Permit .a .. Ir
IN . CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT PERMIT #: PLM2006 -00556
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 11/14/2006
PARCEL: 2S 103BB -02500
SITE ADDRESS: 12115 SW 124TH AVE ZONING: R - 4.5
SUBDIVISION: BROOKWAY LOT: 025 JURISDICTION: TIG
Project Description: Replace 45' of sanitary sewer 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: 45 ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Owner: FEES
BRIAN HANSON
12115 SW 124TH Description Date Amount
TIGARD, OR 97223 [PLUMB] Permit Fee 11/14/200E $72.50
[TAX] 8% State Surchart 111141200E $5.80
Phone : Total $78.30 •
Contractor:
APOLLO DRAIN + ROOTER SERVICE
2208 NW BIRDSDALE #8
GRESHAM, OR 97030 REQUIRED ITEMS AND REPORTS
Contact # : PRI 503- 239 -8801
FAX 503- 669 -9568
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 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- ealli0g 503.246.6699 or 1.800.332.2344.
ssued By: L. C�% l...4y Permittee Signatu
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 r POLLO DRAIN 503 669 - 9568 (TUE)NOV 14 2006 14:32/ST.14:29/No.6812889545 P 1 .
Plurnbini Permit Application �m t wit Ol•i••lc :r: t Sr: c).r.N
City of Tigard] � ,V �a Receive. t/ Permit No. � /lsri ��S •
13125 S W Hall Blvd„ Tigard, OR 9T?�, Datell3y; if /y 1,0 � T "r9/ ; o e6 6-- - 9- Y�
Plan Review
P,Itone; 50:3.639.417 I Fax; 503.598.1960 n • :o¢ttm. I Date /Eery: Otter Permit No.:
24- Hour Inspection Line: 503.639.4175 NOV 1 4 20 { . T A I I Date Ready/11r ru: 1;3 S�� t•aa e 2 tar
Internet: www.cirtigard,or,us
pea, I Supplemental our
n •••••:' ., {
T1P1�
T IGA • 0 "' ' FE
T. . ' or 1] New construction Q Demolition Foi s ecial ip urination use checklist,
Desct'i• lion CM Ea, Total
Xi ❑ Other: New I- 2- family dwellings (includes 100 11. for each utility connection)
if *` GATF. CORY.; 4F'; %CONSTRUCTiON'hi;';' ?A:: 4; :`: SFR I bath 249.20
F I • and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 350
• Accessory building 0 Multi - family SFR (3) bath 199
Each additional bath /kitchen 45.00
Q Master uildcr 0 Other: -
Fire sprinkler Q ) Page I• . spn k er ( s , fi, 2
, '
JOB;iSITIE`;IN'FORMAI1ON AND rLOCATIPON`•' 7?a:'f ,. :; .''' Site utilities
Job site address: , -' ♦ Catch basin or area drain 16.60
City /State /ZIP; 1 . C-A a L r) y Q-- 2 23 Drywell, leach line, or trench drain 16.60
Suite /bldg• /apt,no.: Project name: NA� Footing drain (no. linear ft.: ) _ Paget •
" Z Manufactured hone utilities 110.00
Cross street /directions to job site:
Manholes 16.00 .
�.. Rain drain connector 16.60
Sanitary sewer (no. linear 11.4 ) f Page 2
Storm sewer (no. linear ft.: ) Page 2
Subdivision; Lot no.: Water act-vice (no. linear ft.: ) Page 2
Tax I
Fixture or item
dx map /parcc no.;
:... .. :..w,. n valve ¢n In v lv
v l J ��Ir{)Y• ���f ,.� -�sr > .r.• :a... b +'+ i k9� �. �.'.1�!{!t ^y�1" f }.�NS}a ?,ih�` "! �:��t. q tl�`.'k'.
