Permit C ITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT PERMIT #: PLM2008 - 00190
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 5/6/2008
PARCEL: 2S114BB -07300
SITE ADDRESS: 16221 SW 104TH AVE ZONING: R -12
SUBDIVISION: SWANSONS GLEN LOT: 014 JURISDICTION: TIG
PROJECT: RAINS
Project Description: Replacing 100 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: 100 ft
DISHWASHERS: RAIN DRAIN: ft
Owner:
FEES
ELIZABETH RAINS
ALLISON, DEBORAH S Description Date Amount
16221 SW 104TH AVE [PLUMB] Permit Fee 5/6/2008 $72.50
TIGARD, OR 97224 [TAX] 12% State Surch 5/6/2008 $8.70
Phone : 503- 620 -0849 Total $81.20
Contractor:
BOB'S REEDVILLE PLUMBING
5976 SE ALEXANDER ST #0
HILLSBORO, OR 97123 REQUIRED ITEMS AND REPORTS
Contact # : PRI 503- 356 -8832
FAX 503- 356 -5245
Reg #: LIC 168233
PLM 34 -342PB
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 0001 -0010 through OAR 952 - 0001 -0100. You may obtain copies of
these rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By Permittee Signature: -
Call 503.639.4175 by 7:00 a.m. for an inspection that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
May OG 08 OE: 07a Bobs Reedville Plumbing L 5033565245 p.1
P1ulll Per mit A licatia it7 r .
,
FOR OFFICE 'USE ONLY
City of Tigard Da tes i virC Permit No.: erpeol �` jY I et
Y 13125 SW Hall Blvd., Tigard, OR 97223 ,n Plan Review v - l
Phone: 503.639.4171 Fax: 503 - 598- 1960MAY 0 6 ZOO$ Date/By: Other Permit No.:
T t G ARB Inspection Line: 503.639.4175 Date Readyfsy: writ fr6 Set Page 2 for
Internet: www.tigard - or.gov l f - . "Z Ai; C Notified/Method: Supplemental Information
TYPE OF WO , 6a Shlt" i.VI 'i,IfN FEE* SCHEDULE
DemolKyition For special information use checklist
❑ New construction - Description I Qty. I Ea. I Total
Addition/alteration /replacement ❑ Other: New I- 2- family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION • SFR (I) bath 249.20
[(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 AND LOCATION Site utilities
Job site address: ( 2_7 ( I, Li Catch basin or area drain 16.60
City/State/ZIP: 7i -p4 j( )1, l 7 2 4 Drywetl, leach line, or trench drain 16.60
Footing drain (no. linear ft.: ) Page 2
Suite/bldg. /apt. no.: 1J Project name:
Manufactured home utilities 110.00
Cross street/directions to job site: Manholes 16.60
Y _,.._ 1 V Y I A I'Ll Rain drain connector 16.60
Sanitary sewer (no. linear ft.: _J Page 2
- / f � -. { Storm sewer (no. linear ft.: ) Page 2
Subdivision: (� I Lot no : Water service (no. linear ft.: VW) ( Page 2 . C
- Fixture or item
Tax map /parcel no.:
Absorption valve 16.60
DESCRIPTION OF WORK Backflow preventer Page 2
•
Y ! ;ll( WA J 2 5trl hj t`_,,--- Backwater valve 16.60
Clothes washer 16.60
. Dishwasher 16.60
❑ PROPERTY OWNER l ❑ TENANT Drinking fountain 16.60
Ejectors/sump 16.60
Name: n + vi S Expansion tank 16.60
Address: /i ( G v t 0)4 -07 4"1--c__ Fixture/sewer cap 16.60
City/State /ZIP: Ti 7` l• 07 C 7 - 7 2_241 Floor drain/floor sink/hub 16.60
Phone: a ;2)) ((!).-9_ (Fj c f Fax: ( ) Garbage disposal 16.60
•
❑ APPLICANT ❑ CONTACT PERSON Hose bib 16.60
n Ice maker 16.60
-.
Business name 57fy , ] (L,( 0 IA r?, St r" LL C • _ Interceptor /grease trap 16.60
Contact name: (, l ,'1 ,./ / 1'( t, Medical gas (value: $ ) Page 2
Address: ,c17 (,, 5t..::- t_ei i. , 1GCi' l'S d � - Primer 16.60
City/State/ZIP: -fh ( )y0 - GI'7 / Roof drain (commercial) ' 16.60
Phone: (3) 354. '` � - Fax: : 1 l oZ` �� Sinl /basin lavatory 16.60
Tub /shower /shower pan 16.60
E -mail: Urinal 16.60
• CONTRACTOR Water closet 16.60
Business name: Water heater 16.60
Address: Other:
City /State/ZIP: . Subtotal 1,), 1,),. ' . - Minimum permit fee: $72.50 .�t� .0
Phone: ( ) Fax ( ) Residential backflow minimum permit fee: $36.25
CCB Lie.: (((-3 Plumbing Lic. no.:-3l-f - (..� .-4 Plan review (25% of permit fee) ,
Authorized signature: ),(1„, State surcharge (12% of permit fee) �(
c � _ TOTAL PERMIT FEE !� 1.20
Print name: _ _/) sj ) 62 0 L. Date: `/ e/0 �
X . 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.
CITY OF TIGARD , --
BUILDING DIVISION A / PERMIT #: PLM2008 -00130
13125 SW Hall Blvd., Tigard, OR 97223 , DATE ISSUED: 616/2008
Phone: (503) 639 -4171 " � f l
Inspection Requests (24 Hrs.): (503) 639 -4175 &!J
INSPECTION WORKSHEET FOR DATE: 518 /2008 TIME: 7:01AM PAGE: 51
SITE ADDRESS: 16221 SW 104TH AVE CLASS OF WORK:
SUBDIVISION: SWAN SONS GLEN LOT #: 014 TYPE OF USE:
PROJECT NAME: RAINS
DESCRIPTION: Replacing 100 ft. of water service.
OWNER: RAINS, ELIZABETH ANN PHONE #: 503-62(10849
CONTRACTOR: BOB'S REEDVILLE PLUMBING PHONE #: 503 - 356 -8832
Inspection Request Scheduled For: Date: 6/8/2008 Pour Time: A
Code # Inspection Description Confirm # Contact # Message Y 1
330 Water service 069546 -01 503-356-8832 N 0 v
C'orrections /Comm is /Instructions: V
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ASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL CALL FOR INSPECTION I I ADDITIONAL FEES ASSESS D—
V6 t,2cle_______ X 16 2, Inspector: Date: Phone #: (503) 718-