Permit v CITY OF TIGARD PLUMBING PERMIT
° COMMUNITY DEVELOPMENT PERMIT #: PLM2009 -00019
DATE ISSUED: 2/3/2009
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 PARCEL: 2S103DB - 03200
SITE ADDRESS: 11385 SW NOVA CT ZONING: R -4.5
SUBDIVISION: GENESIS LOT: 008 JURISDICTION: TIG
PROJECT: REED
Project Description: Replace 100' of sewer 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: 100 ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Owner:
FEES
BRENT REED Description Date Amount
11385 SW NOVA COURT
TIGARD, OR 97223 [PLUMB] Permit Fee 2/3/2009 $72.50
[TAX] 12% State Surcha 2/3/2009 $8.70
Phone : 503- 799 -9899 Total $81.20
Contractor:
WESTSIDE UNDERGROUND UTILITIES INC
30585 NW EVERGREEN RD
HILLSBORO, OR 97124 -1855 REQUIRED ITEMS AND REPORTS
Contact # : PRI 503- 969 -4631
FAX 503 -681 -8045
Reg #: LIC 110690
PLM 34 -478PB
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 dired questions
to OU NC b • • '13.246.6699 or 1.800.332.2344.
Issue. By: L... // ✓. A Permittee Signat re: ( 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.
ill -
FROM : WESTSIDE UNDERGROUND FAX NO. : Feb. 02 2009 05:13PM P1
r Plumbing Permit Appli • •
Building Fixtures CENED FOR 01 , 1(' 1: t Si: (/ N1,1
City of Tigard 2 2.009 aecrive.s 0 9 Irndlsy. , D� 4 Po,mitNo. ... 1 eD OiZ 4
' 1 11 1 NI 13125 SW 1 hill Blvd., Tigard, OIF�p 3 plan Review
C Phone: 503,639.4171 Fax: 503.598.1960 D udtiY_ Other Permit No.:
1 . I c ; A It 0 Inspection Line: 503.639A175cm OF TIGARD
Dale Ready/By: uy's S P, �e 2 ror
Internet: www.tigard YPE v _• „ DING DIVISION Notified/Method: ,/ pplemental Informntioa
-- d�F FEE* SCHEDULE
St
❑ New construction ❑ Demolition For mfrial information use checklist_
Description _ - . 1 Qty. 1 Ea 1 Total
O Addition/alteration/replacement 2 Other New 1.2- family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (1) bath 249.20
El 1- and 2- family dwelling ❑ Commercial/industrial SFR (2) bath 350.00 -
o Accessory building ❑ Multi -family SFR (3) bath 399.00
Each additional bath/kitchen 45.00
❑ Master builder [] Other:
Fire sprinkler ( _ sq. R) Page 2
. ' JOB SITE INFORMATION AND LOCATION Site utilities
Job site address: 11385 SW Nova Ct. Catch basin or area drain 16.60
City /State/,ZIP: Tigard Or 97223 lhywell, leach line, or trench drain 16.60 `
Suite/bldg./apt. no.: 1 Project riamc: Footing drain (no. linear R: ) Page 2
Manufactured home utilities 110.00
Cross street/directions to job site: Genisis Loop Manholes 16.60
Rain drain connector 16.60
Sanitary sewer (no. linear R: ) 100 Page 2 55.00
Storm sewer (no. linear ft: ) Page 2
Subdivision: Lot no.: Water service (no. linear R: ) Page 2
Fixture or item
Tax map/parcel no.: ---,
Absorption valve 16.60
•
. DESCRIPTION OF WORK Backflow preventer Page 2
Sewer Replacement • Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
® PROPERTY OWNER TENANT •
Drinking fountain 16.60
• Ejectors/sump 16.60
Name: Brent Reed Expansion tank 16.60
Address: 11385 Sw Nova et Fixture/sewer cup 16.60
City /State/ZIP: ITilIteitil Or 97223 Floor drain/floor sink/hub 16.60
Phone: (503)799 -9899 Fax: ( ) Garbage disposal 16.60
® APPLICANT 2 CONTACT PERSON Hose bib 16.60
let maker 16.60
Business name: Westside Underground Utilities Inc.
_ Interceptor /grease trap 16.60
Contact name: Mike Thurman Medical gas (value: $ ) Page 2
Address: 30585 NW Evergreen Rd. Primer 16.60
City /State/ZIP: Hillsboro. Or 97124 Roof drain (commercial) 16.60
Phone: (503) 969 -4431. Fax: : (5503) 651-0045 5inklbasin/lavatory 16.60
Tub /shower /shower pan 16.60 '
E -mail: mthuhunttJhotmaibcom Urinal 16.60
CONTRACTOR Water closet 16.60
Business name: Westaide IlnderCround Utilities Inc. Water herder 16.60
Address: 30585 NW Evergreen Rd. ,Other.
City /State/ZIP: Hillsboro, Or 97124 Subtotal 55.00
Minimum permit fee: $72.50 7250
Phone: (503) 969-4631 Fax: (503) 681 -8045 Residential baddlow minimum permit fee: $36.25
Plan review (25% of permit fee)
CCB Lic.: 110690 Plumbing 1,1e. no.: tin_: 34 -478PB "Atli State surcharge (12% ofpermit fee) 8.70
Authorized signature: G .=- g
.1 TOTAL PERMIT FEE 8120
Print name: Mike't'bnrman Date: 2-02-2009 This permit application expires if a permit is not obtained within
180 days after it has been accepted as complete.
*Fce methodology set by Tri -County Building Industry Service Board_
I: 1Buildiri 5PeemitskPLMR- PermitApp.doe I2I27106 440.4616T(10/02/COM/WER)
CITY OF TIGARD
BUILDING DIVISION A. ..
1 4 DAT ISSUED: PLM2009
13125 SW Hall Blvd., Tigard, OR 97223 213/2009
Phone: (503) 639-4171 14 '1440 1 ( -i Inspection Requests (24 Hrs.): (503) 639-4175 Jag 6 1.)..:
INSPECTION WORKSHEET FOR DATE: 2/5/2009 L - TIME: 7:00AM PAGE: 4
SITE ADDRESS: 11335 SW NOVA CT CLASS OF WORK:
SUBDIVISION: GENESIS LOT #: 008 TYPE OF USE:
PROJECT NAME: REED
DESCRIPTION: Replace 100' of sewer sovice.
OWNER: REED, BRENT PHONE #: 503-799-9899
1 CONTRACTOR: VVESTSIDE UNDERGROUND UTILITIES INC PHONE #: 503-969-4631
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Inspection Request Scheduled For: Date: 215/2009 Pour Time:
CV
Code # Inspection Description Confirm # Contact # Mes'
505 Sanitaly sewer 000334-01 503-969-4631
•
Corrections/Comme s Instruc . ons:
■ • . f Inif`._ •
0
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.. _
01_ PASS 0 PARTIAL APPROVAL fl CANCEL fl NO ACCESS
FAIL 0 CALL FOR INSPECTION E ADDITIONAL FEES ASSESSED
f ,
Inspector: Date: Phone #: (503) 718- ?
, . •