Permit -'�a CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT PERMIT #: PLM2007 -00061
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 2/14/2007
PARCEL: 2S 103CD -03200
SITE ADDRESS: 13815 SW 115TH AVE ZONING: R - 4.5
SUBDIVISION: LOT: JURISDICTION: TIG
PROJECT: EVES
Project Description: 80' water service.
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:
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LINE: 80 ft
DISHWASHERS: RAIN DRAIN: ft
Owner: FEES
PAT EVES
13815 SW 115TH Description Date Amount
TIGARD, OR 97223 [PLUMB] Permit Fee 2/14/2007 $72.50
[TAX] 8% State Surcha 2/14/2007 $5.80
Phone : 503- 624 -2976 Total $78.30
Contractor:
3 MOUNTAINS PLUMBING
PO BOX 386
SHERWOOD, OR 97140 REQUIRED ITEMS AND REPORTS
Contact # : PRI 503- 925 -1342
FAX 503- 925 -9104
Reg #: LIC 169499
PLM PB99
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: � G� Permittee Signature: 0-k (t �L-cf� 4.
GG
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.
02 -13 - 2007 14:35 3 MTNS PLUMBING 5039259104 PAGE3
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Plumbine Permit
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City f Tigard Re
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131 SW Haul B d., 'l igard, OR 97223 F `;1 1 1001 Plea cvi • Woe) z 6 Peru it No.: �� �W S0. &v'7 --19004P( Phone: 503.639.4171 Fax: 503.598.1960 . ••+I• �ti Dste/i3 : OtherPa No.:
24 Hour inspection line: 503.639.4175 N t I Ti ... pa g� `LJ b "" Ni pair (I Rc/M etho S see Page for -
Internet: www.
1 1. . w � L NMifipdtiv[pthod: Supplemental lamination
1;YgE, Q WFi ' allk - T FEE` SCHEDULE
El New construction CI Demolition
For apertd/ lrrfosmetlou use checklist
,� --- Description I Qty. I ha- I . Total
[J Addition/altcration/replacement 0 Other: New 1 - 2- family dwellings (includes 100 II. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (1) bath 24920
E 1 - and 2 - family dwelling 0 Commercial mdustrial 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
T_ JOB SITE INI ORMATION AND LOCATION Site utilities _ "
Job site address: /306- 5t✓ I / P' Jwoe Catch basin or area drain 16.60
-
City /State2IP: `r .. �� 9 �A a Drywell, leach line, or trench drain 16.60
Suite /bldgJapt. no.: Project name: Wat -, 5 e v✓,' rooting drain (no. linear ft,: ) Page 2
Manufactured home utilities 110.00
Cross street/directions to job site: Manholes 16.60
Rain drain connector 16.60
W
Sanitary scwcr (no. linear ft.: ) Page 2
Storm sewer (no. linear ft: ) Page 2
Subdivision: Lot no.: Water service (no. linear ft.:. ) Page 2 _ rr, p=
Tax map/parcel no.:
Fixture or item
- --�. Absorption valve 16.60
DESCRIPTION OF WORK Backflow preventer Page 2
Backwater valve 16.60
- ...... Clothes washer 16.60
Dishwasher 16.60
(PROPERTY OWNER El TENANT
Drinking fountain I6 60
r Ejectors/sump 16.60
Name: ��f b. ve5 .
Expansion tank 16.60
Address: Fixture/sewer cap 16.60
City /State/ZIP: Floor drain/floor siNJhub 16.60
Phone: C S� ' . 014 7( Fax: ( ) Garbage disposal 16.60
❑ APPLICANT 0 CONTACT PERSON
Hose bib 16.60
---- -- Ice maker 16.60
Business name:
., .,, Interceptor /grease trap I6.60
Contact name; Medical gas (value: $ ) Page 2
Address: Primer 16.60
City /State/ZIP: Roof drain (commercial) 16.60
Phone: ( ) Fax :: ( ) Sink/basin/lavatory 16.60
-^
E-mail: -mail: Tub /shower /shower pan 16.60
•-- _ ---- -- _ Urinal 16.60
CONTRACTOR Water closet 16.60
Business name: ,y - ! a _
3 / (UUt'j / D�v,� l f > Water heater 16.60
Address: !� U •••‘ y5 - y5 - 5e,./ 4 / 'f s < Uthcr _ -- _
City/State/ZIP: 0 q7. / tie) ( 6 Subtotal
Minimum permit fee: $72.50
Phone: ( ) 7 5 / J y2, if ,c ' pg Fax: (5`a 3) 4a 9 _ - %j/0 y 1 Residential backflow minimumyermit fee: $3625 , '
t2
CCB Lic.: j6 f y f 9 Plumbing Lie_ no.: p8 gr / Plan review (25% of permit fee)
State sum-lunge (8% of permit fee) i sN
Authorized signature:.
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Pnt name: TOTAL PERMIT FEE _9-'3'. 3 C.2_, L-. "_,. J', �/ < n' i°,.,, Dom; a / / �7L. This p ermit Application expires if a permit is not obtained within
.
180 days after it has been accepted as complete.
'Fee methodology set by Id-County Building Industry Service Board.
CITY OF TIGARD
BUILDING DIVISION PERMIT #: PLIV92007 -00061
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 2/1412007
Phone: (503) 639 -4171 lWili
Inspection Requests (24 Hrs.): (503) 639 -4175 "•:
INSPECTION WORKSHEET FOR DATE: 211512007 TIME: 7 :00AM PAGE: 48
SITE ADDRESS: 13615 SW 115TH AVE CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: EVES
DESCRIPTION: 80' vvater service.
OWNER: EVES, PAT PHONE #: 503.6
CONTRACTOR: 3 MOUNTAINS PLUMBING PHONE #: 503 -925 -1342 '
Inspection Request Scheduled For: Date: 2/512007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
330 Water service 043433-01 603 -925 -1 N .
Corrections /Comments /Instructions:
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'PASS Vi PARTIAL APPROVAL Li CANCEL ❑ NO ACCESS
FAIL lir') CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: v key Date: NA Phone #: (503) 718 - 2
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