Permit C ITY OF TIGARD PLUMBING PERMIT
ItgF l, DEVELOPMENT SERVICES PERMIT #: PLM2006-00423
DATE ISSUED: 9/13/2006
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 PARCEL: 2S103BA - 00129
SITE ADDRESS: 12085 SW 116TH AVE ZONING: R -4.5
SUBDIVISION: LERON HEIGHTS NO. 2 LOT: 043 JURISDICTION: TIG
Project Description: Pressure reducing valve.
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: CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES: 1
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Owner: FEES
MARLENE DUTTON
12085 SW 116TH AVE Description Date Amount
TIGARD, OR 97223 [PLUMB] Permit Fee 9/13/2006 $72.50
[TAX] 8% State Surcha 9/13/2006 $5.80
Phone : Total $78.30
Contractor:
CROWN PLUMBING
5429 SE FRANCIS
PORTLAND, OR 97206 REQUIRED ITEMS AND REPORTS
Contact # : PRI 503 -771 -9449 •
FAX 503 - 771 -9454
Reg #: L1C 42671
PLM 34 -70PB
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 0001 -0010 through OAR 952 - 0001 -0100. You may obtain copies of
these rules or direct questions to OUNC by calling 503 - 246 -6699 or 1- 800 - 332 -2344.
Issued By: ���/ Permittee Signature: _5_ 0.
Call 503 - 639 -4175 by 7:00 a.m. for an inspection that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
09/13/2006 08:48 5037719454 CROWN PLUMBING PAGE 02
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Pli'nbing Permit Applies ` �on • City of Tigard Q 10 Date/FSy, RaerBe �4 Pe rmit NT lM� o O� ad 42
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13125 SW Hall Blvd. Tigard, OR 97223 plan Revie Ot1 Permit No.:
Ph onc: 503.639.4171 Fax: 503598.1960 • JzMt,1Ay: i ''' , � .' Dntd$y:
24- Hour Inspection Linc: 503,639.4175 • J D or _ I •`1 'Onto Rutdy/By: ""' 1, E1 See Pair 2 for
Internet: www_ci,tigflyd,or -us S. "\. Notified/Mctbnd: 0 SupplementalInformetlnn
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❑New construction d Demolition Description 9tY. Ea- Tola.1
EI Addition /alteration/replacement ❑ Other: New 1-2-family dwellings (includes 100 R for each utility connection)
:: 1. bath 249.20
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e s: . . ;e : :: a.::: r�t• r . ,2i "4f:' ;;;..;; :. >: as. :c•'. °9;c <•s :E :!. ;.: !: ,,;,;; ... .,.: , :; {f; z; ?�. �. n:., '. ?1 2) bath 35 p.Ob
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® .1 -and 2- family dwelling El SFR ( Commercial /industrial
❑ Accessory building ❑ Multi - family
SFR (3) bath 399.00
Each additional bats/kitchen 45.00
❑ Master builder ❑ Other : Fire sprinkles( - , sq. ft.) Pagc 2
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:t�., - ,.i :•` � :• '�# .} : !.s: <; :...... „ , ....... Site ntiliNcs
lob site address: 12085 SW 116 AVENUE catch basin or area drain 16.60
City/State /7.IP: TIGARD, OR 97223 Drywell, leach use, or trench drain 16.60
J
Suite/bldg./apt. no.: I Project name: Footing drain (no. linear ft.: _J Page 2
Manufactured home utilities 110.00 -
Cross street/directions to job site: - Manholes 16.60
Rain drain connector 16.60
Sanitary sewer (no. linear ft: _) Page 2
• r Storm sewer (no. linear ft.: �_) Page 2
Water service (no. lintxu ft : ) Page 2
Subdivision: l Lot no.: .- -
Fixture or item
Tax map /parcel no.: Absorption valve 16.60
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Page 2
: �C' ..,r. „YES.. ,t :.?e.z ..... ..........
Rackflo
w venter
e� i:� : '�f :F!''
:'3r''rr' : :f : rte; �4s ?�f :1i't�i : :i :'!•� % ?� { ���5. .....� �,��..,..< L ...
INSTALL PRESSURE REDUCING VALVE Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
¢s< Drinking fountain. 16 -60
,rrrrr• ^:•,,:;t. > :,;; �, F.r rir tts:es' • a �� , sr > :fair. -
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t' :i� ?� :� .�.. ,.,; :: :` "�'< :;;: ,. >;, 1.6.60 •
Name: MARi,ENE DUTTON Expansion tank 16.60
-
Address: 12085 SW 116 AVENUE Fixture /sewer cap 16.60
City /State /ZIP: TIGARD, OR 97223 Floor drain/floor sink/hub 16.60
.. Garbage disposal 16.60
Fax:
Phone: ( ) ( )
:?. > : :ss :;; :. .. s :. Hose bib ice •:a+• ire :% 5'e!'
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Ylii;� j i�.ib: : t� :a
16.60
Business name: CROWN PLUMBING Interceptor /grease trap 16.60
Contact name: DENNIS UNDERWOOD, DISPATCHER Medical gas (value: S ) Page 2
Address: 5429 SE FRANCIS STREET Primer 16.60
CitylStatc/ZIP: PORTLAND, OR 97206 Roof drain (commercial) 16.60
Sink/basin/lavatory 16.60
Phone: (503) 771 - 9449 I Fax: : (503) 771..9454 16.60
Tub /shower /shower pan -
E-mail: Urinal 16.60
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s: -.�.� s.. X3;5;' � €,. 16.6
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Business name: CROWN PLUMBING Water heater 16.60
Address: 5429 SE FRANCIS STREET Other: P T V I 114, Q /
Subtotal -
City /S1a[e /7_IF: PORTLAND, OR 9720U Minimum permit fee: 572.50 •-�
Phone: (503) 771 - 9449 Fax: (503) 771 - 9454 Residential backflow minimum permit feel $36.25 / v . Sb
CCD Lic,: 42671 Plumbing Lie. no.: Me ,; 1431 _ Plan review (25% of permit fee)
_ a / State surcharge (8n% of permit fee) ,�
Authorized signature: I _ /
- ` �`� TOTAL PERMIT FEE 7,SP
Print name: Dennis Underwood Date: 09/13/2006 lisle 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.
i; \RuildingTomtits \PL? PennitApp.doe 12/03 440- 1616T0a/D//COM/WEB)
CITY OF TIGARD
BUILDING DIVISION / PERMIT #: PLM2006-00423
13125 SW Hall Blvd., Tigard, OR 97223 O 93. DATE ISSUED: 9/13J2006
Phone: (503) 639-4171 A#40".
Inspection Requests (24 Hrs.): (503) 639 -4175 , -'�
INSPECTION WORKSHEET FOR DATE: 9118/2006 TIME: 7:01AM PAGE: 59
SITE ADDRESS: 12065 SW 116TH AVE CLASS OF WORK:
SUBDIVISION: LERON HEIGHTS NO. 2 LOT #: 043 TYPE OF USE:
PROJECT NAME: DUTTON
DESCRIPTION: Pressure reducing valve.
OWNER: DUTTON, MARLENE PHONE #:
CONTRACTOR: CROWN PLUMBING PHONE #: 503- 771 -9449
Inspection Request Scheduled For: Date: 911€/2006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
399 Plumbing final 036655 -01 503-771-9449 N
Corrections /Comments /Instructions:
Pg fro ..."-...12 64/ VC) #
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47 PASS n PARTIAL APPROVAL ❑ CANCEL I I NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Vb - c / . Date: 9 / 1 / Phone #: (503) 718- it&