Permit CITY TIGARD PLUMBING PERMIT
, „.l I \ DEVELOPMENT SERVICES PERMIT #: P /7/200 -00506
�, 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 11/7/2005
PARCEL: 2S110BC -00900
SITE ADDRESS: 12475 SW BULL MOUNTAIN RD ZONING: R -1
SUBDIVISION: LOT: JURISDICTION: TIG
Project Description: Well House. Other fixtures: Hose bibb, primer, eyewash.
CLASS OF WORK: NEW GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS: 2
OCCUPANCY GRP: U2 FLOOR DRAINS: 6 TRAPS:
STORIES: WATER HEATERS: 1 CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: 1 URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES: 3
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Owner: FEES
TIGARD WATER DEPT. Description Date Amount
8777 SW BURNHAM ST
TIGARD, OR 97223 [PLUMB] Permit Fee 11/7/2005 $275.40
[PLMPLN] Plan Review 11/7/2005 $68.85
Phone : 639-4171 395 [TAX] 8% State Surcharl 11/7/2005 $22.03
Total $366.28
Contractor:
HAMPTON PLUMBING CO.
411 S COLLEGE ST REQUIRED ITEMS AND REPORTS
NEWBERG, OR 97132
Phone : 503 -538 -5629
Reg #: LIC 160927
PLM 36 -102PB
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes
and all other applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is
not started within 180 days of issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law
requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 - 0001 -0010 through OAR 952 - 0001 -0100. You may obtain copies of these rules or direct questions to OUNC by
calling 503 -246 -6 9 or 1- 800 -332 -2 4.
Issued By: Permittee Signature: K cfi2r,
Call 503 - 639 -4175 by 7:00 a.m. for an inspection that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
_ 1
SEP- 2'9— �45 AM SCHNIEDER EQUIPMENT 503 633 2668 P.02
Plumbing Permit Apt °'(, )(J ether Permit No .S
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Rceetved r , 1 Permit
City of Tigard EP OO
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1312 SW Hall Blvd., Tigard, OR 97223 2 plan Review' / o°' . w 0V /$
Phone: 503,639 " Fax: 503,598.1960 �% ,,,,+� i p, Date/By: l - Db 0
24- Hour Inspection line: 503,639.4175 ' CITY �� T1G ` Date Ready /By °' ' gee Page 1 for
Internet: www,ui,tigard,or,us Notified /Method; j Supplemental ;Inflation
t Pt 1 MTh 011.! WWI I I W; e'• , I 1 1111
" 1 1 II tfi,lilglif 11'p1111 it 1 1'0 111 1
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;i�1: � � ' � �t� `� i;It�l 01 ' ' 11; i�, 111,,�1�a� I NIN f[ �I I i ll laiJll II�II�I 1 f ell f i ;i glii� i t kI <il lIni �9 . • For a +ecla!!n ormation use checklist
® New construction [f Demolition
. Degel'I tion Mil Ea. TOW
Q Addition /altcration/replacemcnt j1 ( ! irk0 Other: New 1- 2-family dwellings (includes 100 ft. for each utility connection)
. 0: r ! II I' �� :1 !rn t(Il gii t a tiltf 4`HI l itt�� S �+nP�7111Aiii l i iiii liil�iilsRlii �lll 111lllif l�': N1. it ll fill SFR (1) bath 249.20
E] I - and 2 - family dwelling ►'4 Commercial /industrial SFR (2) bath 350,00
SFR (3) bath 399.00
Multi -famil
❑ Accessory building ❑ y
Each additional path /kitchen 45,00'
- M aster builder ❑ O —
Q Fire sprinkler ( ,.sq. R.) Page 2
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. ..,:,. .. dr f Ill f ) iii �flfe4tli11E%,ltulll�a ,ii ' I � . � l i Site utilities
Job site address: 12475 S.W. Bull Mountain Road Catch basin or area drain 16.60
City /State /ZIP: Tigard, OR 97224 Drywell, leach line, or trench drain 16,60
