Permit CITY TIGARD PLUMBING PERMIT
i 4, DEVELOPMENT SERVICES PERMIT #: PLM2006 - 00228
`�'` ''III DATE ISSUED: 5/2312006
13125 SW Hall Blvd., Tigard, OR 97223 503- 639 -4171
PARCEL: 2S 103CC -05300
SITE ADDRESS: 13617 SW 121ST AVE ZONING: R -4.5
SUBDIVISION: LOT: JURISDICTION: TIG
Project Description: Replace 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: 60 ft
DISHWASHERS: RAIN DRAIN: ft
Owner: FEES
CAROL STOTLER
13617 SW 121ST AVE Description Date Amount
TIGARD, OR 97223 [PLUMB] Permit Fee 5/23/2006 $72.50
[TAX] 8% State Surcha 5/23/2006 $5.80
Phone : 503 -590 -1071 Total $78.30
Contractor:
CASEY'S PLUMBING INC °
PO BOX 30075
PORTLAND, OR 97294 REQUIRED ITEMS AND REPORTS
Contact # : PRI 503- 253 -0030
FAX 503- 262 -8251
Reg #: LIC 147298
PLM 26 -725PB
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: « r / �(1 Permittee Signature: , t,
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.
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Plumbing Permit Appl r
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, FOR OFFICE USE ONLY
City of Tigard Dat «,Bed, , . ` j� _
Date/13 : .1 'v) Perwt o' \ �a: w / 06, " 'Iii
13125 SW Hall Blvd,' Tigard, OR 97223 Yla ❑Rr trn
Phone: 503.639.4171 Fax: 503.593.1960 e th
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24- Hour Inspection Line: 503.639.4175
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Internet: www.ci- tigard.or.us �� -s ( Y o � I ( � S See moat for
�y TIUndili Notified/Mcthod I Supplemental Information
j 1 }I c pint:, Tire TOI FEE* SC'HED[7LE
El New construction � ' I e l moi ti o ` t `-` " x For special information use checklist.
De criMinn I Qty. I Ea. 1 Total
XAdditiordalteration/replaccment CI Other: New 1- 2- family dwellings (includes 100 ft_ for each utility connection)
CATEGORY OF ('ONSTRU(TION SFR (I) bath 249.20
Sit 1 - and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 350.00
❑ Accessory building ❑ Multi - family SFR (3) bath 399.00
CI Master builder Each additional bath/kitchen 45.00
❑ Other:
Fire sprinkler ( sq. If.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities
Job site address: r f '3r ly J7 0 , 2\ . Ave_- Catch basin or area drain 16.60
City /State/ZIP: ( - i /�(�� of.., O - I g F � Y � Dr well, leach line, or trench drain 16.60
Suite/bldg. /apt- no.: . J Project name: Footing drain (no. linear t : ) Page 2
J
Cross street/directions to job site:
Manufactured home utilities 110.00
Manholes 16.60
Rain drain connector 16.60
Sanitary sewer (no. linear ti: ) Page 2
Storm sewer (no. linear ft.: ) I Page 2
Subdivision: I Lot no.: . ' Water service (nu. linear it.: C ) } ] Page 2 53
Tax map /parcel no.: Fixture or item
Absorption valve 16.60
DESCRIPTION OF WORK Backflow preventer Page 2
'! Si g
r o QQ (..„...Y re... Si r... Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
4 PROPERTI OWNER 1:i TENANT
Drinking fountain 16.60
Name: CO k � ��
Ejectors/sump 16.60
L Expansion tank 16.60
Address: 13 Lo •1 t--1 5su 3 1 l< r - Fixture /sewer cap 16.60
-
City /State/ZIP: ------c:‘ c 0 t'L ,, 1 i C -.1‹"-.Q ' Floor drainifloor sink/hub 16.60
Phone: (a4:5) 5 Q S -) -1 ) F ax: ( ) J Garbage disposal 16.60
APPLICANT Hose bib 16.60
A
❑ CONT ACT PERSON
Business name: CaS,L . 1 u . ,.,,, I _ ! - 1 C
Ice maker 16.60
t� Y 1 V> �[�() Interceptor /grease trap 16.60
Contact name: �IA�.M1 C ash Medical gas (value: S ) Page 2
Y v c--..6i,.. Address: e� g
j7 )t ` Primer 16.60
City; State /! lP: ` �-1 -� � Q
C^` q Lt. Roof drain (commercial) 16.60
Phone: (s - 0 3 lC 2 53.0030 Fax: Sink/basin/lavatory 16.60
�� ) a - 8� s (
Tub/shower/shower pan 16.60
E -mail:
A . ' IL .• a__ ' •I ' it - AL Urinal 16.60
CONTR.- TOR Water closet 16.60
Business name: SAX_ Water heater • 16.60
Address: Other:
City /State/ZIP: Subtotal
Minimum permit fee: $72.50 `--r
Phone: ( ) Fax: ( - ) Residential backflow minimum permit fee: $36.25 I
CCB Lic.: 1 14-1 C, PlumbingLic. no.: 0(p- 72s Plan review (25% of permit fee)
� -' State surcharge (8% of permit fee) 6
Authorized sienatum: kr n � 0.0-4T1ph C 7g ,' U J TOTAL PERMIT FEE c30
Print narnc:j i ` ` ` l I ' n m p h e_ I i Date: 5/) a /Q(i This permit application expires if a permit is not obtained within
4 180 days after it has been accepted as complete.
*Fee methodology set by T'ri- County Building Industry Service Board.
is/ Building `.Vermits\ -Pe: nitApp.dec 06105 410-4616T(1 N0LCOM/WEB)
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CITY OF TIGARD
BUILDING DIVISION = r PERMIT #: PL.M2006- 00
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 5/23/2005
Phone: (503) 639 -4171 u�ii��
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 5124/2006 TIME: 7:12Atvi PAGE: 55
SITE ADDRESS: 13617 SW 121ST AVE CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: STOTLER
DESCRIPTION: Replace water service.
OWNER: STOTLER, CAROL PHONE #: 503-690-1071
CONTRACTOR: CASEY'S PLUMBING INC. PHONE #: 503-253-0030
Inspection Request Scheduled For: Date: 5/24/2006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
330 Water service 030486-01 503. 253 -0030 i
Corrections/Comments/Instructions:
L .Le — ,5
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"ASS iPPARTIAL APPROVAL n CANCEL ❑ NO ACCESS
I FAIL n CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: l k Date: Phone #: (503) 718 1/,3/