Permit 171
CITY OF TIGARD' PLUMBING PERMIT
COMMUNITY DEVELOPMENT PERMIT #: PLM2008 -00006
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 1/8/2008
PARCEL: 2S104DC -03000
SITE ADDRESS: 13265 SW CLEARVIEW WAY ZONING: R -4.5
SUBDIVISION: BENCHVIEW ESTATES LOT: 030 JURISDICTION: TIG
PROJECT: SKIDMORE
Project Description: Replace 50' 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: 50 ft
DISHWASHERS: RAIN DRAIN: ft
Owner:
FEES
LARA SKIDMORE
13265 SW CLEARVIEW WAY Description Date Amount
TIGARD, OR 97223 [PLUMB] Permit Fee 1/8/2008 $72.50
[TAX] 12% State Surch 1/8/2008 $8.70
Phone : 503 -521 -1299 Total $81.20
Contractor:
ARS LLC
PO BOX 20698
PORTLAND, OR 97294 REQUIRED ITEMS AND REPORTS
Contact # : PRI 503- 235 -8784
FAX 503 -491 -2932
Reg #: LIC 127325
PLM 34 -168PB
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: �`. L/` Permittee Signature: 7-'
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 ApplicatiollN a
City of Tigard Received
1t Per 06 f frii'l pj
ini m ,1 g - 6
r),,y,
, q 13125 SW Hall Blvd . Tigard. OR. 97223 " n ")11
Pltu, Review
Phone: 503.0,39.4171 Pax: 503.5 98.1960 IY V Other Permit No.:
n o /
Inspect ion Line, 5(13.639,41 75 OF TIGA ® u: , I)utc Rwul lud d See Page 2 for
TtGARD
�� 8 H Internet: www.tigard-or.gov � 7 i l ratif /Mo,ho& ' 1 ` 5n 'cinema, tnformntlnn
' . TY''1t'7o'r worn t.. + ' t:.E ;SC.'iith iELE
❑ New construction ❑ Demolition For Special information use cbrcklim'.
Description r Qty. I Ea. I Total
71 Addition /alteration /replacement ❑ Other: New I- 2•fatnlly dwellings (includes 100 fl. for each utility connection)
' CATI:CORS Or CONSTRt1:CTION ; SFR (I) huth _ 249.20
® 1- and 2- family dhwelling ❑ Commercial /industrial SFR (2) hatb 350.00
❑ Accessory building ❑ Multi-i'amily SPR (3) bath 399,00
Each additional bath /kitchen 45.00
❑ Master builder ❑ Other: - -- ,.• . -- Fire sprinkler ( sy_ It) Page 2
JOB SITE •:INFO,RMATION AND i,;O(A',I tON
Site utilities
Job site address: 13265 SW CLEARVIEW WY Catch basin or area drain -M 16,60
City /Stole /Z11': TiGARD , OREGON 97223 1)rywcll, leach line, or trench drain 16.60
Suite/bldg./apt, no Project name: SKIDMORE Footing drain (no. linear fl.: _) -- Page 7 -
^' °'
Manufactured home utilities 110.00
Cross street /clireetions to site: SW 13ENCFIVIEW TR - »...
Manholes 16.60
Rain drain connector 16.60
Sanitary sewer (n0, lineal' 1t: _ ) Page 2
Storm sewer (no. linear fl.: _) Page 2
Subdivision; Lot no.: Water servic (no. linear lt.: _) 50 Pale 2
Fixture or item
iax map /parcel no,: MAP - 655 -A5 I110MAS GUIDE .- ....,.- „_
----- ._.. _ Absorption valve 16.60
DESCRIPTION OF WORK
13ackflow prey enter Pare 2
RI P1 A(I I -1/4” WATER SERVICE 13ackwatcr valve 16.60
Clothes washer T 16.60
Dishwasher 16.60
® PROPERTV OWNER Drinking fountain 1(,.GO
A NT .
. I1N» .� ..,., „,,,
F », I dors /sump 16,6(1
Name: LA.RA SI(IDMORl - Expansion tank 16.60
Address; 13265 SW (U ARVIEW WY Fixture /.sewer ca - " 16,60
City /State /ZIP: 'I'IGA171)
0 CONTACT T :PERSON , OREGON 97223 Floor drain /floor sink /huh 16.60
. __,
Phone: (503)521-1299
), 521 - 1 -12299 Fax! ( ) ».� Garbage disposal I6,60 ~
^ -
i� APPLICANT 1 1 osc bib „M - 16
._.
Business name: ARS dint JACK HOWK PLUMBING & DRA I Iccmukcr
- -.- _..,..
Interceptor /grease trap 16.60
Contact name: DAWN JACKSON Medical gas ( $ ) Page 2
Address: P.O. BON 20698 Primer 16,60
City /State /ZIP: PORTLAND , OREGON 97230 Roof drain (commercial) 16.60
Sink/basin/lavatory I 6, 60
Phone: (5(13) 23,5. Fux:: (5(13) 491 -2932 ,...,,. _
— E-mail: Tub /shower /shower pan 16.60 -y
- ,.- ,.,....,mm-,.....,,.»..- » .............-. .._ Urinal 16.60
•
C ONTRAC " "1'C)R Water closet
._,...- »..,._ c ;' ; ,i 16,6(1
Rosiness name; ARS dha ,TACK 1•IOWI( PLUMBING & DRAIN Water heater 16,60
Address: P.O. RON 20098 Other: - -
J City /State /ZII': PORTLAND, OREGON 97230 - __- -•.. -. ` Subtotal - —
Minimum permit fee! $72.50
Phone: (503) 235 -8784 Fax: (503) 491 -2932 Residential backflow minimum permit fee: S36.25 72.50
CC'13 Lie.: 12732". --.- Plumbing Lie. no.: 34-168PB Plan review (25% of permit fee)
-____. stair ,surcharge (12% of permit fee) 8.70
Authorized , '])atone
- .. , , - -
r _ TOTAL PERMIT 14:1: st 1 ,217
Print. name: DAWN .iACKSON Dale: 1 /7/08 I This permit application expires it' a permit is not obtained within
180 days after it has been Accepted as complete.
*Fee mclhodningy net by Tri- County Building Industry Service Board.
l:\ Building \Prnniia \ri.lv,_pennil App doe w,26 '4n_1<1rrltnm7.rCOMAVEM
CITY OF TIGARD ry
'BUILDING DIVISION PERMIT #: 1);3i,11 , ;, : ;:,10S
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 1N2C08
Phone: (503) 639 -4171
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: i'14. TIME: 7:0'4,M PAGE: .;$0
SITE ADDRESS: 'I rf ; +t?.: CLASS OF WORK:
SUBDIVISION: Hf::i +V7'i - 1'',/ ;: ` ?'' ;i ;z'1 LOT #: OYtt TYPE OF USE
PROJECT NAME:
DESCRIPTION: "
OWNER: '. ° {;ILA _ r- 1..APA 1..\P PHONE #: T.t: ?•
CONTRACTOR: ,\Rt.. PHONE #:
Inspection Request Scheduled For: Date: 'MO CI( ) =; Pour Time:
Code # Inspection Description Confirm # ¢ Contact # Message
,>>} V'Va.os .,, ti �f!€ 4` o■'y- °:14 •,o3
Corrections /Comments /Instructions:
Whet-100Q Imo✓ � , i �, •Rc la "j PVC f L ---i . Rie i n , •
Ca ✓e fr
•
1)(1 PASS n PARTIAL APPROVAL n CANCEL ❑ NO ACCESS
FAIL CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED
,., e �
Inspector: ‘ Date: b7 Phone #: (503) 718 -