Permit 1�r
C ITY OF TIG ARD PLUMBING PERMIT
I DEVELOPMENT SERVICES
PE
DEVELOPMENT PLM2005 - 00295
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 7/6/2005
PARCEL: 2S102BC -00102
SITE ADDRESS: 12595 SW BROOKSIDE AVE ZONING: R -4.5
SUBDIVISION: WALNUT ACRES LOT: 001 JURISDICTION: TIG
Project Description: Water line replacement.
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
WINTER, RAVEN
12595 SW BROOKSIDE AVE Description Date Amount
TIGARD, OR 97223 [PLUMB] Permit Fee 7/6/2005 $72.50
[TAX] 8% State Surcha 7/6/2005 $5.80
Phone : 503- 653 -5301 Total $78.30
Contractor:
MR ROOTER OF PORTLAND
PORTLAND SERVICES INC
15033 SE MCLOUGHLIN BLVD #344 REQUIRED ITEMS AND REPORTS
MILWAUKIE, OR 97267
Phone : 503- 653 -5301
Reg #: LIC 138941
PLM 3 -434PB
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: -�y Permittee Signature: L(J - -
.,Q
Call 503 - 639 -4175 by 7:00 a.m. for an inspection that business day. \ e
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.
JUL- 06- 200504ED) l4:06 MR ROOTER PLUMBING (FRX)503 653 5376 P. 001 /001
.. RECO \ %( „& V d�,.
0 `
Plumbing Permit Application 0 6 2005 FOR OFFICE USE ONLY
City of Tigard 'Received
te/ 7 f (� '9,-j”- PcrmftNd,_ 0S -- 0o.293_
13125 SW Hall BIvd..Tignrd,OR 97223 CITY OFTIGAr,D 1?ia:Review `
Phone: 503.639,4171 Fax: 503,598.1960 BUILDING DIVI' ' "' " (t 1 re/�y OtherpertnlrNo.:
2.4 - Hour Inspection Line: 503.639,4175
' Internet ww w.el.tigard.or.us ' ate D ; \ Si pt t e; t for
Natlticd/led/M Mctli niad: !J j \5 Sapptentsilt.7l Information
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it f I ; ;,� u t, Y " `IQ ' til< � .AlkEi' . ;,, .1':," {f. :•h_''' fi xi �rt!. l.. _ "- I ° : -;� >' k".. S.C137• 04 ..
nru�. n-, 1 ,. �tt�' Ixlf�l�x!_ Jt[ �+ ��v. �uktl' �d,: tsf !nra;..,..,.a4�1.:,.._..IMPI� . �L .ltlr...,,°It.�.��`:Sst°. !h.:bl� :d..:�� _. �.., ,�..ii.._ ,... ......., _.., _,..,........
❑ New c0natruetion ❑ Demolition Perspeclut inform ilon use checklist,
_Description I Qty. I ea I t. Tow ❑ Arts ition/aiteration/replace:tient 1:1 Other: New 1.2famlly dwellings (includes 100 ft. for with utility connection)
w a y ,P 1 ru y ` ,, -,h,.p� '.171 : r .• �. � m�, I vl 1121 lia I�!iCi C+lP i*r. 1 I ii
?'inrilai ` 'Iailli " �nt i 0,E0 ° ailir riMill 51% ( 1 )
bath 24920
ar anti 2- nuttily dwelling 0 Commercial/industrial SFR (2) math , T 350,00
0 Accessory building CI Multi- futnily • SFR (3) bath 399.00
Muster builder C��; their additional batli/kheb 45,00
'1 o 1 IPA l pn a P I w _ Fitt uprinldcr (,.,.— aq, ft.) Page 2
1 iifiO Mil : f1grff' LLE ,,, F� �f 'i slt� unlit., 1 /. i., fiu� n� I Ild
Job sIte address; ) �,c5 � Atey:>K. ,1/4, Ave Utah bruin or area drain 16,60
City/Slat;rZTP: isi.„. Cr( -L ' i 1-z3 Drywell, leach line, or trench drain 16,60
Suite/bldgJupt.na.: Project Hurst .. --- Hootingdrain (nn. linear IL: Page
Crams str,rel/ditticlions to job Hire: Manufactured home utilltles 110.00
' ` — Munhales 16,60
0-;f ' Y*`-.•±'_ - L.4 Rain drain connector 16.60
