Permit ! CITY OF TIGARD' PLUMBING PERMIT
COMMUNITY DEVELOPMENT PERMIT #: PLM2007 -00350
TI 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 8/7/2007
PARCEL: 2S 104BC -03300
SITE ADDRESS: 12625 SW ASCENSION DR ZONING: R -7
SUBDIVISION: HILLSHIRE WOODS LOT: 044 JURISDICTION: TIG
PROJECT: HOLLOWAY
Project Description: Installing irrigation system and backflow preventer.
CLASS OF WORK: OTR GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS: 1
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: ft
DISHWASHERS: RAIN DRAIN: ft
Owner: FEES
JASON HOLLOWAY
12625 SW ASCENSION DR. Description Date Amount
TIGARD, OR 97223 [PLUMB] Permit Fee 8/7/2007 $36.25
[TAX] 8% State Surcha 8/7/2007 $2.90
Phone : 503 -590 -0171 Total $39.15
Contractor:
OWNER
REQUIRED ITEMS AND REPORTS
Contact # :
Reg #:
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 b ailing 503.246.6699 or 1.800.332.2344.
Issued = • . � ���� � / Permittee Signature: /� (� &n
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.
Aug 06 07 02: Mark L. Holloway (503) 670 -9517 p.1
' 1 I I I CEIV ED , .
Plumbing Permit ApplicatG1 , FOR OFFICE USE ONLY -
City of Tigard AUG 0 6 2007 Date/13y: g ?/03..... SL/"' pi,./200.7 ,0o353
P nnil No.:
M ill
.1 13125 SW Hall Blvd., Tigard, OR 97 Plan Review
Phone: 503.639.4171 Fax: 503.5 °It TI DateBy: Other Permit No.:
TIGARD Inspection Line: 503.639.4175 BUIWINGDIViSION Date Rcady'By: H Sec Page 2 for
Internet: www.tigard or.eov Notified /Medved: S upplemental In
. ..... ° SCHI
❑ New construction ❑ Demolition For special information use checklist.
Description I Qty. 1 Ea. , Total
Addition/alteration/replacement LI Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF' !CO JVSTRI3C1aOi'das::';:r:..�` ::•:::•• `i:'' : -: FR (1) bath -
SFR 249 20
INJ I- and 2- family dwelling El 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
.. • JaSITE , SITE I \`F`ORMriiTiQN _ A,�TD :.EOCA;1?1 -: :
� . .. � -:•''; .: Site utilities
Job site address: / S 02 &Z .514 e. i.1 Sl . Catch basin or area drain 16.60
City /State /ZIP: ' ( (,b vtz 7aa3 Drywell, leach line, or trench drain 16.60
Suite /bldg- /apt. no.: 1 Project name: Footing drain (no. linear ft.: �) Page 2
Manufactured home utilities 110.00
Cross strcct/directions to job site:
Manholes 16.60
/
C..o4--A1 e.g.. O F dot_ I Zd...1 [3tJ A .415 Rain drain connector 16.60
I $G.T...i+/ /,- J Lk. o f,. d C.,, ' ,,1 Q , Sanitary sewer (no. linear ft.: _) Page 2
Storm sewer (no. linear ft.: `) Page 2
Subdivision: `Lot no.: Water service (no. linear ft.: ) Page 2
Fixture or item
Tax map /parcel no.:
:.,:•:.: Absorption
•OF. WORK ac o eventer
- orp ion valve
... B kfl w pr , •
/, 4%Ii I ea./ OAT7crAi $ Y57'gM A/cad Pi; jtA(si- Backwater valve 16.60
f Clothes washer 16.60
ate- R-I-s/ 0 ' ..rr, -1._ ► . _ _ _-1,
Dishwasher 16.60
:.. . Drinking m
- fountain
PYtOPEitTY OSYEll. ❑ TEy1i1NT ..,
. Ejectors /sump 16.60
Name: ^
JAsSe1'.1 14171.../..,(!).%/AY Expansion tank 16.60
Address: A , 2 ,. / AS c " Fixture /sewer cap . 16.60
City /State /ZIP: � e_ q? Floor drain /floor sink/hub 16.60
/
�! 7 Garbage disposal 16.60
Phone: (5 S`j 0 .. p 1 7 1 Fax: (1 (010 - 1
APP1LICANT' . , :.- ; .. . ::- CON1 :PE Hose H
'". .. -r` :... - ... Ice maker 16.60
Business name: O1.0� p (' Interceptor /grease trap 16.60
Contact name: ` Medical gas (value: $ ) Page 2
Address: Primer 16.60
City /State /ZIP: Roof drain (commercial) 16.60
Sink/basin /lavatory • 16.60
Phone: ( ) I Fax:: ( )
Tub /shower /shower pan 16.60
E -mail: Urinal 16.60
GOIS'PT2d.CTOR-
Water closet
16 .60
Business name: O W (l ei)C Water heater 16.60
Address: Other:
Subtotal
City/State/ZIP:
Minimum permit fee: $72.50
Phone: ( ) Fax: ( ) Residential backttow' minimum permit tee. $36.25 3(,. Ls -
Plumbing Lie, no.: clan review 7 o o permit fcc)
State surcharge (8% of permit fee 2 .,t)
Authorized signatur / / d friA7CYt TOTAL PERMIT FEE J T 47. /S
Print name: o.../ / 4111 . 11 . 11 . 11111P Date: e/4� 7 This permit application expires if a permit is not obtained within
180 days after it has been accepted as complete.
*Fee methodology set by Tri- County Building Industry Service Board.
1P.nuildin5\Pennia \PL>1- PermitApp doc 06/26/05 440- 4516T( I O /02 /COM(wfl13)
CITY OF TIGARD
BUILDING DIVISION PERMIT #: PLM2007- 00:350
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 8/712007
Phone: (503) 639 -4171 40 00101
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 8/22/2007 TIME: 7:01AM PAGE: 40
SITE ADDRESS: 12625 SW ASCENSION DR CLASS OF WORK:
SUBDIVISION: HILLSHIRE WOODS LOT #: 044 TYPE OF USE:
PROJECT NAME: HOLLOWAY
DESCRIPTION: Installing irrigation system and backflow preventer.
OWNER: HOLLOWAY, JASON PHONE #: 503 - 590.0171
CONTRACTOR: OWNER PHONE #:
Inspection Request Scheduled For: Date: 8/22/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
399 Plumbing final 054436 -01 503 - 580 -0171 N
Corrections /Comments /Instructions:
care_ )4.4.
PASS I I PARTIAL APPROVAL n CANCEL n NO ACCESS
FAIL n CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED
•
Inspector: � k f I \i9 �" ' — Date: ?I 22-10 Phone #: (503) 718- •