Permit ti
CITY v
.. OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT PERMIT #: PLM2008 - 00117
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 3/19/2008
PARCEL: 2S 112CC - 03300
SITE ADDRESS: 08060 SW CHURCHILL CT ZONING: R -12
SUBDIVISION: BOND PARK NO. 3 LOT: 061 JURISDICTION: TIG
PROJECT: ELLIOTT
Project Description: Replace 40' of water service.
CLASS OF WORK: ALT 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: 40 ft
DISHWASHERS: RAIN DRAIN: ft
Owner:
FEES
SABRINA ELLIOT
8060 SW CHURCHILL CT Description Date Amount
TIGARD, OR 97224 [PLUMB] Permit Fee 3/19/2008 $72.50
[TAX] 12% State Surcha 3/19/2008 $8.70
Phone : Total $81.20
Contractor:
BLACK CAT PLUMBING
BOX
OR EGON CITY, OR 97045 REQUIRED ITEMS AND REPORTS
OR
Contact # : PRI 503- 656 -9664
FAX 503- 656 -9774
Reg #: LIC 178183
PLM PB467
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 callin . 46:6699 or 1.800.332.2344.
----)61 .- .. .._ _
Issue d Permittee Signatu e: ,, . III ,
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.
Plumbing Permit Application
Building Fixtures tr io. iii . I OR t o t it i i . ON i
City of Tigard Received , / eounit No.: Ad U ` / g' / / / .'
III Y:
_ • 131 SW Hall Blvd., Tigard, OR " Date/ By:
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R
s • • Phone: 503.639.4171 Fax 503. OEJ� 1 LU � paPlan l eview Other Permit No.;
I I i 1 A I. I} Inspection Line; 503.639.4175 a A P� 1 r+ i� 1 Date Ready /By: tutu' El Sae Pete 2 tor
Internet; www.tigard- or.guv `` 04 . �� V , `... ii ti .tified/iViethoci: / its SOI plewentalluformati0n
TYPE OF WORK ' FEE* SCHEDULE
0 New construction 0 D:. _ `on
For s. eclat I ormation use checklist
17escri -tion 01031111M11 Total
I _ ddition/alterationhcplactxrtent ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION SFR(1)bath _ In 249.20 =
,! - and 2- family dwelling El Commercial /industrial SFR (2) bath 350.00
❑ Accessory building ❑ Multi- family
SFR (3) bath 399.00
Each additional bath/kitchen 45.00
Q Master builder ❑ Other:
Fire sprinkler (. sq. ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities
Job site address: al) i a . G ! % . G Catch basin or area drain 16.60 NMI
City /State/ZIP: - "r I e f s -e,D De, ci - 7 �- i 4_- Drywell, leach line, or trench drain 16.60
i
Suite/bldg. /apt- no.: ( Project names et,.., O� Footing drain (no. linear ft.: _
Manufactured home utilities 110.00 Mil
Cross street/directions to job site: Manholes III 16.60 Mil
Rain drain connector 16.60
Sanitary sewer *linear ft.; ---) _
Storm sewer (no. linear ft.: ,,,,,_) Page 2
Subdivision: no.: Water service (no. linear ft.: 1 4 Cr ) j Page 2
Fixture or item
Tax map /parcel no.:
. .. _ absorption valve 16.60
DESCRIPTION OF WORK lacktlow preventcr Page 2
:ackwatcrvalve 16.60
lothes washer 16.60
bishwasher 16.60
inking fountain III 16.60
7. PROPERTY OWNER 0 TENANT
-_
_ , jcctvtslsttmp 16.60
Name: / _f A - _ _ D I 'xpension tank M
Address: ' ixtureisewer cap 16.60
I= drain/floor sink/hub 16.60 IIII
Phone: ( ) Fax: ( ) ,arbage disposal 16,60
❑ APPLICANT 0 CONTACT PERSON I ose bib 16.60
133111M 16.60
Business name: 'Interceptor /grease trap MEI 16.60
Contact name: 'Medical gas (value: $ . ) WM Page 2 IEEE
Address: 'Primer 16.60 MIN
r(commercial) 16.60 /basin/lavatory 16.60
Phone: ( ) Fax:: ( ) /shower /shower pan 16. MEIN
E -mail: ' 16•60 -
CONTRACTOR ' Water closet 111. 16.60 NMI
LI=EMEIM M 1 L / illi,1•M• ' Water heater 16.60 NMI
Address: P gip, 1 A 2_,--7 I Other: IIIII _WM
City /State/ZIP: ,, r u sz 0 '? 7 c l--6 I Subtotal ,..:.
