Permit A , CITY OF TIGARD PLUMBING PERMIT
I� DEVELOPMENT SERVICES PERMIT #: PLM2005 -00197
'l l 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 5111!2005
PARCEL: 2S112CA -13000
SITE ADDRESS: 15566 SW 76TH AVE ZONING: R -7
SUBDIVISION: RENAISSANCE WOODS NO. 2 LOT: 054 JURISDICTION: TIG
Project Description: Remodel fixtures. Other fixtures: 3 ice makers.
CLASS OF WORK: ALT GARBAGE DISPOSALS: .00 MOBILE HOME SPACES:
TYPE OF USE: WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: R3 FLOOR DRAINS; TRAPS:
STORIES: WATER HEATERS: CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: 2 URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES: 3
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: ( RAIN DRAIN: ft
Owner: FEES
HUTTON, BRIAN D + DEBORAH A Description Date Amount
15566 SW 76TH AVE
TIGARD, OR 97224 [PLUMB] Permit Fee 5/11/2005 $99.60
[TAX] 8% State Surcharl 5/11/2005 $7.96
Phone : 503 624 - 6761 Total $107.56 /y3, 'f
Contractor:
FOUR STAR PLUMBING INC
10745 SE EASTMONT DR REQUIRED ITEMS AND REPORTS
GRESHAM, OR 97080
Phone : 503- 663 -6722
Reg #: LIC 139370
PLM 3 -437PB
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes
and all other applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is
not started within 180 days of issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law
requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 - 0001 -0010 through OAR 952 - 0001 -0100. You may obtain copies of these rules or direct questions to OUNC by
calling 503 - 246 -6699 or 1-800-332-2344.
Issued By /CL. -v C ci?Z- Permittee Signature: '7 or 02-it
Call 503 - 639 -4175 by 7:00 a.m. for an inspection that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
May 09 05 04:O1p p.4
My•U9 05 04:05p FourStar Plumbing Inc_ 503 -663 -6332 p.l
RECEIVED p.z
I
Building Fixtures
Plumbing Permit Applicatib hon OFFICE «sE CI L
®20 Y ,
City of Tigard '4�a s.r .-
t 3125 SW Halt Blvd., Tigard, OR 97223 CITY OF TIG RG Da c/By- .5
. D/p Penrotrro. 5 p(7/ rj -7 Phone: 303.639.4171 Fax: 503.59&1960 ; ;,. � I ..r. PIQiRe+ie. ! ��` ~
�. �'� ®`�� ®� r •'^• :'' .Other Permit Na-:
24 -}tour inspection Line: 503.539.4175 , .� i , naictav:
Intranet: wwrr.ei.tipytd.ot.us _�;�!,!'i ....r Date Ready/By. twis : 3 SC. Pare >! for
I Nerifud/MatDo3: �� S vpplemeucr lJrderroailo°
.{'- . :�: u' f if :r . \.. '.`Ya,�.r • -Y.. .k., .li: ..p.. - � =.. .�. :
ys . : ... .; •' : :$:": .. ;'.i.:;'7.:"-.." il, : klrtg: Y [- �� _
❑ New construction D Elcnto :ition For special iejorrwn>ron use cheeilist
Description f Qty. f Fs. 1 Total )
. ��A dditionialteratioa/xpiatemcnt I D Othe . New 1- 2- family dwellings (includes 100 0. for each utility connection) I
. r' _: • F :r... .��� O.t.S Y1, d ,n.�.... .. SFR 1 bash
. . =" . : :' %: : ' ...1 ..,. .�� :a :• .a�- O 209.20
w and 2- family dwelling ! 0 Cornmereialfindustrial "'' SFR (2) bath _ 150.00
D Accessary building I ❑ Multi- family SFR (3) bath 344.00
• ❑ Master btuldcr Other. Each aA1ilionnl ba•,hfkitchem 45.00
a„ ° , r . . 0 Fite Winkle'
6 -) P a 2
.. :j'.n,.: . >a S:s ;1[ 1 ' k.. r 2 O i. - 11R m 3 R -A t'1- j. . :? _ ,,,,-,,,,.. % :7 z8
to utilities
lob Site a ddress: /.<415,6 C eC f -7 / �/ �� 16.60 s/ / ! Catch basin or arcs drain 16 ,
Cfity/Statd23P ,[mil tn.V 4( 9 Zz41 Drywefl leach lire, or trench drain 16.60
Suit Jhldg.lapt. no.'. Project name. f Folding drain (no. kncar It: _ 1 .
