Permit �,.., CITY O F !•Tl GARD PLUMBING PERMIT
` " I ° `' COMMUNITY DEVELOPMENT PERMIT #: PLM2007 -00112
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 3/20/2007
PARCEL: 1S136CA-04700
SITE ADDRESS: 10960 SW 79TH AVE ZONING: R - 4.5
SUBDIVISION: FRIENDLY ACRES LOT: 001 JURISDICTION: TIG
PROJECT: HENRIE
Project Description: Replace approx. 250' water line inside house. Galvanized to copper.
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: 250 ft
DISHWASHERS: RAIN DRAIN: ft
Owner: FEES
DAMON HENRIE
10960 SW 79TH AVE. Description Date Amount
TIGARD, OR 97223 [UHRPLM] Hourly Plu 3/20/2007 $115.74
[UHRTAX] Hourly 8% c 3/20/2007 $9.26
Phone : 503- 860 -4780 Total $125.00
Contractor:
OWNER
REQUIRED ITEMS AND REPORTS
Contact # :
Reg #:
. 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: 4 ' /. Permittee Signatur tillr
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.
- � ' c`" . L. . � ^' " 3 FOR OFFICE USE ONLY
Plumbing Permit Applicgiion ° .
City of Tigard p Date /B b `� 207
ff, tr�� Permit N . •
. � 13125 SW Hall Blvd., Tigard, OR 1rf 23 is 0 2007 Plan Review Lam±
Phone: 503.639.4171 Fax: 503.598.1960 Date /By: Other Per it No.: ®0 J/ a -
TIGARD Ins ectiott Line: 503.639.4175` p d � t� 6 ' ' Date Read /B r El See Page 2 for
p i ilk t 4�l n t Ready /By:
Internet: www.tigard _ .� ry T Notified /Method Supplemental Information
u ' 1 ; ' TYPE't > ORKt` u i E* " CS C
❑ New construction ❑ Demolition
For special information use checklist
_ Description Qty. Ea. Total
® Addition /alteration /replacement 111 Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
CATE OT CONSTRUCTION ` t SFR (1) bath 249.20
pj 1- and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 350.00
SFR (3) bath 399.00
❑ Accessory building ❑ Multi- family
Each additional bath /kitchen 45.00
❑ Master builder ❑Other: Fire sprinkler ( sq. ft.) Page 2
JOB SITE INFORMATION ANDS "LOGATIONN i
� . „_ ete _ .. Site utilities
Job site address: tO loco 4 w • Catch basin or area drain 16.60
City /State /ZIP: 'C it Aao I 61.1, 91.223 Drywell, leach line, or trench drain 16.60
Footing drain (no. linear ft.: ) Page 2
Suite/bldg./apt. no.: Project name:
Manufactured home utilities 1 10.00
Cross street/directions to job site: Manholes 16.60
C PI 78' LEFT Rain drain connector 16.60
- rU 1FrrAft.S le-VC Sanitary sewer (no. linear ft.: _) Page 2
cf t'ef ~ Q Storm sewer (no. linear ft.: ) Page 2
Subdivision: I Lot no.:
Wafer service (no. linear ft.: _) Page 2
Fixture or item
Tax map /parcel no.: Absorption valve 16.60
. . , _ .: , �, DESCRIP: , N OF N'ORIC N y x; Backflow preventer Page 2
- Ec C A Q Li) t . COPP� -. Backwater valve 16.60
,/� n , n / AGO e ^n "y ex., . A p t`-"�OJr J, , _ Clothes washer 16.60
I �t 1'w � Lt�.�� (/ Dishwasher 16.60
Drinking fountain 16.60
PROPERTY° OWNER 'Y TENANT
-
Name: ._ Ejectors /sump 16.60
Name: - y`pt ti taAe Expansion tank 16.60
Address: tcf(O St.\ - 29, 11 - Ac Fixture /sewer cap 16.60
City /State /ZIP: .-nb_ CQ cr7 2ZS Floor drain /floor sink /hub 16.60
Garbage disposal 16.60
Phone: (5 73) c) L{')�Q Fax 61:9") 9:14;?, -275S Hose bib 16.60
a
.,• ri„ APPLICANT DyCON I ACT PERSON
Ice maker 16.60
Business name: Gt �0'' , �L 9 Interceptor /grease trap 16.60
Contact name: 7� Medical gas (value: $ ) Page 2
Address:
Primer 16.60
City /State /ZIP: Roof drain (commercial) 16.60
Sink /basin /lavatory 16.60
Phone: ( ) Fax:: ( )
Tub /shower /shower pan 16.60
E -mail: Urinal 16.60
i k „GON1 RACT012,. Water closet 16.60
Business name: Water heater 16.60
Address: Other:
Subtotal
City /State /ZIP: permit fee: $72.50
Phone: ( ) Fax: ( ) Residential backflow minimum permit fee: $36.25 ti 5.
CCB Lic.: Plumbing Lic. no.: Plan review (25% of permit fee)
State surcharge (8% of permit fee) 67. - Authorized signature: \ TOTAL PERMIT FEE A9,5.06
Print name: R. �� �`�� 5 I Q ` Date: ``V' 0 This permit application expires if a permit is not obtained within
�a�� 180 days after it has been accepted as complete.
*Tee methodology set by Tri- County Building Industry Service Board.
1: \Buildin \Permits \ PLM- PermitApp.doc 06/26/06 440 -461 6T(I 0 /02 /COM /WEB)
l
a .CITY OF TIGARD JD
BUILDING DIVISION PERMIT #: PLM2007- 00'112
U G SION
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 312012007
Phone: (503) 639 -4171 iiN�i +o
In Requests (24 Hrs.): (503) 639 -4175 �
INSPECTION WORKSHEET FOR DATE: 6/5/2007 TIME: 7:01AM PAGE: 93
SITE ADDRESS: 10960 SW 79TH AVE CLASS OF WORK:
1 SUBDIVISION: FRIENDLY ACRES LOT #: 001 TYPE OF USE:
PROJECT NAME: HE.NRIE
DESCRIPTION: Replace approx. 250' water line inside house. Galvanized to copper.
OWNER: HENRIE, DAMON PHONE #: 503 -860 -4780
CONTRACTOR: OWNER PHONE #:
Inspection Request Scheduled For: Date: 615/2007 Pour Time:
Code # Inspection Description Confirm # t # Message
330 Water service 049342 -01 503- 860 -4780 Y
Corrections /Comments /Instructions:
r 4
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0 (4//- / / / ' 1
I,
/ . .
PASS n PARTIAL APPROVAL • n CANCEL n NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: 0 ' v Date: _
1 ')__'
1 Phone #: (503) 718-