Permit I ll N
CITY OF TIGARD PLUMBING PERMIT
_ COMMUNITY DEVELOPMENT PE
COMMUNITY PLM2009 -00026
DATE ISSUED: 2/13/2009
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 PARCEL: 1S134CA -00507
SITE ADDRESS: 11125 SW 119TH AVE ZONING: R - 4.5
SUBDIVISION: PANORAMA NO.2 LOT: 018 JURISDICTION: TIG
PROJECT: FABIAN
Project Description: Replace 60' of water service.
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: SEWER LINE: ft
WATER CLOSETS: WATER LINE: 60 ft
DISHWASHERS: RAIN DRAIN: ft
Owner: FEES
GOLDA FABIAN Description Date Amount
11125 SW 119TH AVE
TIGARD, OR 97223 [PLUMB] Permit Fee 2/13/2009 $72.50
[TAX] 12% State Surcha 2/13/2009 $8.70
Phone : Total $81.20
Contractor:
CASEY'S PLUMBING INC
PO BOX 30075
PORTLANDD, , O R 97294 REQUIRED ITEMS AND REPORTS
OR
Contact # : PRI 503- 253 -0030
FAX 503- 262 -8251
Reg #: LIC 147298
PLM 26 -725PB
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 OU NC • - = • 503.246.6699 or 1.800.332.2344.
Iss -d By: • $ /' Permittee Signatu e: , , 1■iri;
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.
f 19 09 03:48p Case's Plumbing 5032628251 p.1
Plumbing Permit Application
Building Fixtures g CE'IED FOR OFFICE USE ONLY
City of Tigard Rev
aceiBed anima
Rr Hall Blvd., Tigard, OR Da[e/Hy: Permit No.: ' �� 4 ,, D dI
IIII • 13125 S
11 Phone, 503.639.4171 Fax: 503.598.1960C B 13 2.009 Date/By: Plan Review Other Permit No.:
Inspection Line: 503.639.4175
T 1 G A R D Date Ready/By: 0 See Page 2 for
Internet: www.tigard- or.gov N otified/Method: ^
r`TV pF T�DARD I! Supplemental Information
TYPE OF w il�Qli`1�4�ISI ®sJ FEE* SCHEDULE
❑ New construction emolition For special information use checklist
Description 1 Qty. I . 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
and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 350.00
`❑ Accessory building ❑ Multi - family SFR (3) bath 394,00
❑ Master builder Each additional bath/kitchen 45.00
❑ Other: . - -- i
Fire sprinkler ( sq. ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities
Job site address: r 1 ■ 2..6 aw l l JE Catch basin or area drain
16.60
City/State /ZIP: i ■ n, ,,, c1 23) Drywell, leach line, or trench drain 16.60
Srutelbldg. /apt. no.: Project name: Footing drain (no. linear ft.: ) Page 2
Cross street/directions to job site:
Manufactured home utilities 110.00
Manholes 16.60
- AI lb i � • I C_-Q. Rain drain connector 16.60
•
Sanitary sewer (no. linear ft.: ) Page 2
Storm sewer (no. linear ft.: _ ) Page 2
Subdivision: Lot no.: Water service (no. linear ft.: iftC)) Page 2
Tax map /parcel no.: _ Future or item
Absorption valve 16.60
DESCRIPTION OF WORK Backflow preventer Page 2
LLxl:��e t- � � g
i i C.-'e Backwater valve 16.60 -
Clothes washer 16.60
Dishwasher 16.60
❑ PROPERTY OWNER I 0 TENANT Drinking fountain 16.60
Ejectors /sump 16.60
Name: -
Expansion tank 16.60
Address: Fixture /sewer cap 16.60
City /State /ZIP: Floor drain/floor sink/hub 16.60
