Permit CITY TIGARD PLUMBING PERMIT
DEVELOPMENT SERVICES PERMIT #: PLM2006 - 00027
I I� 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 1/23/2006
PARCEL: 2S 111 AD -01600
SITE ADDRESS: 14670 SW 88TH AVE ZONING: R -4.5
SUBDIVISION: PINEBROOK TERRACE LOT: 013 JURISDICTION: TIG
Project Description: (1) water heater.
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: 1 CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES:
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Owner: FEES
RICHARD BUSH
14670 SW 88TH AVE. Description Date Amount
TIGARD, OR 97223 [PLUMB] Permit Fee 1/23/2006 $72.50
[TAX] 8% State Surcha 1/23/2006 $5.80
Phone : 503- 968 -1408 Total $78.30
Contractor:
COLUMBIA CONTRACTING SERVICES INC
38197 SE HUDSON
SANDY, OR 97055 REQUIRED ITEMS AND REPORTS
Contact # : PRI 503- 225 -0774
Reg #: LIC 103764
PLM 3 -505PB
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: att
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.
Jan 23 06 10:40a p.2
Plumbing Permit Application 0\1 '. V, Fc)lz ol�r•ic l t �r 0NI,~, /,�,� Cit cif Tigard Rrcc��d y - /) 6 � Permit N6.3 * 2 /I 6 e tt 7
l)atellly: 1 1 (/ `
13125 SW hull Blvd., Tigard, Olt 97B Other Permit No.:
24- Hour Ins I�I, Review
Phone: 503,639 ,4171 Fax: 503.59R, „, ,,:;.,,
I Date/ray
Irt Inspection Line: 503,639.4175 I I I 1
P 2 3 2 ∎ ., Lat i c:r l y / It y ; 0 Sec Page 2 for
ernet: www.ci.tigard.or.as SAN Notified/Method: ' ) ( Supplemental Information
TYPE 01 WO It f y FEE* SCFIEDULE
a , { � l
❑ New construction V� 101\ _ For s eclat in ormadon use checklist.
Description Qty. i;n 'I "otnl
0 'addition /altcration rcplaccmcnt B ter: New I- 2-family dwellittp,s (includes 100 11, for each utility connection)
CATEGORY OF CONSTRUCTION SFR (1) bath 249.20
I- and 2- family dwelling ❑ Commerciul /industrial SFR (2) bath 350.00
❑ Accessory building ❑ Multi - family SFR (3) bath 199 "00
Each additional bath/kitchen 45.01)
❑ Master buildcr ❑ Other:
lire sprinkler ( , sq. It.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities
31b site add ress; / 4" —7� �D Si) g .4..W- Catch basin or area drain 16.60
-
City /State/ZIP: / o_ Drywoll, leach line, or trench drain 16,60
Suite/bldg. /apt. no.: V ff
[ Project name: Footing drain (no. linear ft.: ) Page 2
-- Manufactured home utilities 110.00
Cross street /d ireclions top!) Site:
Manholes 16.60
Rain drain connector 16,60 _
Sanitary sewer (no. linear IL: ) Page 2
Storm sewer (no. linear tl,; ) Page 2
Subdivision: Lot no.: Water service (no. linear ft.: ) Page 2
Fixture or item
Tax map /parcel nn,:
Absorption valve 16.60
DESCRIPTION OF WORK Backilow prevcnter Page 2
a J.4,'/&4 re. Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
PKOPF R I"Y OWNER L 0 TENANT thinking fountain 16.60
Ejectors/sump 16.60
Name: ,4,..4.4, .Ii'Q" "F&4 Expansion tank 16.60
Address: Fixture /sewer cap 16.60
City /State/ZIP: Floor drain/floor sink/hub 16.60
Phone; ( ) 21QF - / 1P4941-) Fax' ( ) Garbage disposal 16.60
❑ APPLICANT ❑ CONTACT PERSON Hose bib -- 16.60
Ice maker 16.60
Business name; Interceptor /grease trap 16.60
Contact name: Medical gas (valuer $ ) Page 2 _ ^
Address' Prima 16.60
City /State /ZIP: Roof drain (commercial) 16.60
Sink/basin/lavatory 16.60
Phone:
( ) I Fax ::( )
Tab / shower /shower pan 16.60
E-mail! . Urinal 16,60
CONTRACTOR Water closet 16.60
Business name: /u lfv7 6 r a m el� ea 56 Water heater / 16.60
Address: 3'g/ 2 7 5 �Gr.�S O Other: [
Subtotal
-
City /Statc/ZIP: �� elz-
Minimum permit ice: $:72,50
Phone: ( ''5 - " I L, 77"Y Fax: ( ).6'.54--..? 2b/ Residential hackilow minimum permit fee: $36.25
CCB Lie.: `es 76 Plumbing Lie. Ito_: 3 -',54,5 ,oa Plan review (25% of permit fee)
State surcharge (8% of permit fee)
Authorized signature: v-c__ ,d7
TOTAL PERMIT FEE
Print name: �p "6 ,'3' -tQC 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.
: Toildin x Ten itelPLM ParmitApp 12/03 440.4616T(l0l02/C01vf/WER)
CITY OF TIGARD - PI i 0 la —00027
BUILD ING DIVISION PERMIT . :
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED:
Phone: (503) 639 -4171 /��r�uiNmHpiglili�� _
Inspection Requests (24 Hrs.): (503) 639 -4175 J _ / of eG 6' d 5 J e) D5� j3
INSPECTION WORKSHEET FOR DATE: \ /// v 6 TIME: i PAGE:
SITE ADDRESS: , l 41 O 0 Iv Q Q . C. ‘ SS OF WORK:
SUBDIVISION: LOT #: - t USE:
PROJECT NAME:
DESCRIPTION:
OWNER: PHONE #:
CONTRACTOR: PHONE #:
Inspection Request Scheduled For: Date: Pour Time:
Code # Inspection gescription C nfirm #. Contact # Message
- 57 O ( lAkw) b i v, c ` w.
-- 5 g (�� on 0 L h �_ G �
Corrections /Comments /Instructions:
•
11
.
' ASS _ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
n FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
1/2-5/662
Inspector: 1 C� Da te: Phone #: (503) 718- 2--Y2-y-