Permit C ITY OF TIGARD PLUMBING PERMIT
DEVELOPMENT SERVICES PERMIT #: PLM2006 - 00477
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 10/16/2006 PARCEL: 2S112CC - 01800
SITE ADDRESS: 15965 SW 81ST CT ZONING: R -
SUBDIVISION: LOT: JURISDICTION: TIG
Project Description: 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: 60 ft
DISHWASHERS: RAIN DRAIN: ft
Owner: FEES
JUDITH BENJAMIN
15965 SW 81ST CT Description Date Amount
TIGARD, OR 97224 [PLUMB] Permit Fee 10/16/200E $72.50
[TAX] 8% State Surcha 10/16/200E $5.80
Phone : Total $78.30
Contractor:
LOVETT EXCAVATING INC
2925 SW HARTLEY DR
GRESHAM, OR 97080 REQUIRED ITEMS AND REPORTS
Contact # : FAX 503- 288 -1630
PRI 503 -504 -2847
Reg #: LIC 125507
PLM 26 -773PB
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: � Permittee Signature: 'P,
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.
10/13/2006 14:28 5032881630 PAGE 02/02
I 9:) fi +' 1E. :9 lltit; ()NT 3.1
plumbing Permr�it A l .i COI !! 7
Reached Pit N ,. \c U
City of Tigard 1 � „e/B ; _ � V � . l��
13125 5W Hall Blvd., Tigard, OR 97223 Plan Revlcw Other Permit No.;
Phone: 503,639,4171 Fax: 503.598.196 '�' %”" '}' 1 mac/ y'
Q.3i s. V.t•. i�.���� I t� . rid El St:cPnRcAfar 24 -Hour Inspection line: 503.639,4175 7 : �. . r , Dam ed/Met y: Supplemental lnrormatinn
Internet: www.ei,tigard.or.us _ : , ; Nn,iflcd/Merhod:
. TYPE OF WORK
Fora taal inJor matlon use checklist
0 New construction ❑ Demolition `Description Ea. I Total
ffilAddilion /alteration/replaeement ❑Other; • New 1-2-family dwellings (includes t (10 ft, for each utility connection) • • (:ikTli;t OR C01�iST1iLICT10N .. ; � , • . • .
SFR (I) bath 24920 L •
SO,On
1- and 2. famil dwellin ❑ C S. (2) ball, 335000
SFR (3) bath a
❑ Accessory building ❑ Multi- family Each additional hath/kitchen 4500
❑ Master builder « ❑ Other - Fire sprinkler ( sq. ft.) - Page 2
IOU SITE INFORMATION AND LOCATiON ' " . Site utilities
:
Job site address: 1 I / U �.} Catch basin or arcs drain 16.60
•
�
City /Smtel7JP: -1 oc.. on Drywall, leach line, or trench drain 16.60 _
Footing drain (no. linear ft.. ) Paso 2
Suite/bldg. /apt. no.: Project name: - Manufactured borne utilities 1 10.00
— Cross strcct/directions to job site: _ Manholes 16.60
—_________Dixo--iculeL___. Rain drain connector 16.60
Q, , L Sanity y sewer (no. linear ft.: ) Page 2
� `J Storm sewer (no, linear ft.: ) Page 2
Subdivision: • Lot no.;
Water service (no. linear ft.: I Page 2
- - Fixture or item -
Tax map /parcel no,: _ - Absorption valve 16.60 •
• ijr.SCR1FTIION OF WORK Backflow proventcr Page 2 •
+,� „ , , t ^ ji Backwater valve 1 6.60
�.�lJl/V�W •� �[�- Clothes washer 16.60
L`�` Dishwasher 16,60
' Drinking fountain 1 6.60
❑ PROVERTV OWNE J ❑ TENANT . Ejectors/sump 16.60
Name: Expansion tank 16.60
Address: Fixture/sewer cap 16.60 •
CitylStatc/7.iP:
Floor drain /floor sink /huh 16
- - 16.60
Qarbage disposal
Phone: ( ) Fax: ( ) Hose bib 16.60 •
,. ' • En Atli, lC:,k�1T'. _ ❑ CONTACT.. IPE1Ls+ 1 . tee maker 1 6.60
Business name: ante: Interceptor /grca.c trap 16.60
Contact name: _Medical gas (value: $ ,) Page 2
Address: Primer 1 6.60
Roof drain (commercial) 1 6,60
City/State/ZIP:
Sink/basin/lavatory 16.60
Phone: ( ) Fax:: ( ) Tub /shower /shower pats 16.60
E-mail: Urinal 16.60^
CONTRACTOR _ Water closet 16.60
Business name: 'La - or Water heater 16.60
• w Other:
Addre ^a- ..: ' Subtotal
Ctty /Statc/ZIP; (`.z1 —�U ■ d A Vow Minimum gcnnit fcc: $72.50 al
Phone: (50 3) �J' oq _- aO Fox: (50) O �$_3 - / I �JV Residential hackflnw minimum permit fee: $36.25
' ' Plumbing Uc. no.: 0,76-72_311 Plan review (25% of permit fcc)
CCU Lie.: _ State surcharge (8 %of permit roc) • Authorized signature: j � TOTAL PLeRMiT FR5
I Print name: (Ca Date: 0 WC?! This permit application expires if a permit is not nhtai wlthit
180 days after It has been accepted as complete.
*Fee methodology set by Tri- County Building Industry Service Boar
;; tnundinxn 'ennlutPLa•1.Pormtinpp•dx WO I1O- 4V,ir•rt i0/02JCOM/wSA1
CITY OF TIGARD
BUILDING DIVISION PERMIT #: PLM2006-00477
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 10/ 16/2006
Phone: (503) 639 -4171 Aro m „ ��,:: , '
Inspection Requests (24 Hrs.): (503) 639-4175 .
INSPECTION WORKSHEET FOR DATE: 10/17/2006 TIME: 7 :04AM PAGE: 61
SITE ADDRESS: 15965 SW 81ST CT CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: BENJAMIN
DESCRIPTION: Water service.
OWNER: BENJAMIN, JUDITH PHONE #:
CONTRACTOR: LOVETT EXCAVATING INC PHONE #: 503- 5042847 .
Inspection Request Scheduled For: Date: 10/17/2006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
330 Water service 038318 -01 503 - 288-1527 N
Corrections /Comments / Instructions:
416,61//,,j) (
1(
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
n FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: IV); v �� Date: Phone #: (503) 718-