) 16.60
t
� �t1' �.. `,i
•.. , .... Frreit''f ^` i m7i',:: )I` M, ` , ,u °9,ww 'i,,O1P q i i M �) r!Ns ,1 X31' 'ACMIO
s,.. :.,., ", ,...� .,.�c0.� )tut ,� :: ` Backfluw prcventer Page 2
P ! f , a. l ` a .g . " WC( q . 6 Backwater valve 16.60
Clothes washer 16.60
Dishwasher 1 6.60
' . .,,:...,.. Drinkin fountain 16.60
'�,r PitOP 1ia �), t �;c :z;.;.,��,..:,, `'ea "�:I�.:K _.., ,.A A >;, >„ :a;,.: g
� y C- t
c; ",,.a,.:a'tl,,..d,.,?+! ...:.. ........ ...,.
�� ^ -• - L•jextnrs /sump 16,60
Name: u s /�
_ - 1� J � � ) 11�y Expansion tank 16 60
Address: Fixture/sewer cap 16.60
City /State /ZIP: Floor drain/Iloor sink/huh 10.60
Phone: ( ) fax: ( )
Garbage disposal 16.60
, .,,. se h t . 16.60
Hose
Ice maker .
Business name;
Interceptor /grease trap 16.60
Contact name:
Medical gas (talon. S ) Paget
Address: Primer 10.60
City /State /ZIP;
Roof drain (cotntnercial) 16.61)
Sink/basin/lavatory 16.60
Phone: ( ) Fax: : ( ) - --
-- - Tub/shower/shower pan 16.60
P:- rrtsil:
- Urinal 16.60
,:..;'': ',' 'CONTRACTOR.`: 'rte closet
W, 16.60
V
Ftusi name: 420 r - " ii Water heater
s �16�ti0
Address: 2 kivo is r 0 Other:
City /State /ZiP: a 0 30
Subtotal
- - �l ,n Minimum permit fee: 572.50 �� ` j s1
Phone; ( ) 2,3°1-se -se -Q1 Fax: ( ) 10 (C4 - lOtY Residential hacklTnw minimum permit fee: S36.25
CCB Lie.: 1 6 Plumbing Lic. no.: Ztv - 5 3 3 PG Plan review (25% of permit fee)
State surcharge (8%o of permit tee) 5, ‘tc
.4uthorized signature: 0 - t+4
i __ _ TOTAL PliRM IT FEE - �
Print name 4 ., ) t C io fl j4 / Date: l` 1' 14 -0 (0 This pc•rndl a e
ppiitnlion .,pires it's permit is not obtained within
1 ) r i L 180 days after it has been accepted as complete.
*Fee methodology set by Tri- County Building Industry Service Board.
Huilding I' rmiis 11L.1- I•rrmiLApp.do +c 06 lb 4Il0-16161 (•O ?1 wijm
CITY OF TIGARD
-
BUILDING DIVISION PERMIT #: IV12006-006
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 11/14/2006
Phone: (503) 639 -4171 ANSAI
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 11/17/2006 TIME: 7 :01Alvl PAGE: 46
SITE ADDRESS: 12115 SW 124TH AVE CLASS OF WORK:
SUBDIVISION: BROOKWAY LOT #: 025 TYPE OF USE:
PROJECT NAME: HANSON
DESCRIPTION: Replace 45 of sanitary sewer service.
OWNER: HANSON, BRIAN PHONE #:
CONTRACTOR: APOLLO DRAIN + ROOTER SERVICE PHONE #: 50 - 239.6801
Inspection Request Scheduled For: Date: 11117/2006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
505 Sanitary sewer 039946 -01 503 - 23943801 Y
° I � Fi N AL-
orrections /Comments /Instru 'ens:
IA i S At t 14A5 Pe O a`ri 6eR,v /tom
•
PASS P1 PARTIAL APPROVAL H CANCEL I NO ACCESS
FAIL CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED
Inspector: v • ' " 66 Date: a I b Phone #: (503) 718- /14