Permit .. r:„.. 7 �� CITY OF TIGARD PLUMBING PERMIT
° COMMUNITY DEVELOPMENT PERMIT #: PLM2008 -00199
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 5/8/2008
PARCEL: 1 S135DB -10300
SITE ADDRESS: 11120 SW 95TH AVE ZONING: R -4.5
SUBDIVISION: MAYFAIR LOT: 002 JURISDICTION: TIG
PROJECT: GRIMES
Project Description: Replacing 20 ft. of water service.
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: 20 ft
DISHWASHERS: RAIN DRAIN: ft
Owner:
FEES
DEBRA GRIMES
11094 SW 95TH AVE Description Date Amount
TIGARD, OR 97223 [PLUMB] Permit Fee 5/8/2008 $72.50
[TAX] 12% State Surch 5/8/2008 $8.70
Phone : 503- 620 -4302 Total $81.20
Contractor:
BEAVERTON PLUMBING INC
13980 SW TUALATIN VALLEY HWY
BEAVERTON, OR 97005 REQUIRED ITEMS AND REPORTS
Contact # : PRI 503- 643 -7619
FAX 503- 643 -7620
Reg #: LIC 12889
PLM 34 -4PB
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. N.
Issued By: ``� _ _ _ Permittee Signature: ���(/ / l2'l./
t
�i1
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.
A
-,.. -1.1atl 08 08 03:38p Beaverton Plumbing Inc 503G437820 P • 2
.-..
0 ... Mu rn binta Permit APPlicatkinRECEIVED
Site Utilities FOR OFFICE USE ONLY
_ City of Tigard Reec,„J
„,„„,,,. "Iv '
/3 , 77P. 'erma No :Aryl ...Ca g
13[25 SW I lall Illvd., Tigard, OR 97223 MAY 0 8 2008
1 1 • = • ••• Phone; 503.639 4171
Fox 503.5" OF TIGARD p D.cihii,
lly. Oilicr Penni( Nu.:
Inspection Line: 503.639.
TIOARD -- Daic Readvilly: LI IN. El See rage 2 6r liner-11er; www,tittaickor.tov BUILDING DIVISION.. .Notilled/Ivietliml: Kupplemyntal Information
-,
" rYPC. OF WORK FEE* SCIIEDIJ LE
El New construction El Demoliiion For special ialarniatiati u.ve checklist.
Descriptio1 ------ )1T1.:a. 7 Tomi
E Addition/alteration/replacement 0 Other;
New I- 2-family dwellings (includes 100 ft. for each laillly connection)
- - __.
CATEGORY OF CONSTR)MION SIR 11) bath 249.20
....... ,...,. . ... ___
0 I- and 2-tinnily dw]lin0 Cornmereial/industrial SFR (2) bath 350,011
SI'lk (3) bath 399.00
0 Accessory building El Multi-family
• Filch additional bath/kitchen 45.00
0 Masler builder 0 Other:
,._ - Fire sprinkler ( sq. 11.) l'ae 2
JOB SM.; INFORMATION AND LOCATION
Site 1101110
Job site address; 1 I 1121.1 SW 95 AVE Catch basin Or LaCil drain l 16 el0
. -
City/Stater/1 I': TI(:Alti) OREGON 97223 1)rywell, leach line, nr tre.neh drain 16 60
Suite/hIdg,/tipt. no.: Project name; - routing drain Om. ( ineic 11..; ) Page 2
- - .---- manidiictured home utilities 110.00
Cross sin:et/directions to job site:
.... ,
. .
Manholes 16.60
kain drain canneetor I S.V)
- ... .
Sanitary sewer (no. linear (1,; _ ) Pare 7
- -- _
Storm sewer (no. linear 11.: ) Page 2
__.......... . .. _.............._._
Subdivision:
- --
Water service (no. linear II,: ) 20 Page 2 55.00
I,ot no,;
-
Fixture or item
Tax map/parvel no :
....- . Ahsyrpi kin valve 16.60
DESCRIPTION OF WORK
-,- L• ____„ Backilow presenter l'av,e 2
WAFER SERVICE
Backsvater 16.60
. _ valve
(Inthes washer 16.6n
: •-• - -
___.
Dishwasher 16.60
__ .......
-- -
Drinking Fountain 1 b.h0
0 PROPERTY OWNER
L Cl 'TENANT
. LiectorsAtimp 16.60
Name: DEBBIE CRIMEs
_ I'spans ion tank 16 60
. ._.
