Permit ay 1.1* C _ h /�
Pr CITY O 1 1'1 V A 1\ D PLUMBING PERMIT
COMMUNITY DEVELOPMENT PERMIT #: PLM2008-00051
• TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 2/11/2008
PARCEL: 25111 CC -01800
SITE ADDRESS: 10315 SW CENTURY OAK DR ZONING: R -
SUBDIVISION: SUMMERFIELD LOT: 015 JURISDICTION: TIG
PROJECT: GALLIEN
Project Description: Replace 100ft sewer line.
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: 100 ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Owner:
FEES
ELWOOD GALLIEN
10315 SW CENTURY OAK DR Description Date Amount
TIGARD, OR 97224 [PLUMB] Permit Fee 2/11/2008 $72.50
[TAX] 12% State Surch 2/11/2008 $8.70
Phone : 503- 624 -7079 Total $81.20
Contractor:
CASEY'S PLUMBING INC
PO BOX 30075
PORTLAND, OR 97294 REQUIRED ITEMS AND REPORTS
Contact # : PRI 503- 253 -0030
FAX 503- 262 -8251
Reg #: LIC 147298 •
PLM 26 -725PB
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 0001 -0010 through OAR 952 - 0001 -0100. You may obtain copies of
these rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By: Alt i dabZ Permittee Signature:
Call 503.639.4175 by 7:00 a.m. for an inspection that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
_ Feb_11. 08 04:26p Case's Plumbing 5032628251 p.2 •
t f, E] VF T i •
Plumbing Permit Application Fox OFFICE•, USE ONL1•
City of Tigard 1E3 1 1 2008 Received
lig 13125 SW Hall Blvd., Tigard, OR 9 723 Datc Revi / 1 1 101 B$ Pennit NorkMatog ....040,"5/ 2 Phone: 503.639.4171 Fax: 5E3 581910 �i, , a J� n By. Other Permit No.:
Inspection Line: 503.639.4175 Date Ready /By: hid H See ['a 2 for
1IGA Internet: wtivw.tigard or. ] J �� T ' �j4 T of vtethod: Supp[ c.nental In formation •
TYPE OF WORK Y 1 , FEE* SCHEDULE
❑ New construction ❑ Demolition
For special it formation use checklist
Description I Qty. I Ea. I Total
, Addition/alteration /replacement ❑ Other: New 1- 2- family dwellings (includes 100 R. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (1) bath 249.20
Al- and 2- family dwelling ❑ Commercial/industrial SFR (2) bath 350.00
❑ Accessory building ❑ Multi - family SFR (3) bath 399.00
Each additional bath /kitchen 45.00
❑ Master builder ❑ Other:
Fire sprinkler ( sq. ft.) Page 2
.10B SITE INFORMATION AND LOCATION Site utilities
Job site address: 1 (7.4 31.)`0 e_1--r*1,,,,,-� - bc^, Catch basin or area drain 16.60
City/State /ZIP: ---- 1 ---C 1 ()Q_ cnOa Drywell, leach line, or trench drain 16.60
Suite /bldg. /apt. no.: I Project name: Footing drain (no. linear ft.: _) Page 2
Manufactured home utilities 1 10.00
Cross street/directions to job site:
Manholes 16.60
Rain drain connector 16.60
Sanitary sewer (no. linear a.: ) Page 2
Storm sewer (no. linear II: ) Page 2
Subdivision: Lot no.:
Water service (no. linear ft.: ) Page 2
Tax map /parcel no.: Fixture or item
Absorption valve 16.60
. DESCRIPTION OF WORK Backflow preventer Page 2
a° - f l l 001 n Backwater valve 16.60
►J Clothes washer 16.60
/� Dishwasher 16.60
J Z( PROPERTY OWNER I ❑ TENANT Drinking fountain 16.60
Ejectors /sump 16.60
Name: - ��4Cr,Q b e't1 Expansion tank 16.60
Address: ` 5 \ .--, L J {.�.tA CN cA ` Fixture /sewer cap 16.60
City /State /ZIP: t , a a- \ aa Floor drain /floor sink/hub 16.60
C'� Q' ► •-� b"I9 Fax: Garbage disposal 16.60
Phone: ( �j) t�1 �i ( )
APPLICANT ❑ CONTACT PERSON Bose bib 16.60
Ice maker 16.60
Business name: r 5 S' e, U h) A -1 1 " [nterceptor /grease trap 16.60
Contact name: 'I //
t $ el Medical gas (value: $ ) Page 2
Address: f 0 6 CD x 390 7 5 Printer 16.60
City /State /ZIP: ts,' - /a d / 7 6,2 j I L Roof drain (commercial) 16.60
Phone: (5 ) • �3- CO - 30 Fax:: 603) fro - F.3r'. /
Sink/basin/lavatory 16.60
,
Tub/shower/shower pan 16.60
E -mail
C Q S til S � 1 f.t,h -•t i i x, C co,fri Cc5 /i �1 � � Urinal 16.60
.J CON1' ACTOR _ Water closet 16.60
Business name: C aSe . I S i o% m h -> y -�i� C Water heater 16.60
PO Address: O le x Soo 7 ( 5 Other:
City /State /ZIP: , 14/2 ✓7 d c „e_ / 7c 5 4/ Subtotal
/ Minimum permit fee: $72 C0
Phone: 66 3 ) .:253 - -oo 30 Fax: (503) 2- 5" 5. / Residential hack flow minimum pennit fee: $36.25 A.
CC[3 Lic.: i 4/ 7,9_9 g" Plumbing Lie. no.: ,:26,.. 7 5/08 O Plan review (25% ofpennit fee)
tare surcharge.gr <fpermit fee) 0
Authorized signature: / <<.�. v[r� TOTAL PERMIT FEE �/ /. Lv
Print name: r f, I7 d� Vte: 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. . Suildiug \Permits\PLM- I'crmltApp.doc O5R6&O6 440 -4e IST(10 /02 /CoM/WEts)
, • „.. . __ ___
CITY OF TIGARD
BUILDING DIVISION PERMIT #: MA20013-00051
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 2111/2008
Phone: (503) 639-4171 440 i A
Inspection Requests (24 Hrs.): (503) 639-4175
INSPECTION WORKSHEET FOR DATE: 211 512008 TIME: 7•00Alvi PAGE: 43
SITE ADDRESS: 10315 SW CENTURY OAK DR CLASS OF WORK:
SUBDIVISION: SUMMERFIELD LOT #: 0.15 TYPE OF USE:
PROJECT NAME: GALLIFN
DESCRIPTION: Replace 100ft wryer line.
OWNER: GALLIEN, ELWOOD PHONE #: 503-624-7079
CONTRACTOR: CASEY'S PLUMBING INC PHONE #: 503-253-0030
Inspection Request Scheduled For: Date: 2115/2008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
330 Water service 065065-01 503-253-0030 N
loe
Corrections/Comments/Instructions:
C ol. i . c . ',.........A 9t..)
1
•
Zi PASS El PARTIAL APPROVAL fl CANCEL El NO ACCESS
I I FAIL fl CALL FOR INSPECTION El ADDITIONAL FEES ASSESSED
Inspector: sCrvt.A__ VVYk---- Date: :2) i'l 0,7 Phone #: (503) 718-
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