Permit CITY TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT PERMIT #: PLM2007 - 00004
T[GARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 1/4/2007
PARCEL: 1S125DB-12200
SITE ADDRESS: 09403 SW 74TH AVE ZONING: R - 4.5
SUBDIVISION: PP1990 - 008 LOT: 003 JURISDICTION: TIG
Project Description: Replace 25' of water service.
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: SEWER LINE: ft
WATER CLOSETS: WATER LINE: 25 ft
DISHWASHERS: RAIN DRAIN: ft
Owner: FEES
WARREN AN EY
9403 SW 74TH Description Date Amount
TIGARD, OR 97223 [PLUMB] Permit Fee 1/4/2007 $72.50
[TAX] 8% State Surcharl 1/4/2007 $5.80
Phone : 503- 246 -8613 Total $78.30
Contractor:
CASEY'S PLUMBING INC
PO BOX 30075
PORTLAND, OR 97294 REQUIRED ITEMS AND REPORTS
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 OUNC by calling 503.246.6699 or 1.800.332.2344.
Issues By: / 4 1 / / ; I PermitteeSig :ture:
■•■•■ - .
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.
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Plumbing Permit Application. - ' FOlt OF ICL E SE ONLY 3 2007
City of Tigard A ' Received � �i Permit No.: ` j oo 7���
, 723 , , /,.� g Date/By: 5 _ q 13125 SW Hall Blvd., Tigard, 2t • 1 1ItU D an Review
Phone: 503.639.4171 Fax: 9 l t. w Date/By: Other Permit No.:
TIGARD Inspection Line: 503.639 . �y - Tr., y �q 1 Date Ready/By: luris; fd Sec Page 2 for
Internet: www.tigard or.go�Ti 19 Y 1 1 ° INK ° l ��t Notified/Method: f 0 Supplemental Information
TYPE OF WORK FE * SCHEDULE
❑ New construction ❑ Demolition For special information use checklist
Description I Qty. 1 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: 9403 SW 74 Ave Catch basin or area drain 16.60
City /State /Z1P: Tigard, OR 97223 Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: 1 Project name: Footing drain (no. linear ft.: ) Page 2
Manufactured home utilities 110.00
Cross street/directions to job site:
Manholes 16.60
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.: .1_5) Page 2 55.00
Fixture or item
Tax map /parcel no.: -
Absorption valve 16.60
DESCRIPTION OF WORK Back-flow preventer Page 2
Replacing exterior water service Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
® PROPERTY OWNER I ❑ TENANT Drinking fountain 16.60
Ejectors/sump 16.60
Name: Warren Aney
Expansion tank 16.60
Address: Same as above Fixture/sewer cap 16.60
City/State/ZIP: Floor drain/floor sink/hub 16.60
•
Phone: (503)246 -8613 Fax: ( ) Garbage disposal 16.60
® APPLICANT ❑ CONTACT PERSON Hose bib 16.60
Ice maker 16.60
Business name: Casey's Plumbing, Inc -
Intereeptor /greasetrap 16.60
Contact name: Julie Campbell Medical gas (value: $ ) Page 2
Address: PO Box 30075 Primer 16.60
City / State/ZIP: Portland, OR 97294 Roof drain (commercial) 16.60
Phone: (503) 253 -0030 Fax: : (503) 262 -8251
Sink/basin /lavatory 16.60
Tub /shower /shower pan 16.60
E -mail: caseysplumbing @comcast.net
Urinal 16.60
CONTRACTOR Water closet 16.60
Business name: Casey's Plumbing, Inc Water heater 16.60
Address: PO Box 30075 Other.
City /State/ZIP: Portland, OR 97294 Subtotal 55.00
Minimum permit fee: $72.50 72.50
Phone: (503) 253 -0030 Fax: (503) 262 -8251 Residential backflow minimum permit fee: $36.25
CCB Lic.: 147298 Plumbing Lic. no.: 26 -725PB Plan review (25 %ofpermit fee)
Authorized signature: ., / ) 4 State surcharge (8% of permit fee) 5.80
�u:.��� / TOTAL PERMIT FEE 78.30
Print name: Julie Ca + i hell Date: 01/03/07 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.
[:\ BuildingWermits \PLM- YermitApp.doc D6/26106 440- 4616T( IC /02JCOM/WEB)
CITY-QF-TI.GARD .
BUILDING DIVISION PERMIT #:
P
13125 SW Hall Blvd., Tigard, OR 97223 D ATE ISSUED:
Phone: (503) 639 -4171 vA iiq
Inspection Requests (24 Hrs.): (503) 639 -4175 IL.
INSPECTION WORKSHEET FOR DATE: 1/5/2007 TIME: 7:00AM PAGE: 10
SITE ADDRESS: 09403 SW 74TH AVE CLASS OF WORK:
SUBDIVISION: ppi990 LOT #: 003 TYPE OF USE:
PROJECT NAME: ANEY
DESCRIPTION: Replace 25' of water service_
OWNER: ANEY, WARREN PHONE #: 503..246.8513
CONTRACTOR: CASEY'S PLUMBING INC PHONE #: 503 -253 -0030
Inspection Request Scheduled For: Date: 1/5/2001 Pour Time:
Code # Inspection Description Confirm # Contact # Message
330 Water service 041853-01 503.253.0030 N
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Corrections/Comments/Instructions:
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PASS n PARTIAL APPROVAL n CANCEL 1 NO ACCESS
n FAIL CALL FOR INSPECTION ❑ ADDI IONA FEES ASSESSED •
Inspector: Date: Phone #: (503) 718-