Permit a CITY OF TIGARD PLUMBING PERMIT
114 COMMUNITY DEVELOPMENT PERMIT #: PLM2007 -00022
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 1/24/2007
PARCEL: 2S 102CA -00217
SITE ADDRESS: 13165 SW ASH DR ZONING: R -4.5
SUBDIVISION: VIEWCREST TERRACE LOT: 015 JURISDICTION: TIG
Project Description: 60' of new 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
LOIS GANOE
13165 SW ASH DRIVE Description Date Amount
TIGARD, OR 97223 [PLUMB] Permit Fee 1/24/2007 $72.50
[TAX] 8% State Surcha 1/24/2007 $5.80
Phone : 503- 639 -6719 Total $78.30
Contractor:
BEAVERTON PLUMBING INC
13980 SW TUALATIN VALLEY HWY
BEAVERTON, OR 97005 REQUIRED ITEMS AND REPORTS
Contact # : PRI 503- 643 -7619
FAX 503- 643 -7620
Reg #: LIC 12889
PLM 34 -4PB
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 ct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Iss d B OgLite Permittee Si . re: —_ �i f'
Call 503.639.4175 by 7:00 a.m. for an inspection that bu= ness 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.
Plumbing Permit Application FOR OFFICE USE ONLY
City of Tigard Received "�
Ei
II 13125 SW Hall Blvd., Tigard, OR 97223 DateBy a`y 'p7 permit No.: 7 [.C�J` / ,
Phone: 503.639.4171 Fax: 503.598.1960 Plan Revie Other Permit No.:
Date/By:
Inspection Line: 503.639.4175
TIGARD Ready /By: D ate Read /B _ii, ® Page Pa e 2 for
Internet: www.tigard - or.gov Notified /Method: r II Supplemental Information
' TYPE OF WORK_ ?° . . ' - FEE* SCHEDULE` ' •
❑ New construction El Demolition For special information use checklist
Description I Qty. Ea. Total
® Addition/alteration /replacement El Other: New 1 - 2 - family dwellings (includes 100 ft. for each utility connection)
- • ' ` CATEGORY OF CONSTRUCTION - • ,, ' ,'''• SFR (1) bath 249.20
® 1- and 2- family dwelling El Commercial /industrial SFR (2) bath 350.00
El Accessory building ❑ Multi - family SFR (3) bath 399.00
Each additional bath/kitchen 45.00
El Master builder ❑ Other:
Fire sprinkler ( sq. ft.) Page 2
• JOB SITE INFORMATION AND LOCATION ." , . Site utilities
Job site address: 13165 SW ASH ST Catch basin or area drain 16.60
City /State /ZIP: TIGARD, OREGON 97223 Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: 1 Project name: LOIS CANOE 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: Lot no.: Water service (no. linear ft.: 60) Page 2 55.
Fixture or item
Tax map /parcel no.:
. Absorption valve 16.60
DESCRIPTION OF WORK, n - , ' Backflow preventer Page 2
NEW WATER SERVICE Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
® PROPERTY OWNER I Drinking fountain 16.60
' ,
❑ 'TENANT
Ejectors /sump 16.60
Name: LOIS CANOE
Expansion tank 16.60
Address: 13165 SW ASH DR Fixture /sewer cap 16.60
City /State /ZIP: TIGARD, OREGON 97223 Floor drain/floor sink/hub 16.60
Phone: (503)639.6719 Fax: ( ) Garbage disposal 16.60
Hose bib 16.60
'❑ APPLICANT_ ' ,. ❑ . CONTACT PERSON"
Ice maker 16.60
Business name:
Interceptor /grease trap 16.60
Contact name: Medical gas (value: $ ) Page 2
Address: Primer 16.60
City /State /ZIP: Roof drain (commercial) 16.60
Phone: ( ) Fax: : ( ) Sink/basin/lavatory 16.60
Tub /shower /shower pan 16.60
E -mail: Urinal 16.60
• ' , CONTRACTOR, • • Water closet 16.60
Business name: Beaverton Plumbing, Inc Water heater 16.60
Address: 13980 SW TUALATIN VALLEY HWY Other:
City /State /ZIP: BEAVERTON, OREGON 97005 Subtotal
Minimum permit fee: $72.50 72.50
Phone: (503) 643.7619 Fax: (503) 643.7620 Residential backflow minimum permit fee: $36.25
CCB Lic.: 012889 Plumbing Lic. no.: 34 - 4PB Plan review (25% of permit fee)
Authorized signature: p State surcharge (8% of permit fee) 5.80
buccun `- 1,20 r e TOTAL PERMIT FEE 78.30
Print name: SUSAN DEAN Date: 1/24/07 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.
L\Building \Permits \PLM- PermitApp.doc 06/26/06 440- 4616T(10/02/COM/WEB)
' •
CITY OF TIGARD
BUILDING DIVISION PERMIT #: PLIv12007-00022
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 1/24/2007
Phone: (503) 639-4171
Inspection Requests (24 Hrs.): (503) 639-4175
INSPECTION WORKSHEET FOR DATE: 1/25/2007 TIME: 7; 03A1v1 PAGE: 30
SITE ADDRESS: 13165 SW ASH DR CLASS OF WORK:
. SUBDIVISION: VIEWCREST TERRACE LOT #: 016 TYPE OF USE:
PROJECT NAME: GAI■10E
DESCRIPTION: 60' of new water service.
OWNER: GANOE, LOIS PHONE #: 03,639-6714
CONTRACTOR: BEAVERTON PLUMBING INC PHONE #:
Inspection Request Scheduled For: Date: 1/25/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
330 Water service 042501-01 503-643-7619
Corrections/Comments/Instructions:
lig 11\
410.1ArvArAiri X.
• -
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1 Or I r
PASS PARTIAL APPROVAL I I CANCEL I I NO ACCESS
FAIL n CALL FOR INSPECTION 0 ADDITIONAL FEES ASSESSED
Inspector: Date: //-2- Phone #: (503) 718--•2/16?)