Permit CITY TIGARD PLUMBING PERMIT
DEVELOPMENT SERVICES PERMIT #: PLM2005 -00294
��' 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 7/6/2005
PARCEL: 2S 115AD -00600
SITE ADDRESS: 16740 SW 108TH AVE ZONING: R -4.5
SUBDIVISION: WILLOW BROOK FARM LOT: 030 JURISDICTION: TIG
Project Description: Repipe guest house, waste, vent & water.
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: 2 OTHER FIXTURES:
TUB /SHOWERS: 1 SEWER LINE: ft
WATER CLOSETS: 1 WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Owner: FEES
MAY MARTHA Description Date Amount
16740 SW 118TH
TIGARD, OR 97223 [PLUMB] Permit Fee 7/6/2005 $83.00
[TAX] 8% State Surchan 7/6/2005 $6.64
Phone : 503 350 - 2700 Total $89.64
Contractor:
DLH PLUMBING
PO BOX 3309 REQUIRED ITEMS AND REPORTS
OREGON CITY, OR 97045
Phone : 503 656 - 0929
Reg #: LIC 158878
PLM 3 - 506PB
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes
and all other applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is
not started within 180 days of issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law
requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 -000 10 thr. gh OAR 952 -0001 -0100. You may obtain copies of these rules or direct questions to OUNC by
calling 03- 246 -6699 a r 4001;2-2344.
Issu By: � ,./ Vi Permittee Signatur :
Call 503 - 639 -4175 by 7:00 a.m. for an inspection that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Jul 05 05 04:30p DLH Plumbing p.2
Plumbing Permit Applient 6i1ENED FOR OPER'1.: fist oNLA
it,„ 013terPennit No.;
City of Tigard D e r y a 7 - _Os „"i- Permit No. � �()�) . � _ p p
`�y,�qt,
13125 SW Hall Blvd., Tigard, OR 97223 �� Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 jlij 0 2 %0,..4.4 r .. IA Date/By:
24- Hour Inspection Line: 503.639.4175 OF �( o •'tom Date Ready/Hy: El See Page 2 for
Internet: www.ci.tigard.or.us Cj.t Y ' .n rltttlltut Notitied/Metlod: j ) /if Supplemental Information
TYPE O WU�Rf( _ FEE' SCHEDULE
❑ New construction ❑ Demolition For special information use checklist.
Description I Qty. I Ea 1 Total
($ Addition /alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (1) bath 249.20
® 1- and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 350.00
❑ Accessory building ❑ Multi- family
SFR (3) bath 399.00
Each additional bath/kitchen 45.00
❑ Master builder 0 Other: Fire sprinkler ( sq. ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities
Job site address: 16740 SW 108 Ave. Catch basin or area drain 16.60
City /State /ZIP: Tigard, Or. Drywell, leach line, or trench drain 16.60
Suite /bldg./apt. no.: I Project name: Footing drain (no. linear ft.: ______) Page 2
Manufactured home utilities 110.00
Cross slrcctfdirections to job site: Manholes 16.60 1
Rain drain connector 16.60
Sanitary sewer (no. linear ft.: _) Page 2
Storm sewer (no. linear ft.: ) Page 2
Subdivision: I Lot no.: Water service (no. linear ft.: - ) Page 2
Fixture or item
Tax map /parcel no.:
Absorption valve 16.60
DESCRIPTION OF WORT( tt Backflow preventer 1 Page 2
pit i / ' ' P �u • 3 0 -- Via, f" - Via, . ' _, Ceps Backwater valve 16.60
. Clothes washer 16.60
Dishwasher 16.60
Drinking fountain 16.60
0 PROPERTY OWNER I 0 TENANT Ejectors/sump 16.60
Name: Expansion tank 16.60
Address: Fixture /sewer cap 16.60
City /State/ZIP: Floor drain/floor sink/hub 16.60
Phone: ( ) Fax: ( ) Garbage disposal 16.60
Hose bib 16.60
❑ APPLICANT ❑ CONTACT PERSON 16.60
• Ice maker
Business name: DLH Plumbing Interceptorigrease trap 16.60
Contact name: Dave Harris Medical gas (value: S ) Page 2
Address: PO Box 3309 Primer 16.60
City/State/ZIP: Oregon City, Or. 97045 Roof drain (commercial) 16.60
Sink/asinilavatory a 16.60 33 tZ 0
Phone: (503) 656 -0929 Fax: : (503) 657 -1402
Tub /shower/shower pan I 16.60 t ke , (�
E -mail: Urinal 16.60
CONTRACTOR Water closet ' 16.60 (kQ .