Suite /bldg. /apt. no.: Project name: Tigard ASR 2 Well House Footing drain (no. linear ft.: ) Page 2
Manufactured home utilities 110,00
Cross street/directions to job site: 125 Avenue /Bull Mountain Road •
Manholes 16,60
Rain drain connector 16,60
Sanitary sewer (no. linear ft_: \ Page 2
Storm sewer (no, linear P . Page 2
Subdivision: I Lot no.: Water service (no. linear ft.: Page 2
Fixture or Item
Tax map /parcel no.: f� i i I (�j'f VIII ( t {� -
�" r + t f' � , Ali' />�1rt;tlP ;�o'aiilmiii { 111 I � H. ,... ` 11Iilfll111111 11111111111141 Backflo p eyenter 2 Pa g e 2
Page Fi`f' IF. D
Construction of well house over existing well Backwater valve _ 16.60
Clothes washer 16.60
Dishwasher 16.60
y � j f(�f I){�I
.... ' ;'4''.# ' n '. u ` iiNf � i l li!fililiu lillit 1111 111111111111VV? :_111 ����111 III �IIIIIl111tlIII i ; '. Ejectors/sump o /sum p tain 16.60
Name: City of Tigard 16.60
_ 6zpanslon tank
Address: 13125 S.W. Hall Blvd. Pixturo /sewer cap 16.60
Floor drain /floor si /huh '
City /Sttue /ZIP: Tigard, OR 97223 ��( 6 16.60 I 99. BO
Phone: (503)639 -4171 f�(� ('I Fax: (503 0772 k Iq Me bib Garbage disposal 16,60
:."!' ;Jl;: <i R. Ijl(ii�t ills i !., l I1111ttfiil1111181111411iIIll i li iii,ih �u>Sff ii' nti !l ;l l l � I 1 g Ice maker rill 16.60 M/ 0
Business name: Schneider Equipment, Inc, - Interceptor /grease trap 16.60
Contact name: Stan Schneider Medical gas (value: $ ) Page 2
Address: 21881 River Road N.E. Primer 06. 16.60 16.60
City /State /ZIP: St. Paul, OR 97137 Roof drain (commercial) 16.60
Phone: (503) 633 - 2666 Fax:: (503) 633 -2668 Sink /basin/ lavatory / 16.60 16.60
Tub /shower /shower pan 16.60
E -mail: stan@seldc.com Urinal 16.60
, . is •!: !'•;'•f;iii i' ■ I I i �] illl I1l11fillI IRISHMEN itli �ii ilill�liilmji I s• , — I . ,• .:..'i 111112114 111P1 Water closet 16.60
Business name: Hampton Plumbing Co. Water heater 16.60 16. SO
Address: 411 S. College • — Other: • � 1„j „A\ -
Cit /Statezlpt Newberg, OR 97132
-1.■ Subtotal - 2.15
Minimum permit fee: 572,50
Phone: (503) 538 -5629 Fax: (503) 538 -5629 Residential backflow minimum permit fcc: $36.25
CCB I.ic,: 160927 , Plumbing Li . no.: 36 -102PB Plan review (25% of permit fee) b i. 85: ,
Authorized si nature: ✓ State surcharge (8% of permit fee) ' -1, 3
g % TOTAL PERMIT FOP. °31plp �O
Print name: Bob Hampton 1 bate: 9/28/05 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.
i:\ Building \Pcrmita\PLM- PcrmitApp.doc 00/05 440-46 I 6T( I 0/02/C0 NA/WEB)
•
CITY OF TIGARD
BUILDING DIVISION .. PERMIT #: PLM2006 00506
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 11/7/2005
Phone: (503) 639 -4171
Inspection Requests (24 Hrs.): (503) 639- 4175' .. •
INSPECTION WORKSHEET FOR DATE: 12/2/2005 TIME: 7:19AM PAGE: 8
SITE ADDRESS: 12475 SW BULL MOUNTAIN RD CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: CITY OF TIGARD
DESCRIPTION: Well House. Other fixtures: Hose bikes, primer, eyewash.
OWNER: TIGARD WATER DEPT., PHONE #: 639 -4171 395
CONTRACTOR: HAMPTON PLUMBING CO. PHONE #: 503-538 -5629
Inspection Request Scheduled For: Date: 12/2(2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
305 Plumbing underslab 022853 -01 503633 -2666 N
Corrections /Comments/ Instructions:
'SS PARTIAL APPROVAL ❑ CANCEL I I NO ACCESS
n FAIL I I CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: h Date: lip- / I Phone #: (503) 718 -