Sanitary sewer (no, linear ft,: ) Page 2
Swan sewer (no. linear it.: Page
Water service (no. linear ft.: 1 c pl •
Subdivision: Lot ao
Fixture or hem
Tax map /parcel no,:
V r 7 9 I P �� 1 i L Irl : t r t ny �! 4 Abaarplion valve 16'.60
�I I! �FIRENIIIlr }fin �� 11��1ENEN §gitnA � li len'11 11 ui 01 }Air ail - Bac1dlow preventcr page :
a > _�, t.,� t Buakwntervalva 16.60
1 Clothes washer _ 16.60
Dishwasher 16.60 •
MIME . - 46. 41 1 '`" 111 NlI � bull l t 1 r 4'� �I''1� t�l � 1 r 1) r ng fauntaln i G,Gg
1 , ! t _ .. f ,_ t n x I l;jecttlra/antttp 16.60
. Expansion tank 16,60
Addreaa: I .2 s `7 5 -r-...W 6r -cbFsa' eL. A.re� Flxtutehewer cup . 16,60
City/State/ZIP:
IP: —1-- ,, pr.� c17 2. Z. 3 Floor drain /floor sink /hub 16.60
Phone: (,03 ) 'ct-1 - Z 4 93 rtt:t: ( ) aurb:tua diupntud 16,60
1 ,10 1 ' ;, Y ' d i�rl Ill ll>i' 1 Raig heitl ' Ili Masa bib 16,60
Gl ftt " I ° Ice curia 16.60
Interceptor/grease trap 16,60
Contact rune: r.� TBf K fy i c 7 Medical guu (value: S ) Page 2
Adds 111: �) 7 ~ „ . i t.t c. ( y, l z ,..,. -2,1,, -"4 Printer • 16,60
City/Stut&JZIP: 1.,,,1;0,., c .,.,... 1.:-„ QY .. 9"11] (0^) Roof drain (commercial) 16,60
Phone- (61*) (,S 3 - 5 1 F : (mac ) 3 ) .L 53 - 537 f r, slnk/bnslnnavatory 16 -
Tublshower/ahowcr pan - 164 -
r.,-mail: Urinal 16,60
y . , 1 f. , r q. » al 1 r 1 a 1 r.. I. r'•M ^+nil ti 1 I
a �G ., ;1 3 :, i - .I�, i :a11�. " ,° o ,,,1...,- i1i o o ill i l li r �i i og rthgllii i: rli, r f' A Watcrcioset 16.60
rinaiaeaa name: Water heater 16,60
Address: Other:
City/State/ZIP: Subtotal
Minimum permit fee: 572.50
Phone: ( ) Fax: ( ) Residential 1=1k minimum permit fan: p5,35
'CB Lip,: I. Cj 4 ( Plumbin Lie no.: ,5 3c/ P8 Plan review (29tbb orpertnit fee
■ State surcharge OM of permit fee)
..- Authorized signature✓ 7 d+.r -- TOTAL PERMIT FEE 75?i3 0
Print \.,„ c .,, L. 0 1 ,, Dutc: 1 [p / This permit application expires K Cu permit in nut. obtained within
180 days after It has been accepted ax comp:etc.
°Fee methodology act by Tri- County Building Industry Service Board,
tiHl(JlrtaeaNgi -rE thAti .Joc :2103 4404e t6T(rarar/coM/wttn)
•
CITY OF TIGARD
BUILDING DIVISION PERMIT #: PLM2005-00296
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 7/6/2005
Phone: (503) 639 -4171 7
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 7/1212005 TIME: 7:06AN1 PAGE: 31
SITE ADDRESS: 12595 SW BROOKSIDE AVE CLASS OF WORK:
SUBDIVISION: WALNUT ACRES LOT #: 001 TYPE OF USE:
PROJECT NAME: WINTER
DESCRIPTION: Water line replacement.
OWNER: WINTER, RAVEN, PHONE #: 503- 653 -5301
CONTRACTOR: MR ROOTER OF PORTLAND PHONE #: 503 -653 -5301
Inspection Request Scheduled For: Date: 7/12/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
330 Water service 0/123501 503 - 849 -4917 N
Corrections /Comments/ Instructions:
411 e5
V PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL H CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: / 7 0 l.), Date: 7/i/6J Phone #: (503) 718 -