Permit ix / � k ' a k a CITY OF TIGARD
PLUMBING PERMIT
3r.
COMMUNITY DEVELOPMENT PERMIT #: PLM2007 -00492
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 11/2/2007
PARCEL: 1S134BC-90020
SITE ADDRESS: 10825 SW 121ST AVE ZONING: R -7
SUBDIVISION: WOODSPRING CONDOMINIUMS LOT: 020 JURISDICTION: TIG
PROJECT: MILLER
Project Description: Kitchen remodel.
CLASS OF WORK: ALT GARBAGE DISPOSALS: 1 MOBILE HOME SPACES:
TYPE OF USE: SFA WASHING MACH: 1 BACKFLOW PREVNTRS:
OCCUPANCY GRP: R3 FLOOR DRAINS; TRAPS:
STORIES: WATER HEATERS: 1 CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: 1 URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES:
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: 1 RAIN DRAIN: ft
Owner:
FEES
DAVID MILLER
10825 SW 121ST Description Date Amount
TIGARD, OR 97223 [PLUMB] Permit Fee 11/2/2007 $83.00
[TAX] 8% State Surcha 11/2/2007 $6.64
Phone : 503 -579 -3239 Total $89.64
Contractor:
E J CASSELLA
2000 NE 42ND #189
PORTLAND, OR 97213 REQUIRED ITEMS AND REPORTS
Contact # : PRI 503- 233 -4563
FAX 503- 963 -1803
Reg #: LIC 35622
PLM 26 -1195C
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 ad pted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 0001 -0010 through OAR 952 - 0001 -0100. Yo may obtain copies of
these rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
1 �� 1
Issued By: — I Permittee Signature: �l J IN/ ` '
— . _ ,
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.
ECEIWED
., . ...
Plumbing Permit Applicam FOR OFFICE USE ONLY
iiii City of Tigard � � 3 t >✓ • 2007 Date/By: Received ! a�p? 46 S Permit 'VA/2/4512_ pz, �f. --
a 1 3125 SW Hall Blvd., Tigard, OR 9 "
_ � � ®F TICARD Plan By: Other Permit No.:
Phone: 503.639.41 Fax: 50 Date /By:
T I G A RD Inspection Line: 503.639.4175 BUILDING DIVISION Date Ready /By: lot 10 See Page 2 for
Internet: www.tigard or.gov Notified /Method: Supplemental Information
TYPE OF WORK FEE* SCHEDULE
❑ New construction ❑ Demolition For special information use checklist.
Description 1 Qty. 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: lore- G ] � k) it1 r AdW__ Catch basin or area drain 16.60
City /State /ZIP: I�A1 .r) f.7 611223 Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: y Project name: W D O D r y pm Footing drain (no. linear ft.: ) Page 2
` — Manufactured home utilities 110.00
Cross street/directions to job site:
Manholes 16.60
121 '71 ) 6003 - Rain drain connector 16.60
1 ( 60-2 � r ( J � I l h )I V Sanitary sewer (no. linear ft.: ) Page 2
I� V Storm sewer (no. linear ft.: ) Page 2
Subdivision: I 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
Kom i.' 1 b L MDAD ' )K I knOV2 � Backwater valve 16.60
Clothes washer I 16.60 I(o,
Dishwasher I 16.60 «p 40
Tlf PROPERTY OWNER 1 CI TENANT Drinking fountain 16.60
Ejectors /sump 16.60
Name: '3 v v_,(1wxetz, Expansion tank 16.60
Address: I ge ) 2c- 7 c° 12I :j <scV-E-__ Fixture /sewer cap 16.60
City /State /ZIP: -11 ma,c) L Floor drain /floor sink/hub 16.60
( 60D 3 - _ Garbage disposal 1 16.60 1(0, �(�
Phone: (6y- ��� �} 4 v `N/ / Hose bib 16.60
APPLICANT ❑ CONTACT PERSON
4.151.70.E_ Ice maker 16.60
Business name: � 4ra� � Interceptor /grease trap 16.60
Contact name: Medical gas (value: $ ) Page 2
Address: Primer 16.60
City /State /ZIP: Roof drain (commercial) 16.60
Sink/basin/lavatory I 16.60 Ica (on
Phone: ( ) Fax:: ( )
A,, Tub /shower /shower pan 16.60
E-mail: �' (ZZZ(O 4o , (.0s i t Urinal 16`;60
CONTRACTOR Water closet 16.60
Business name: E'� ( Water heater ( 16.60 ( ,(00
Address: 2 1 ,1E '-IZ 151 Other:
Subtotal
City /State /ZIP: ' „q Ly) t (re_ 6 2(
Minimum permit fee: $72.50
Phone: (Q j) z ,_( (0 3 ,�y� Fax: ( ) of b s - o . Residential backflow minimum permit fee: $36.25
CCB Lic.: � (a 2 2 y I' 1 09 Plumbing Lic. no.: � � -F' Plan review (25% of permit fee)
t 94 -I i q 5 State surcharge (8% of permit fee) (� 1, -I
Authorized signature: / , 'h. •O TOTAL PERMIT FEE 'C (A
Print name: i / / rIT N Date: 1 2 o7 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\PLM- PermitApp.doc 06/26/06 440- 46t6T(I0/02 /COM/WEB)
T
CITY OF 1IGARD t '
BUILDING DIVISION PERMIT #: PL_M2007 -00492
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 11/2/2007
Phone: (503) 639 -4171
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 1//8/2007 TIME: 7 :00AM PAGE: 48
SITE ADDRESS: 10825 SW 121ST AVE CLASS OF WORK:
SUBDIVISION: WOODSPRING CONDOMINIUMS LOT #: 070 TYPE OF USE:
PROJECT NAME: MILLER
DESCRIPTION: Kitt :hen remodel.
OWNER: MILLER, DAVID PHONE #: 03-579-3239
CONTRACTOR: Ell CASSELL.A PHONE #: 503 - 233.4563
Inspection Request Scheduled For: Date: 11/8/2007 Pour Time:
Code # Inspection Description • Confirm # Contact # Message
320 Plumbing rough -in 059246-01 503 -349 -4036 Y
Corrections /Comments /Instructions:
PASS . ❑ PARTIAL APPROVAL ❑ CANCEL n NO ACCESS
FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: `"'"'`. Date: ) )/313 Phone #: (503) 718-
Case Activity Listing /177 i 10/8/2008
GCE!. Case 54�37AM
Case #:�PLl�I2007 -00492 i
Assigned Done Updated
Activity Description Date 1 Date 2 Date 3 Hold Disp To By By Notes
PLMI010 Application received 11/2/2007 None RECD BB 11/2/2007
BB
PLM1020 Permit created 11/2/2007 None DONE BB 11/2/2007
BB
PLM1030 Check for parcel tags 11/2/2007 None DONE BB 11/2/2007
BB
PLM1280 Issue permit 11/2/2007 None DONE BB 11/2/2007
BB
PLM2320 Plumbing rough -in 11/7/2007 11/8/2007 11/8/2007 None PASS JW 11/8/2007 059246 -01 -- 503- 349 -4036 - VM -
STI Y
//e) N ot
Page 1 of 1 CaseActivity..rpt