Phone: ( ) Fax: ( ) Garbage disposal 16.60
0 APPLICANT ❑ CONTACT PERSON Hose bib 16.60
Business name: C,.aSec S ^v `_ Y ��
Ice maker 16.60
�`��[] Interceptor/grease trap 16.60
Contact name: �A` Medical gas (value: $ ) Page 2
Address: g
-d � pt>yL "'y� Primer 16.60
City /State/ZIP: t az CFI 204 Roof drain (commercial) 16.60
Phone: () v Fax: : Sink/basin/lavatory 16.60
3 00 ( ) aLCa 61 Tub /shower /shower an
E -mail: Coy��G .c P 16.60
��� '�'c-r`cti `t'lq' Cr�t'`!'� Urinal 16.60
CONT CTOR J Water closet 16.60
Business name: S 16.60
Ji trl C� Water heater
Address: `> d r x "-u5-15 Other:
City /State/ZIP: - ! ce on a_Gi Subtotal
Minimum permit fee: $72.50
Phone:
(esla) 0)3- 0030 Fax: (��,33) , kgo_a6 i Residential backflow minimum permit fee: $36.25
CCB Lie.: 1 41 Q973,- Plumbing Lic. no.: ,- V125 Plan review (25% of permit fee)
Authorized signat a r t 1 _ State surcharge (12% of permit fee)
O PJ��� TOTAL PERMIT FEE
Print name: �1��o1e 11.�ed �(�� Date :� . j?� G G This permi app(icatio eiprres if a permit is not co obtainpleteed within
18 days a ft e r it has been a ccept ed m.
•Fee method set by T -County B uilding Industry Service Board.
1:l8uildingw ermitsWPLV1F- PvmitApp.dos 17/27106 44o- 1616T(1 0/02/COMMEB)
CITY OF TIGARD
BUILDING DIVISION - Ci P - MIT #: PLM2009-00026
13125 SW Hall Blvd., Tigard, OR 97223 0 Le DAT SUED: 21: 3/2009
Phone: (503) 63 eiph401 I 1 1' .
Inspection Requ 9-4171 ests (24 Hrs.): (503) 639-4175 ,,--44' IL
INSPECTION WORKSHEET FOR DATE: 2/17/2009 TIME: 7:00AM PAGE: 5
SITE ADDRESS: 11125 SW 119TH AVE CLASS OF WORK:
SUBDIVISION: PANORAMA 1\10.2 LOT #: 010 TYPE OF USE:
PROJECT NAME: FABIAN
DESCRIPTION: Replace 60' of water service.
OWNER: FABIAN, GOLDA PHONE #:
CONTRACTOR: CASEY'S PLUMBING INC PHONE #: 503-253-0030
Inspection Request Scheduled For: Date: 2/17/2009 Pour Time:
Code # Inspection Description Confirm # Contact # Message
330 Water senvice 080569-01 503253-0030 N
Corrections/Comments/ Instructions:
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Inspector: _ DatDate: -)/ oq
Phone #: (503) 718-
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13125 SW Hall Blvd., Tigard, OR 97223 C i) DAT SUED:
Phone: (503) 639-4171 A
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Inspection Requests (24 Hrs.): (503) 639-4175 AtilrALIILa Cdor tilli°
INSPECTION WORKSHEET FOR DATE: 7117,12tV)9 TIME: LONA PAGE: a
SITE ADDRESS: 111 y:, : . i i9 i ,„,,,,', CLASS OF WORK:
SUBDIVISION: id,,ApiipApAp„ I LOT #: 016 TYPE OF USE:
PROJECT NAME: FANAN
DESCRIPTION: Rcpir GU r A t-V3t, Of :•=f-:1"Yi r4;. ,
OWNER: 'AI:3/14.4, ( DA PHONE #:
CONTRACTOR: Cy';: 21 1,..4 i NC , PHONE #: f':Q3 T:4:1- 0030
Inspection Request Scheduled For: Date: ki 11A30E: Pour Time:
Code # Inspection Description Confirm # Contact # Message
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Corrections/Comments/Instructions:
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Inspector: Phone #: (503) 718- -