Permit CITY TIGARD PLUMBING PERMIT
' I DEVELOPMENT SERVICES PERMIT #: PLM2005 -00227
F,�� 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 6/1/2005
PARCEL: 2 S 103 B D -10400
SITE ADDRESS: 12833 SW 116TH AVE ZONING: R -4.5
SUBDIVISION: HUNTER'S WOODLAND LOT: 016 JURISDICTION: TIG
Project Description: Install residential backflow prevention device.
CLASS OF WORK: OTR GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS: 1
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: ft
DISHWASHERS: RAIN DRAIN: ft
Owner: FEES
TYSON MAHUNA Description Date Amount
12833 SW 116TH AVE
TIGARD, OR 97223 [PLUMB] Permit Fee 6/1/2005 $36.25
[TAX] 8% State Surcharl 6/1/2005 $2.90
Phone : 503 239 - 8801 Total $39.15
Contractor:
APOLLO DRAIN + ROOTER SERVICE
2208 NW BIRDSDALE #8 REQUIRED ITEMS AND REPORTS
GRESHAM, OR 97030
Phone : 503 239 - 8801
Reg #: LIC 49418
PLM 26 - 533PB
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 ou to follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 :1101-00 • • rough OAR 952 - 0001 -0100. You may obtain copies of these rules or direct questions to OUNC by
c. ing 503 - 246 -66• • • :a-332-2344.
•
Is . ued By: , Permittee Signatt�Ye 4 � �I ///
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.
FROM APOLLO DRAIN 503 - 669 - 9568 (TUE)MAY 31 2005 15:58/ST. 15:58/No. 6812889331 P 1
e ' Buii4+,iag Yixtures , Tix .
, ,
Plumbing Permit Ai 'e ' FOR OFFICE LSE ON
City ofTigard Received 1j'I
:7125 SW Ilan B pp ^^ Blvd., Tigard, OR 97223 ,� 31 2005 vateal : jaN _ ,R, r.,:" - Os a
Plan Review r
Phone! 503.639.4171 Fax: 503.598.1960V1H Gt..: .,n Other Pe "t No.
\ Dau/9y
:a Hour Inspection Line: 503,G39.a 175 Date R t IEI See Page a for
Internet: www_ci.tigard.or.us Y O . �r a d By: - Notified/Method: ( Suppleme,ltal Infarrnbtion
' ye . � vs ee } ' sK • .'' :;y I t Zi ; al ce "'V:.r: - i �' ' `r : w `s
s ,;c ', R ) +'4; .r,;,.; ' Q > ;. 1 `2:,t a„ . : .. r : F .3 ' x ' . , .. , .. AS 1I E D U I: E •
New construction • t!eekllsl•
`] ❑ Demol
Description I Qry. 1 Ea [ Total
j Addition/alteration/replacement ❑ Other: New 1.2 family dwellings (includes 100 ft for each utility connection)
�' ;1 ^,14', a ga i1' • 4. _ - •
� r ��, . � 1 . , e ms* ,, .. �- § ��= d= . -•N � 7 `'. _ - `' F::,. - . ? SFR t ( ) bath 249.20
_
[] 1- and 2- family dwelling M1 a Commercial/industrial SFR (2) bath 350.00
❑ Accessory building ❑ Multi - family SPR (3) bath 399.00
- - Each additional bath/kitchen 45.00
❑ Master builder ❑ Other: Pa e 2
,..y��e ,L45 ' 'ax rt •a ' r 1 ,r,Gt, h r . r rq 4 ^ � 5., ; •;,: ; a yy.: .
Fire sprinkler ( sq, ft.) g
; �
td�Yit:447y?iPi - •. n ,_ t
' , � , 1,: ...w 1 ` . f _ � • ; ' . , .. :4 : : I to utilities
: �: ^ -.. w : � $
Job site address: 1 Z 133 szu) ` I (fi = I`idL. Catch basin or arcadrain i6 ;60
City / State/ZIP: 'QQ f -1 t L 11d- Qyi 17 Drywcll, leach line. or trench drain 16.60
Suite/bldg. /apt. no.: - Project name: Footing dram (no. linear fl.: ) Page 2
1 Manufactured home utilities 10.00
Cross street/directions to job site: .. .
