Permit C ITY OF TIGARD PLUMBING PERMIT
a i DEVELOPMENT SERVICES PERMIT #: PLM2005 -00350
Lia 6.- 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 8/4/2005
PARCEL: 2S 103BB -03200
SITE ADDRESS: 12198 SW 125TH AVE ZONING: R -4.5
SUBDIVISION: BROOKWAY LOT: 032 JURISDICTION: TIG
Project Description: 40' of 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: 40 ft
DISHWASHERS: RAIN DRAIN: . ft
Owner: FEES
DAWN SPRAGUE Description Date Amount
12198 SW 125TH AVE
TIGARD, OR 97223 [PLUMB] Permit Fee 8/4/2005 $72.50
[TAX] 8% State Surcharl 8/4/2005 $5.80
Phone : 503 - 579 - 5093 Total $78.30
Contractor:
WOLCOTT PLUMBING CONTRACTORS
1075 W HISTORIC COLUMBIA RIVER REQUIRED ITEMS AND REPORTS
TROUTDALE, OR 97060
Phone : 503- 667 -1781
Reg #: LIC 23847
PLM 26 -208PB
•
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- 1 rough OAR 952 - 0001 -0100. You may obtain copies of these rules or direct questions to OUNC by
calling 3-246-6691- - 332 -2344.
Issue By: ` Permittee Signatur
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.
08/04/2005 09:28 5034912932 JACK HOWK PAGE 01
' Plumbine Permit App1ica:ti it V E • FOR OFFICE USE ONLY
City of Tigard Received
, Per„ +it No.:
13125 SW hall Blvd., Tigard, OR 97223 " + e -t 4 (� Pla e ,h A�
Phone; 503.639.4171 Fax: 503,598.1960 nn G,. ,O
r° " � `' Other Permit No.:
1 Date/Ely: `' 1- I
24- Hour Inspection lane: 503.639.4175 r �i cI i i Due Ready/By: lv 1Z See Page 2 for
Internet: www,ei,ligard.or,us Cl''' ' I I�ai1 , • , Notified/Method: ,...
/ 1 a Supplemental information
TYPE OF'W-c.)RK-`a DIVI s1OI\1 FFF SCHFDI'LF •
❑ New construction ❑ Demolition For special information ILte checklist
Description .1 Qty. i Ea. i Total
Vi Addition/alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 fl. for each utility connection)
CATEGORY OF ('ONSTRTTCTTON SFR (1) bath 249.20
3'4 1- and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 350.00
❑ Accessory building ❑ Multi - family SFR (3) bath 399.00
Q Master builder ❑Other: Each additional bath/kitchen 45,00
Fire sprinkler ( , sq. ft.) Page 2
_
JOB SITE INFORMATION AND AND LOCATION Site utilities
Job site address: 2 • :r .„./B. t . Catch basin or area drain 16.60
City /State /ZIP; g :l. , illi e _ / . Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: Project name: ''1 AS4uQ 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 _
d 1 =� / Sanitary sewer (no. linear ft.: ) Page 2
• r- Storm sewer (no, linear ft.; �) 4 0 Page 2
Subdivision: Lot no.: Water service (no. linear ft.: 1.( .'� Page 2 b
Tax map /parcel no.; • 6 '~ 4ill Fixture or item
Absorption valve 16.60
DESCRIPTION OF WORK - Backflow preventer Page 2
II r . A � \' tf
' 11 Backwater valve ' 16.60
�
. T Clothes washer 16.60
Dishwasher 16.60
Drinking fountain 16.60
7 PROPERTY OWNER 1 � ❑TEN TENANT -
Ejectors/sump 16,60
Init 1 -1 - al At , ! Expansion tank 16.60
Address: ' Di , + ' rt J , , 0 Fixture /sewer cap 16,60
City/State/ZIP; At 4 ' e�bre6 Floor drain /floor sink/hub 16.60
Phone: _ill - - ;; -- r T Fax: ( ) Garbage disposal 16.60 •
Hose bib 16.60
174 _ !TIT(' ANT ❑ C:ONT_tCY' PERSON ' •--
lee maker 16.60
Business name: Wolcott Plumbing dba Jack Howk Plumbing interceptor /gretsetrap 16.60
Contact name; , , tJ ■ \ a p n Medical gas (value: $ ) Page 2
Address; 1075 W Historic Columbia River Hwy Primer 16.60
City /State/ZIP: Troutdale, OR 97060 Roof drain (commercial) 16,60
Phone: (503) 235 -8784 I Fax: : (503) 491 -2932 Sink/basin / lavatory 16.60
Tub /shower /shower pan 16.60
E -mail: Urinal 16.60
CONTRACTOR Water closet • 16.60
• Business name: Wolcott Plumbing dba Jack Howk Plumbing Water heater • 16.60
•
Address: 1075 W Historic Columbia River Hwy (her;
City /State/ZIP: Troutdale, OR 97060 Subtotal �L L
Minimum permit fee: $72.50
Phone; (503) 235 -8784 Fax; (503) 491 -2932 Residential backflow minimum permit fee: $36.25
CCB Lie.; 23847 Plumbing 1 ic. no.: 26 -208 PR Plan review (25 %ofpermit fee)
Authorized signature: re State surcharge (8% of permit fee) i
TOTAL PERMIT FEE deir.
Print name . , `0 .- Date. +1.N ig"ll, _ This permit application expires if a permit is not obtai
180 days after it has been accepted as complete.
*Fee methodology set by Tri- County Building Industry Service Board. .
I ; _ -
CITY OF TIGARD
BUILDING DIVISION t'..- PERMIT #: PLM200& -00350
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 8/4/2005
Phone: (503) 639 -4171 /p
Inspection Requests (24 Hrs.): (503) 639 -4175 'Li—
INSPECTION WORKSHEET FOR DATE: 8/9/2005 • TIME: 7 :05AM PAGE: 25
SITE ADDRESS: 12198 SW 125TH AVE CLASS OF WORK:
SUBDIVISION: BROOKWAY LOT #: 032 TYPE OF USE:
PROJECT NAME: SPRAGUE
DESCRIPTION: 40' of water service
OWNER: SPRAGUE, DAWN PHONE #: 5 -6093
CONTRACTOR: WOLCOTT PLUMBING CONTRACTORS PHONE #: 503 -667 -1781
Inspection Request Scheduled For: Date: 8/9 /2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
330 Water service 013176 -01 503 - 235 -8704 Y
Corrections /Comments /Instructions: cc ° / k ' q:4/\ ,
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• S ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
• FAIL n CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
/.
Inspector: Date: 7 1 , % Phone #: (503) 718-