Minimum pamit tee: $72.50 a .50
Phone: ( ) / (p , Fax: p3) (p % -4 7 7 1 Residential baclrllow minimum . • tit fee: $36,25
CCB Lic.: r i 5 , pm Plumbing Lic. no.: 1 42M11 Plan review (25% of permit fee)
Authorized signature: 7 06 State surcharge (12% of permit - ',MEW/
..if I TOTAL PERMIT FP, ;.?
fA e� i
Print ; ■ • . f Date: � ! This permit application expires If a permit is not obtained within
180 days after it has been accepted as complete.
*Fee methodology set by TN- County Building Industry Service Boarej „
I;1u,sisi sksermita\PI.MP- PernutAmeoe I 2121/06 440- 46t6T(le/02/COMIWea) '61.. %�/
1:00/Z00 XF3 OC:1 8002 /6T /C0
CITY OF TIGARD
BUILDING DIVISION PERMIT #: PLM2008-00117
•
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 3t19/2008
•
Phone: (503) 639-4171 ,apvtit
Inspection Requests (24 Hrs.): (503) 639-4175
INSPECTION WORKSHEET FOR DATE: 3/24/2008 TIME: 7:00AM PAGE: 36
SITE ADDRESS: 08060 SW CHURCHILL CT CLASS OF WORK:
SUBDIVISION: BONE) PARK NO, 3 LOT #: 051 TYPE OF USE:
PROJECT NAME: ELLIOTT
DESCRIPTION: Replace 40 of water service.
OWNER: ELLIOT, SABRINA PHONE #:
CONTRACTOR: BLACK CAT PLUMBING PHONE #: 5a6 66-9 6 64
Inspection Request Scheduled For: Date: 304/2008 Pour Time:
Code # Inspection Description Confirm # Contact # Message •
330 Water service 067179-01 503-656-9664
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Corrections/Comments/Instructions:
P\) ( 9! -1 Re.e\ar-rA M
Cc CdLt
24,-)
[;g1 PASS PARTIAL APPROVAL Ti CANCEL fl NO ACCESS
1 I FAIL [1] CALL FOR INSPECTION 11] ADDITIONAL FEES ASSESSED
Inspector: CTS\evt-^—./....." Date: ,211,4440 Phone #: (503) 718-
CITY OF TIGARD •
BUILDING DIVISION PERMIT #: I LM2008 00117
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 3/19/2008
Phone: (503) 639 -4171 ;Nit
Inspection Requests (24 Hrs.): (503) 639 -4175 J....
INSPECTION WORKSHEET FOR DATE: 3/21/2008 TIME: 7:01AM PAGE: 2
SITE ADDRESS: 08060 SW CHURCHILL CT CLASS OF WORK:
SUBDIVISION: E3OND PARK NO. 3 LOT #: 061 TYPE OF USE:
PROJECT NAME: ELLIOTT
• DESCRIPTION: Replace 40' of water service.
OWNER: I:LLIOT, SABRINA PHONE #:
CONTRACTOR: BLACK CAT PLUMBING PHONE #: 50 "3- 556.9664
Inspection Request Scheduled For: Date: 3/21/2008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
330 Water service 067119 -01 503.656.9$64 Y
Corrections /Comments /Instructions:
A(313 ir TO Go v,e, ✓ c-%4
F L,
Re-/ c -Agov. 2a1 o RS - c. erb etc 00 c,,,,,.,. o
. A ' t" i") -
e, t-ji
e e, c re,A t\o wVal% s-) of 3121 \ O c)
❑ PASS g PARTIAL APPROVAL ❑ CANCEL I I NO ACCESS
I li ❑ CALL FOR INSPECTION ADDITIONAL FEES ASSESSED
Inspector: C3 -1 AVI •-a.. Date: 2 12'V' ?J Phone #: (503) 718 -
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