Permit CITY TIGARD PLUMBING atio ' r DEVELOPMENT SERVICES PERMIT #: PLM2005 -00421
- 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 9/1/2005
PARCEL: 2S 103BB -05900
SITE ADDRESS: 12550 SW 124TH AVE ZONING: R -4.5
SUBDIVISION: BROOKWAY LOT: 059 JURISDICTION: TIG
Project Description: Replace water heater.
CLASS OF WORK: ALT 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: OTHER FIXTURES:
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Owner: FEES
WILLIAM MANAHAN Description Date Amount
,12550 SW 124TH AVE
TIGARD, OR 97223 [PLUMB] Permit Fee 9/1/2005 $72.50
[TAX] 8% State Surcharp 9/1/2005 $5.80
Phone : 503 - 579 - 9226 Total $78.30
Contractor:
MT TABOR PLUMBING
12165 SW ANN PL. REQUIRED ITEMS AND REPORTS
TIGARD, OR 97223
Phone : 503 -579 -8134
Reg #: LIC 110945
PLM 34 -358PB
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: /3 f ( . l i U Permittee Signature: / J
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.
C e . ,..
Plumbing Permit Aim i"eati'Q FOR OFFICE USE ONLY
ri LA./ P No.:
City of Tigard Date/By: y r /D .5* -3 J-11 a of - o 0 ye l
13125 SW Hall Blvd., Tigard, OR 97223 A - 'Ng Plan Review
Phone: 503.639.4171 Fax: 503.598.19601 etnrdl� � � � Date/By: Other Permit No.:
24- Hour Inspection Line: 503.639.4175 J . !I_I Date Ready/By: t s • ® See Page 2 for
Internet: www.ci.tigard.or.us CITY OF TIGAR Notified/Method: L. Supplemental Information
a � ., _ - " Tyi FAIR lifto 'N'ISION... - _ ,. FEE* SC EDUIE
❑ New construction ❑ Demolition For special information use checklist.
Description I Qty. I Ea. I Total
Z Addition/alteration /replacement ❑ Other: New l- 2- family dwellings (includes 100 ft. for each utility connection)
CATEGORY O F CON STRUCTION SFR (1) bath 249.20
® 1- and 2- family dwelling ❑ Commercial/industrial SFR (2) bath 350.00
SFR (3) bath 399.00
❑ Accessory building ❑ Multi - family Each additional bath kitchen 45.00
❑ Master builder ❑ Other:
Fire sprinkler ( sq. ft.) Page 2
- JOB SITE�:INFORMATION` AND - LOCATION. = -' Site utilities
Job site address: 12550 sw 124th Catch basin or area drain 16.60
City/State /ZIP: tigard, or 97223 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 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: I Lot no.:
Water service (no. linear ft.: ) Page 2
Fixture or item
Tax map /parcel no.: Absorption valve 16.60
t - , -,,i - "` - -- 'DE_ SCRIPTION",OF WORK Backflow preventer Page 2
replace water heater Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
. Drinking fountain 16.60
"" le PROPERTY °,.OWNER El 16.60
,,. ,_ , u - -I Ejectors /sump
Name: (� g\) Expansion tank 16.60
Address: ())<) n� ..42___ Fixture /sewer cap 16.60
City/State /Z[P: Floor drain/floor sink/hub 16.60
Phone:
(4 ) 419 _ R a 1.3,„ ( ) Garbage disposal 16.60
Fax: . Hose bib 16.60
® APPLICANT ' . 4 ❑ CONTACT PERSON" Ice maker 16.60
Business name: Mt. Tabor Plbg -
Interceptor /grease trap 16.60
Contact name: Sam Zern Medical gas (value: $ ) Page 2
Address: 12165 sw ann pl Primer 16.60
City /State /Z1P: tigard, or 97223 Roof drain (commercial) 16.60
Sink/basin/lavatory 16.60
Phone: (503) 579 - 8134 Fax: : (503) 579 - 8134 Tub /shower /shower pan 1 6.60
E -mail: Urinal 16.60
r - GONT- RACTOR ' Water closet 16.60 _
Business name: Mt. Tabor Plbg Water heater 1 16.60
Address: 12165 sw ann pl Other:
Subtotal
City /State /ZIP: Tigard,Or 97223 Minimum permit fee: $72.50 7Z ,
Phone: (503) 579 - 8134 Fax: ( ) Residential backflow minimum permit fee: $36.25
CCB Lic.: 110945 Plumbing Lic. no.: 34 - 358PB
Plan review (25% of permit fee)
.��� State surcharge (8% of permit fee) C ire!
Authorized signature: �� D a te: 8/3 1/05 This permit
TOTAL PERMIT FEE 7? ,() mit application expires if a permit is not obtained within - /-....2 , [print name: S am Z ern 180 days after it has been accepted as complete.
*Fee methodology set by Tri -County Building Industry Service Board.
i:\ Building \Permits\PLM- PermitApp.doc 06/05 440- 4616T00/02/COM /WEB)
CITY OF TIGARD
BUILDING DIVISION PERMIT #: PLM200 &00421
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 9/1/2005
Phone: (503) 639 -4171 v "
Inspection Requests (24 Hrs.): (503) 639 -4175 ''' I..
INSPECTION WORKSHEET FOR DATE: 3/16/2005 TIME: 7:01 AM PAGE: 89
SITE ADDRESS: 12550 SW 124TH AVE CLASS OF WORK:
SUBDIVISION: BROOKWAY LOT #: 059 TYPE OF USE:
PROJECT NAME: MANAHAN
DESCRIPTION: Replace water heater.
OWNER: MANAHAN, WILLIAM PHONE #: 503 - 579 -3226
CONTRACTOR: MT TABOR PLUMBING PHONE #: 503- 579.8134
Inspection Request Scheduled For: Date: 9/16/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message ,
399 Plumbing final 015845 -01 503-655.7558 N
Corrections /Comments/ Instructions:
.
ItPASS fl PARTIAL APPROVAL ❑ CANCEL I NO ACCESS
I FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
de'
9
Inspector: Date: ,. Z.- /
I Phone #: (503) 718-