Manholes 16.60 -
Rain drain connector 16.60
Sanitary sewer (no. linear ft.: ) Page 2
Storm sewer (no. linear ft.: ) Page 2
Subdivision: Lot no.: water service (no. linear ft.: } _ Page 2
- - Fixture or Rem
-
Tax map /parcel no.: - - Absorption valve 16.60
44•P t)�;�i ^ ;ilk : tSLR'1(7F Tis':: <; ;; , t:�, ii.
:,;.. :r.:.> n Dackfiowprcvcntu 1 Page 2
A « .V e _ & O Backwater valve - 16.60
_ r, � 1 C � 1 S . e, v Clothes washer 16.60
1 1 Dishwasher 16.60
i ,. r.t a w, a ,,. � �^ , �' nl .�. s .:.�;�}. a r ,`�St"'r�"� Drinking fountain 16.60
• ' 'r! .'.t r' -. La t /' '' ' � -. ' ;•rX•, Nr` ._.. a d., .
t:ais. 16.6D
�.- � Mt�� Ejectors /sump r
Name: ui.elui _ _ i� 0: pug Expansion tank 16,60
Address: ( 0..Y)v. eta Fixture/sewer cap 16.60
City /State/ZIP: Floor drain/floor sink/huh 16.60
Phone: ( ) •
... ( ) Garbage disposal 16.60
Fax:
�_:, - + ..., :, r �: l" ?', �• , yri�� Hose bib 16,60
_-
1i �I: f � �, c) a 4i: P D' »: ;(ii �'rc qIi tElit �i`�T�' 6 iEigE)1 e
„� 2 t. , .x?;r� -.I. r Z_ . - ,�.::.ri:�G _.� t �^�!; 1.»:; wi.• c b . ,.i..;_ Ice maker 16.60
Business name: interceptor /grease trap 16.60
Contact name: Medical gas (value: S ) Page 2
-
Address: Primer 16.60 _
City / State/ZIP: Roof drain (commercial) 16.60
Sink/basin/lavatory 16.60
r Phonc: ( ) Fax: : ( ) -
Tub/shower /shower pan 16.60
• j E-mail: Urinal 16.60
..i ' .
. ...� I., :. l6.ti0 i
( ' ,4� r „ �,,�...• . , i: ,, 6:.:-..1J .>.'. '�,O� hTRAG;� :a?`i ".c Water close:
Business name: P L
n 1 t 0 0 iron ... Water heater -- 16.60
I i- W 1v V�1 � t CO & ail U _ . 1 Other: ...
Address:
i Subtotal I
1 City / State/ZIP: (3 1 c 4 - c"_1Q
p Minimum permit fee: 572,50
I Phone: ( 3) Z 3 i s� c I Fax: ( ) (1? OM -9-5 r 0 Residential backfinw minimum pemlit fcc: $36.25 .5
I CCB Lic.: g 1 e i t Plumbing Lie. no. : Z(v .. 533 P1.3 Plan review ( 25% of permit fee)
State surcharge (8% of permit fee)
Authorized signature: ) ��4ji TOTAL. PERMIT FEE
Print name: 0 6,1.1 Y) r/10Y1t° r f Date -1 ) s J '!'his permit application expires if a permit is not obtained within
1 80 days after it has been accepted as complete.
'Fee me:hodulu set by T1i -Count' Building Industry Scrvlee Board
i nu :Wins PcrmiIApp.doc 12,'03 n40.4616T(I010 5 /1 /5
CITY OF TIGARD
I BUILDING DIVISION PERMIT #: PLM2005 -00227
;: 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 6/1/2005
s Phone: (503) 639 -4171 amtivAl �
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 5/3/2005 TIME: 7:09AM PAGE: 55
SITE ADDRESS: 12833 SW 116TH AVE CLASS OF WORK:
SUBDIVISION: HUNTER'S WOODLAND LOT #: 016 TYPE OF USE:
PROJECT NAME: MAHUNA
DESCRIPTION: install residential .loaf Ios>prevention_device 1
OWNER: IvMAHUNA, TYSON PHONE #: 503- -239 -8801
CONTRACTOR: APOLLO DRAIN + ROOTER SERVICE PHONE #: 503 -239 -8801
Inspection Request Scheduled For: Date: 5/3/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
325 RP /backflow preventer 008339-01 503 - 2398801 Y
Corrections /Comments /Instructions:
•
I
•
E PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
FAIL n CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: _ Date: 1 p Phone #: (503) 718-