Permit C ITY OF TIGARD PLUMBING PERMIT
DEVELOPMENT SERVICES PERMIT #: PLM2004 -00394
'• I �! 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 8/30/2004
SITE ADDRESS: 09425 SW 70TH AVE PARCEL: 1S125DA -10400
SUBDIVISION: PP1994 -061 ZONING: R-4.5
BLOCK: LOT: 001 . JURISDICTION: TIG
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
Remarks: Remove and replace defective shower stall.
FEES
Owner:
Description Date Amount
WOLLANDER, JON ADAM
9425 SW 70TH AVE [PLUMB] Permit Fee 8/30/2004 $72.50
TIGARD, OR 97223 [TAX] 8% State Surcharl 8/30/2004 $5.80
Total $78.30
Phone:
Contractor:
SUPER SERVICE MECHANICAL
5555 SE MEADOW TER
MILWAUKIE, OR 97267 REQUIRED INSPECTIONS
Phone : 503 - 659 - 2937 Rough -in Insp
Final Inspection
Reg #: PLM 34 - 384PB
LIC 90093
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. ��
Issued By: e. ___ Permittee Signature: _ (-
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business lay
Aug 88 04 12:22p Daniel P. Jennings 503 - 654 -1931 p.1
Plumbine Permit Applicat ,. ke lp FOR 01;110E USE ONLY
City of Tigard 0 0 p r't -30 el Ikl -- �
rertNa C, �l GU 3f
13125 SW hull Blvd . Tip ()R 9 G 0
OQ� Plan Review _...... . .
Phone: 503.639.4171 Fax: e: 503.598. 9900
c� O �1 /..' ' n Other Permit No.:
��4 i Dalemy:
24-1 tour inspection l .inc: 503.639.4175 ` `c J L J Dade R eady/By: 14,0 13 See Page 2 for
Internet: www.ci.ligard.or.us P VV �• . Notified/Method: -r I (f Supplemental Iaformatioa T
•r PE \g p NO PIE" St'HEDI ALE
.gy ...._,... .... ..., -
❑ New constructionC Ik
DemolIlion For Mal in o, oration dce checklist
*a.._01:-1 • acripnon ECM F•a 1'ow1
® Addition /adteraliof/replaccmcrlt 0 (filter: _ New 1 - 2- family dwellings (includes 100 R. for each utility connection)
--
CATEGORY OF ('ONN - FRI T( - 110N SIR(!) bath 249.20
-
® 1 - and 2- family dwelling ❑ Corumeteial /industrial SFR (2) hath 350 00
-
1:1 Accessory building ❑ Multi - family SFR (3) bath 39').00
- - Each additional bath/kitchen 45.00
❑ Master builder ❑ Other: • - '
Fire sprinkler ( sq. R.) Pagc 2
JOB SITE INFoRPIATION AND 1RX'ATIL)N _ Site Windt"
Job site uddrars: 9425 SW 70 Ave. Catch basin oranz drain - 16.60
City/Suite/LIP: Tigard, OR 97223 Drywell, leach line, or trench drain 16.60 --
Suite/bldg. /apt. no.:1 Project name: - Y _ Fooling drain (no linear fl ) Page 2
Manufactured home utilities 110.00
Casa tared/directions to job site:
Manholes 16.60
-
Ram drain connector 16.60
Sanitary sewer (no. lineal ft.: ) Pagc 2
Storm sewer (no. linear R.: ) Pagc 2
Subdivision: 15;17 ci.: Water service (no. linear 0.: ) ----- Page 2
- - Fixture or item
'fax map /parcel no.: -
Absorption valve 16.60
DESCRIPTION OF WORK - Backfluw prevcntcr -- - Page 2
Remove and replace defective shower stall Backwater valve WOO
Clothes washer 16.60
Dishwasher 16.60
® PROPVRT1 OM NER l 0 TENANT Drinking tbuntain
-
Owen/sump 16.60
Name: Wollauder Expansion tank 16.60
Address: 9425 SW 70 Ave. Fixture /sewer cap 16.60
City /Stater /JP: Tigard, OR 97223 Floor drain/tloor sink/hob 16.60
Phone: (503)318 - 9610 Fax: ( ) Garbage disposal 16.60
- Hoc bib 16.60
® . 1'I'LK _ANT ❑ ('ONT.\(T PERSON -
Ice math 16.60
13usn,ess name: Soper Service Mechanical .� _ _ Interceptor /grease trap 16.60
Contact name: Medical gas (value: $ ) Pagc 2
V
Address: Primer 16.60
C1ty /Sratct %IP: Roof dram (commercial 16.60
.. Sink/basin/lavatory 16.60
Phone:( ) Fax::( ) _
'Tub/shower /shower ram ! 16.60 ^
1'-muil: Urinal 16.60
('t)NTR. ►f TOR Water closet 16.60
O {iusincss name: Super Service Mechanical Water heater 16.60
Address: 5555 SE Son MEadow Terrace Other -
7-'•-- Subtotal
Lit /State/ZIP: Milwauhie, OR 97267 -
y Minimum pernul fix.: $7230 -72 r;
1, Phone: (503) 659 - 2937 Fax: (503) 654 - 1931 Residential backlluw minimum permit fcc: $36.25
6 CCB Lic.: 90093 Plumbing I.ic. no.: 34 -384PB Plan review (25% of permit fm)
State surcharge (8% of permit fey) r -
Avthon. ed signature: _ TOTAL PERMIT PRE 2g -
I Print name: Daniel P. Jennings I ate: 08/28/04 I This permit application eapires if a permit is not obtained Within
- IRO days after it has been accepted as complete.
•1 ce madhodoloov set by Tri- ounty Buildine Industry Service Board.