Permit r% q CITY OF TIGARD PLUMBING PERMIT
- COMMUNITY DEVELOPMENT PERMIT #: PLM2008 -00212
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 5/15/2008
PARCEL: 1S136CA-03900
SITE ADDRESS: 11200 SW 79TH AVE ZONING: R - 4.5
SUBDIVISION: FRIENDLY ACRES LOT: 009 JURISDICTION: TIG
PROJECT: ROWLES
Project Description: Repairing 10 ft. of sanitary sewer.
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: 10 ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Owner: FEES
EVERETT & ROWLES
PATRICIA A Description Date Amount
11200 SW 79TH AVE [PLUMB] Permit Fee 5/15/2008 $72.50
TIGARD, OR 97223 [TAX] 12% State Surch 5/15/2008 $8.70
Phone : Total $81.20
Contractor:
ENVIRONMENTAL SERVICES
3540 SE 28TH AVE
PORTLAND, OR 97202 REQUIRED ITEMS AND REPORTS
Contact # : PRI 503-234-2118
FAX 503- 331 -7133
Reg #: PLM 138344
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: -f4 Permittee Signature: fl , 7 r )01 ,---,
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.
From:Soil Solutions 503 331 7133 05/14/2008 10:27 #156 P.001/002
F1ECEIV
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. Plumbing Permit Application • FoR officE USE ONLY
MAY 1 4 2008
City Of Tigard Received / 6 r 1 L 2.0905?..--,00691
D a iv e • Permit No.:
13125 SW Hall Blvd., Tigard, OR 97223 „. .p 1 Q
Plan Review
Phone: 503.639.4171 Fax 503.598.0Q Y Ol itur, �j�,ai� . { ,fi, �
D� Other Permit No.:
24- Hour Inspection Line: 503.639. ,t s �4 � i
Internet: www.ci.tigard.or.us �9.L� 1 .3 C DateReady/By: Allis: H See age21or
Notified/Method:
Supplemental information .•
YPE OF WORK .;' , . ,
T . - . . FEE *.CHEDULE
❑ New construction ❑ Demolition . For spedal information use checklist. . .. .
Description 1 Qty. 1 • Ea. ` 1 Total
ice. Addition/alteration/replacement ❑ Other: New 1- 2-family dwellings (includes 100 ft. for each utility connection)
CATEGORY:-OF CONSTRUCTION SFR (1) bath 24920
0 1- and 2- family dwelling ❑ CommercialPmdustrial SFR (2) bath 350.00
❑ Accessory building: ❑ Multi - family - SFR (3) bath 399.00' •
❑ Master builder 0 Other: Each additional bath/kitchen 45.00
_ . Page 2
JOB SITE .INFORMATION `AND LOCATION,
Fire sprinkler ( sq. ft,)
Site utilities -
Job site address: 11.200 S W lq'I"ga. .Aot. Catch basin or area drain . - 16.60
City/ State/ZIP: a j , 0 � a 3 Drywell, leach Tine, or trench drain 16.60 _
Suite/bldg. /apt. no.: Project name: •
Footing dram (no. linear ft.: ) Page 2
cti 4J P t� t rr l 3 � Man holes red'home utilities 1 10.00
Cross streeddirections to job site: + l
Manholes • 16,60
• Rain drain connector 16.60
Sanitary sewer (no. linear ft.: Lj 1 Page 2
Storm sewer (no. linear ft.: ) Page 2
Subdivision: 1 Lot no.: Water service (no. linear ft.: _) Page 2
Tax map /parcel no.: .
Fixture or item
v e
DESCRIPTION OF..: WORK = ; . -
Absorption alv 16 60
. Hackflow reventer Page 2
f
�-�+ P m G a Q 1 Backwater valve ._ . 16.60 _
t _ _ . p r � 1 �l Clothes Washer 16.60
Dishwasher . . - .. _.. 16.60
;5t PROP *RTY OWNER I] TENANT Drinking fountain 16.60
Ejectors/sump . , 16.60 .
Name:. E�W\Q,4S 42.. Af (�'\-g -.e l
v Expansion tank 16.60
Address: Fixture/sewer cap 16.60
City /State/ZIP: Floor drain/floorsink/hub • 16.60
Phone: ( ) Fax: ( ) Garbage disposal .... . 16.60
is
AP PLICANT CONTACT PERSON Hose bib 16.60
c 1 Ice maker • 16.60.
v
Business name: _\ 6 i` (-0 O Aka IntereP 1're�e 1 m 16.60
- t` 11t( °A e tor/ p
Contact name: p r k 1,0 Q. `\ 1 { Medical gas (value: $ _) Page 2
Address: :. $ t5i0 CS' .,g,45...__ 1 16.60
City/State/ZIP: P X Q� . ! "fc O., Roof drain (commercial) 16.60
Phone: Sink/basin/lavatory 16.60
3) '-3 �f . • ' l B I Fax: Q03) 3 3 1 • q (3 3
•
E -mail: Tub /shower /shower pan : 16.60
Urinal 16.60
... CONTRACTOR.
,. w I
.: ,.. .ter closet ..
: _ 16.60
Business name: i (k �� c Z . ... Water heater . 16.60 '
Address: Other:
City/ State/ZIP: . Subtotal • 65, v13 •
' Minimum permit fee: $72.50 `9-Q,5(3
Phone: ( ) Fax: ( ) _ .. Residential backflow minimum permit fee: 536.25
CCB Lic.: 3? 7J Iii 1' Plumbing Lic. no.: C / t-7 Plan review (25 %ofpermit fee)
Authorized signature: 1� State surcharge/OA of permit fee) 9:'
—'—��' � TOTAL PERMIT FEE g . .(]
Print name: cJ tet0. co n • "(2 1 ,51,,,.) K I (. Date: 5/ f I This permit application expires if a permit is not obtained within
l l 180 days after It has been accepted as complete.
"Fee methodology set by Tri -County Building Industry Service Board.
1: lBuilding \Pcnnita\PLM- PennitApp.doc 06/05 440- 4616T(10/02 COM/WEB)
CITY OF TIGARD
BUILDING DIvrS1ON PERMIT #: PLM2008 -00212
13125 SW Hall Blvd., Tigard, OR 97223 1 DATE ISSUED: 5/15/2008
Phone: (503) 639 -4171 A pui,l
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 5/21/2008 TIME: 7:OOAM PAGE: 16
SITE ADDRESS: 11200 SW 79TH AVE CLASS OF WORK:
SUBDIVISION: FRIENDLY ACRES LOT #: 009 TYPE OF USE:
PROJECT NAME: ROWLES
DESCRIPTION: Repairing 10 IL of sanitary suer.
OWNER: ROWLES, EVERETT & PATRICIA PHONE #:
CONTRACTOR: ENVIRONMENTAL SERVICES PHONE #: 503 -234 -2118
Inspection Request Scheduled For: Date: 5/21/2008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
399 Plumbing final 070211 -01 503 - 234 -2118 Y
Corrections/Comments/Instructions:
CIO' U I( N c3 C) z Pilo; . idt zo Now6 P4011, i,v
(cr( �5 ✓
x i PASS Ti PARTIAL APPROVAL El CANCEL ❑ NO ACCESS
n FAIL ❑ CALL FOR INSPECTION 1 1 ADDITIONAL FEES ASSESSED
tip.
Inspector: 11J 6 - 12 - Date: &) 2J1 V Phone #: (503) 718-