Cross strcef/direc . t _'ob site Manufactured home utilities 1 10.00
��* `Manholes ` 16.60
� r - Rain drain connector 1 16.60
Sanitary sewer (ao. linear fl.: 3 ' Page 2 ;
Storm sewer (no. linear ft.: ) Page 2
{ff Subdivision: Lot no.; Water service (no. linear R.: 3 page 2
Tax map/paled no.: Fixture or hear
_- :_r ::
, •7+:.L:;. ` : � _ " tt011i:O . Ii/ yti . I _,: ,. Absorption valve 16.60
;; _. . . : :6i`el- '- , iTl S
T _. f_: , . - . qt, r,,I, Backflaw pitvcntcr ` Pagc2 •
Y Backwater valve 16.60
Clothes washer 16.60
c� J.X ; J Dishwasher 16.60
zit- :` -if: '-'r 4 T O..r, r :. �. -4k "Ji,11,Fi ' :li4t?� Drinking fountain 16.60
Marne (rl}/14 --,■ r-1-4,-... Ejcctorsisunp 16.60
Address: a� tSS66 s(� -
Expansion tank 1 16.60
Fixture/sewer cap 1 • 16.60
City/Stale/ZIP: vK 97 ZLy Floor drain/floor sink/hub
16.60
77>�Phone: (. ) ` q �� -- 674 ! Fax; ( ) Garbage disposal 9 16.60 J
:ice ! V�R1et r : b L " �'' ? .1 i Y y 3 <r_.- 'Anse 16.60
: .. .ri,c } f•,�+:c' . ._.yi,.,A, CP, .t •
d d. fee rrtslrcr 16.60
Business tame: J ukD 5 c �) ... ` GT/dM ,
Contact name: -00 �O1? Medical gas . S age 2
Medical pas (vz]ve: S ) Page 2
Address: f 7 o y vU j% 71F/LC) Prima 16.60 ' • 1
CityIState7ZuP: Roof drain (oonsmcrci°n 16:60 •
Mewl ( ( ) Sinktaasio/la.atory a 16.60
I Fa x::
E-mail:
- Tub/shower/shower pan 16.60
_ K- `'`� .. ".:c; ..,,yy��.. Vic; _ Urinal
?'4kr,,, ,� " :. *ir; :S.. a _ «;; :(F 'G•r :ch , _1: ,;_ ? :r C::;:.=:..,.• - .. : :: , ;6.60
i - � c �.,:'.. .,. Y . ..` .s;: e'., > - W atcrclort 16.60
O Btumess name: U !�C, !NG� �N C. Water heater 16,60
1` Gty/SrgrerlIP : / teat . _ 1, /� Subtotal (.;54%'()
��- -' rr.tT'e'"�� -, � g
� c Minimum permit fee: 572.50 •
Phone: ( - (_fl 1.,' Fax: (57:11. l Residential baddlow minimum permit fee: 436.25 .
CCBLic.: 1 39' 370 PltmtbingLic.no.: -3_ -c,F3> f Plan review (25% of permit fee)
Authnrizcd signature: / I t) (q State surcharge (5% orpermit fee) 1 -7 .q&
L TOTAL PERMIT FEE
Pr nan1C; �� A....7-5-4 r5
Gt 1 -4 1 i Date:5i 9 - This permit application expires it a permit is not ob(itne-d within
..7 IBA days after it has been accepted us complete.
'Fee methodology set by Tri- Courny Building industry Service - . rd.
1. EE- romkApplu a 12/01 4444167(10/1m03hOwnii
[9 7i 5i7
CITY OF TIGARD
BUILDING DIVISION PERMIT #: PLM200S -00197
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 5/11/2005
Phone: (503) 639 -4171 jo "rili
Inspection Requests (24 Hrs.): (503) 639 -4175 .��� �_..
INSPECTION WORKSHEET FOR DATE: 7/13/2005 TIME: 7:10AM PAGE: 7
SITE ADDRESS: 15566 SW 76TH AVE CLASS OF WORK:
SUBDIVISION: RENAISSANCE WOODS NO. 2 LOT #: 054 TYPE OF USE:
PROJECT NAME: HUTTON
DESCRIPTION: Remodel fixtures. Other fixtures: 3 ice makers. 5/12/05, per contractor relocating (1) dishwasher,
adding another garbage disposal.
OWNER: HUTTON, BRIAN D + DEBORAH A, PHONE #: 503 -624 -6761
CONTRACTOR: FOUR STAR PLUMBING INC PHONE #: 503-663-6722
Inspection Request Scheduled For: Date: 7/13/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
399 Plumbing final 011324 -03 503 - 7099323 N
Corrections /Comments/ Instructions:
d ' l
.,
A
W PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
/yr) , .7
Inspector: Date: r 3 Phone #: 503
P / � ( ) 718 -