Acklivss: 11120 SW 9.5 AVE
FixturUsewei cap 1660
City/State/ZIP: TIC.'A RD OREGON Floor drain/floor sink/hub 16.60
- ......
Phone: (503 Fax; ( ) Garbap,i; disposal ... . 16.60
__
-....__ -,..
El APPI.1(:A.N1' 0 C(N'T'( 16.60 .:T PERSON
- Ice maker I b b0
Business name:
. - ... I nterceptur/grease trap 16.60
-...
Contact name.
- -.. Medical gas (value: $ ) Page 2
Address: Prtmci 16.60
.._ _
City/State/Z1P: Rooldrain (commercial) 16.60
_ .
-- Sitil 16,60
Phone: ( ) 1 Pax; ( )
'' ..... , ...... - TL1h/ShOWCl/S110Wer pall 16 60
E-mail:
I initial I 6.60
,
.. -
CONTRA( WR
Water closet 16.60
_,.. ..
11osiness name: BEAVERTON PL UM RI NG Water heater lb .60
_ _ . .... . .. . _ _ .....
Address: 13980 SW TUALATIN VALLEY H .. WY Othcr;
Cily/State/LIP: 1 OR
3EAVERTON EGON 9700 Subtotal 55.00
- M 1 n i alum permit fee: 572.50
Phone: (5(13.) 643.7619 Fax.: (503-) 643-7620 Residential Isseldliiw u■iuibaon Iwifillt 1,x; 1;36.25 72.50
___ _.,..........
CCB Lic.: 012889
'Inmbing, Lie. no.: 34-41)1) Plan review (25% ta permit ice)
..
_.
' - State sureharec ((2.% id perm it lee) 8.70
A uthoriNd signature 4 6,..a,____,
TOTAL PERMIT Hu: 81.20
Print name; TINA Q1111,1.,A Date: May 8, 2011 - This ptirmil application expires if a permit is not obtained within
- I XII days :lifter it has been ample() as comploe.
"1'03 mothoclolotv :41 by Tri-Cotinty Building Industry Sew ice Board.
1 : ) . 1 kii , filv , gmails\i'1.1) , 10.1"cainaAppdx.; 12/27;uo 44044 I 61111)102.10M/W FR)
CITY OF TIGARD -
BUILDING DIVISION PERMIT #: I I.M2Uf'lt3 00199
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 518/2008
Phone: (503) 639 -4171 � � � � �pn� � iit i i,
Inspection Requests (24 Hrs.): (503) 639 -4175 �- . - `11.
INSPECTION WORKSHEET FOR DATE: 5/1212008 TIME: 7 :01AM PAGE: 32
SITE ADDRESS: 11120 SW 95TH AVE CLASS OF WORK:
SUBDIVISION: MAYFAIR LOT #: 002 TYPE OF USE:
PROJECT NAME: GRIMES
DESCRIPTION: Replacing 20 ft. of water cervice.
OWNER: GRIMES, DEBRA PHONE #: 503620 -4302
CONTRACTOR: t3EAVERTON PLUMBING INC PHONE #: 503 - 613 -7G19
Inspection Request Scheduled For: Date: 5/12/2008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
330 Water ;service 069685 -01 503643 -7619 N
Corrections /Comments/ Instructions:
i
I ' V- o (,a i Cwucc,4 fib el.( r4 — tA Co in to e/ Uoc,„ 20' FR,- T
r ✓O t' cr✓ lA (..4 - urt
•
X PASS I I PARTIAL APPROVAL ❑ CANCEL NO ACCESS
❑ FAIL I I CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: <T) 44.Aw •A•V Date: 61 112i(aT) Phone #: (503) 718 -