Business name: DLH Plumbing Water heater I 16.60 1 ti2
I Address: PO Box 3309 1 Other:
Ni City /State/ZIP: Oregon City, OR . 97045 Subtotal 3
N Minimum permit fee: $72.50
1 Phone: (503) 656 -0929 Fax: (503) 657 -1402 Residential backtlow minimum permit fee: $36.25
CCB Lic.: 158878 Plumbing Lie. no.: 6735JP Plan review (25% of permit fee)
r i State surcharge (8% of permit fee) l
Authorized signature: i ri1\ 3-f� -3 '. 7 - / - D TOTAL PERMIT FEE
Print name: n Ali \ Li (IAN/1S Date: . 7 -6--0 This permit application expires if a permit is not obtained within
180 days after it has been accepted as complete.
'Fec methodology set by Tri- County Building Industry Service Board.
0,13uilding ■Permit,'PLM- Permit \pp.doc 06 /CS 4404616T(Ie/C2 /COM/WEB) kg . 6
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CITY OF TIGARD '
BUILDING DIVISION PERMIT #: I�'LM200S -0;
411k,„ 13125 SW Hall Blvd., Tigard, OR 97223 D ATE ISSUED: 7/6/2(1(15
Phone: (503) 639 -4171 u�p4puypie)g�fiilf 1 Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 1/5/2006 TIME: 7i00AM PAGE: 1
SITE ADDRESS: 16740 SW 108TH AVE CLASS OF WORK:
SUBDIVISION: WILLOW BROOK FARM LOT #: 030 TYPE OF USE:
PROJECT NAME: MM'
DESCRIPTION: Repipe guest house, waste, vent. & water.
•
OWNER: MAY, MARTHA, PHONE #: 503 -3;0 -2700
CONTRACTOR: OLH PLUMBING PHONE #: 503-655 -0929
Inspection Request Scheduled For: Date: 1/512006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
399 Plumbing final 024436-01 503 - 3145674 N
CI lorrections /Comments /Instructions: 0
'`ZM & ` -ems_ i . - t • �1
,K;5 i a - / v o L�k Gi .. . Lc__ .
a,.. n., \
illifi a 1 I IFAV '
(A/„._,471A,' sp ,...J t, --vi,,,, ,:,(,,,e .
E2(...e&ss n PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
n FAIL I I CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED
Inspector: " v` Date: 1 / /° G' Phone #: (503) 718- 2..-y 2_y/
•
•
V
CITY OF TIGARD
BUILDING DIVISION PERMIT #: PLM2005-00294
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 7/6/2005
Phone: (503) 639 -4171 om
Inspection Requests (24 Hrs.): (503) 639 -4175 ='
INSPECTION WORKSHEET FOR DATE: 10/19/2005 TIME: 7:03AI I PAGE: 3
SITE ADDRESS: 16740 SW 108TH AVE CLASS OF WORK:
SUBDIVISION: WILLOW BROOK FARM LOT #: 030 TYPE OF USE:
PROJECT NAME: MAY
DESCRIPTION: Repipe guest house, waste, vent & water.
OWNER: MAY, MARTHA, PHONE #: 503 - 350 -2700
CONTRACTOR: DLH PLUMBING PHONE #: 503.656 -0929
Inspection Request Scheduled For: Date: 10/19/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
320 Plumbing rough -in 018746-01 503-314-5674 Y
Corrections /Comments /Instructions: 0k. Wiz/054425 ' / / 1 1 .61 /7 1', -LP
•
PASS PARTIAL APPROVAL ❑ CANCEL n NO ACCESS
I I FAIL n CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED
Inspector: (T)\14-A P Date: / pp c) f: Phone #: (503) 718-
CITY OF TIGARD -
It
BUILDING DIVISION ; 1
ti : PERMIT #: PLM2005•00294
13125 SW Hall Blvd., Tigard, OR 97223 ; DATE ISSUED: 716/2005
Phone: (503) 639 -4171 9ln�glmgi: �lifl
Inspection Requests (24 Hrs.): (503) 639 -4175 ...' i ��r�a °`
INSPECTION WORKSHEET FOR DATE: 8/12/2006 TIME: 7 :06AM PAGE: 11
SITE ADDRESS: 16740 SW 108TH AVE CLASS OF WORK:
SUBDIVISION: WILLOW BROOK FARM LOT #: 030 TYPE OF USE:
PROJECT NAME: MAY
DESCRIPTION: Repipe guest house, waste, vent & water.
