: 34.197PB plan review (25 %ofpermit fec)
I• State surcharge (12% odpermit fee) VALE
Authorized signature; TOTAL PERMIT FEE gl i
Print name: John CP an Date Iglog This permit application expires if is permit is not obtained within
180 days after It has been accepted as complete.
'Fee methodology set by Tn- County Building Industry Service Board
i\auiidli,y,Pc, ni r1'Lr1F•PCrm :Joe 1212'/Oo 4-10- 4 60 rI I u:.. urvirwC:il
CITY OF TIGARD
BUILDING DIVISION PERMIT #: PLM20 3- 0;1070
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 2 /2.6/2008
Phone: (503) 639-4171
Inspection Requests (24 Hrs.): (503) 639 -4175 1 L
. INSPECTION WORKSHEET FOR DATE: 2/28/2008 TIME: 7:00AM PAGE: 33
SITE ADDRESS: 12991 SW 1106TH Pl. CLASS OF WORK:
SUBDIVISION: HUNTER'S WOODLAND LOT #: 006 TYPE OF USE:
PROJECT NAME: MCCOLLUM
DESCRIPTION: BATH REMODEL
OWNER: MCCOLLUM, YAM PHONE #: 971 -221 -6011
CONTRACTOR: NORTHWEST CENTRAL PLUMBING PHONE #: ' .J03 - 642. - 20£ 7
Inspection Request Scheduled For: Date: 2/28/2008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
320 Plumbing rough -in 0658013 -01 603-642-2067 N
Corrections /Comments /Instructions:
erb v� iL. c ems✓ S fi/1
*PASS n PARTIAL APPROVAL ❑ CANCEL n NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: ad L.-..' NL— Date: 2,1 O.37- . Phone #: (503) 718-
Case Activity Listing
10/8/2008
CCEL1 Case #: LM2#O8 -00070 7 % 9:42:49AM
Assigned Done Updated
Activity Description Date 1 Date 2 Date 3 Hold Disp To By By Notes
PLM 1010 Application received 2/26/2008 None RECD BTT 2/26/2008
BTT
PLM1020 Permit created 2/26/2008 None DONE BTT 2/26/2008
BTT
PLM 1030 Check for parcel tags 2/26/2008 None DONE BTT 2/26/2008
BTT
PLM 1260 PLM signature on 2/26/2008 None DONE BTT 2/26/2008
application BTT
PLM1280 Issue permit 2/26/2008 None DONE BTT 2/26/2008
BTT
PLM2320 Plumbing rough -in 2/27/2008 2/28/2008 2/28/2008 None PASS JW 2/28/2008 065808 - 01 — 503 - 642 - 2067 VM -
STI N
qw 5r N r c Citr�C� -�o� �-•�
Page 1 of 1 CaseActivity..rpt