OWNER: MAY, MARTHA, PHONE #: 503-350-2700
CONTRACTOR: DLH PLUMBING PHONE #: 503 - 656.0929
Inspection Request Scheduled For: Date: 8/12/2005 Pour Time:
Code # Inspection 'Description Confirm # Contact # Message
305 Plumbing underslab 013481 -01 503 -314 -5674 Y
Corrections /Comments /Instructions: J • II y r.ws
t .
✓ /
•
•
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
)27271 ,
Inspector: Date Phone #: (503) 718-
CITY OF TIGARD
BUILDING DIVISION v" _. PERMIT #: PLM2005 -00294
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 7/6/2005
Phone: (503) 639 -4171 „,1 090Ilit
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 7/12/2005 • TIME: 7:06AM PAGE: 18
SITE ADDRESS: 16740 SW 108TH AVE CLASS OF WORK:
SUBDIVISION: WILLOW BROOK FARM LOT #: 030 TYPE OF USE:
PROJECT NAME: MAY
DESCRIPTION: Repipe guest house, waste, vent & water.
OWNER: MAY, MARTHA, PHONE #: 503 -350 -2700
CONTRACTOR: DLH PLUMBING PHONE #: 503 -656 -0929
Inspection Request Scheduled For: Date: 7/12/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
305 Plumbing underslab 011242-01 503 - 656.0929 N
Corrections /Comments /Instructions:
• .0■•• 4 ,1_,,, AillW-..,,,,
.0 C - AP-•Z_Air,,,„ ' ..0 1..Le
O
tY-69 cz.,7;'/N-
,Y W ,iv,e,
`?"/7'1/ AA , (p 3
, /2
, . rv 1. — it A ..e -.IL
40: —
❑ PASS {(PARTIAL APPROVAL ❑ CANCEL 1 I NO ACCESS
FAIL n CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
1 4 S
Inspector: '?Z' Date: 1 7 6 Phone #: (503) 718- 2 4 1 3 I
I k.
F
.I.l.13L 0 Yr L Lajav“.■ • ---„, — ,
Portland, OR 97219 ...
i
Phone 503 244-7002 FAX 503 2 8/2312004 44-6267 — n6I
Bill To
May, Marta —
ldo Marti Walkor
First Real Estate Network
1
i 15040 SW Millikan Way 11222
1 Beuverton, OR 97006
_
_
_... ._. . _
.. .. . . ..
'_—F310.Ntnn1;et- 1 arms I Project .— —
._. _ — --. .— ---- _
. .. ... _ .... _.. ..
Quantity Item Code Description Price Lach Amount
. . .... ..... ... ... ..._. _ .._ _ _ . ___ _.. ...
Decom In-place 1Pump and can tank; fill tank wilh C1)F slurry 1,000.00 1,000.00
. ,
. ,
, .
. ,
1
i
i
.. .... . . ....
. .
. .... . , —I. ... .
Total
$1,000.00 •
. .. _ . __. _. .._ __....
Case Activity Listing 12/6/2005 10:08:23AM
TIDEMARK Case #: PLM2005 -00294
COMPUTER SYSTEMS, INC.
Assigned Done Updated
Activity Description Date 1 ' Date 2 Date 3 Hold Disp To By By Notes
PLM1010 Application received 7/5/2005 None RECD FAX 7/6/2005
DER
PLM1020 Permit created 7/6/2005 None DONE DER 7/6/2005
DER
PLM1030 Check for parcel tags 7/6/2005 None DONE DER 7/6/2005
DER
PLM1280 Issue permit 7/6/2005 None DONE DEB 7/6/2005
DEB
PLM2305 Plumbing underslab 7/11/2005 7/12/2005 7/12/2005 None PART MRS 7/12/2005 011242 -01 — 503- 656 -0929 VM -
STI N —180
PLM2305 Plumbing underslab 8/11/2005 8/12/2005 8/12/2005 None PASS MRS 8/12/2005 013481 -01 -503- 314 -5674-- VM-
STI Y
PLM2320 Plumbing rough -in 10/19/2005 10/19/2005 10/19/2005 None PASS JW 10/19/2005 018746 -0 503- 314 -5674 VM -
STI Y
Page 1 of 1 CaseActivity..rpt