Permit C ITY O TIGARD PLUMBING PERMIT
dik DEVELOPMENT SERVICES PERMIT #: PLM2005 -00694
c 'I I 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 12/19/2005
PARCEL: 2S 103CD -00800
SITE ADDRESS: 11575 SW FAIRVIEW LN ZONING: R -4.5
SUBDIVISION: HOLLYTREE LOT: 003 JURISDICTION: TIG
Project Description: Replace 50' of 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
PAT DUNCAN
11575 SW FAIRVIEW LN Description Date Amount
TIGARD, OR 97223 [PLUMB] Permit Fee 12/19/200E $72.50
[TAX] 8% State Surcha 121191200E $5.80
Phone : 503- 620 -6593 Total $78.30
Contractor:
MR ROOTER OF PORTLAND
PORTLAND SERVICES INC
15033 SE MCLOUGHLIN BLVD #344 REQUIRED ITEMS AND REPORTS
MILWAUKIE, OR 97267
Contact # : PRI 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: �` 1f� Permittee Signature: � 2 1\r,v
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.
0E 19- 2005(M0N) 13:53 MR ROOTER PLUMBING (FRX)503 653 5376 P.003/003
Plumbing Perm Ap D FOR OFFICE USE ONLY .
City of Tigard BUILDING DIVISION ganeBv: Permit t.10 C
131:5 SW Hail Blvd., Tigard. OR 97223JEC 1 9 2005 Reeetve _� ��� i�� �
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❑ NcW construction i J Demolition For pedal Information use checklist.
Dc criptfrn I q I F. 1 Total
:: jlddfdonitilteratlop /replpeetncttt CI Other: • New .142.tamfy dwellings (includes 1001. for each utility connectlml)
'Vat? . g ; � t •. y . ��,� , ' � j .wTM w • t lr:'�ti':
i u� . 1)il . liF1 y 'tnrut~• i. "' -' , . , . ' x .. 1 iiU `) � ,ail: LE „l!jI,, •_,; . SFR (1) bath 249.20
!:I.1- and 24family dwelling D Catnmetdalrndustriul SFR (2) bath 350,00
D As;ccunbry building D Multi•farnily El (3) bath 344.10
I:3 Muster builder D Other
Each additional Bat1t/kltcllen • 45,00
MI r 1' 117 6 i ilti ?, st+. ,.1.... g 1v W f rs«Riiitg 1`1 4 !:, f °;� t•. � 1 ini ,r.. i g , ske. riu&lzr C � �aq (I) Page 2
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rob site uddretuy ,'42 ,' f Ji fL.L) Z,41 Catch basin or arca drain 16.60
City /StnictZIP: 7` 4r rr d 6 / i _ Drywell. Inch tine, or trench drain 16.60 � —
Suite/bldg./apt. no.: " Project mono: F
' Footing drain (no. linear R,: _� Pulp Cross street/directions to job site: //:T" Munufuctured home utilities 110.00 .
Martholea 16,60
• Rain drain connector 16,60
Suuituty newer (nu, linear it.: ) Page 2
Storm sewer (no. linear 112. __) Page 2
•
Subdivision: ! Lot not Wutex uerviae (nu. linear ft : Page 2 +
Tax no.;
Fixture ur Item
'1
EI� ac . +, I � ' 'Yr g �� Aboarpam v4..1; 16.60
l�tW' "l !mot : t ile u I ���. ud .. r rl iM l ir i• I V rigtirg6 17 BackflowlneveMer Page 2
Baeletvatcr valve 16,60 ~
• ;• 30 - .WWI' Clotho washer t 6.60
Dishwasher 16,60
�I� I1'� y(� yy�; "Ulu ll wji l i, t� om*^'a a � ! r , Drinking fountain 16,60
__'V41: '4hi r, li'.'ae r . 1vaP.° ► .'' O ":. 4E REi �j}�1 »� I�� A P' . If�'' ti ! a'6 1 .
�� �/ Ll,r ���C��!11�an1�..7�li7er;l �: s
)///70011 Expansion 16,60
Facpansion ui do 16.60
Address: / Z '7 S[,e 3 Fa ir I' - LJ Finuro owcr 4.4p 16,60 ----
'ty/ tutc/ZIP: i 4,rlr-� () / 7 , 3 Floor druini oorsink/hub 16,60 _
Phone: ( • . tO„:92 ". ( Qarbagc dlppaaal 16,60 .
Y v�I !I! 'c In e 16,60
X11 aF ' � i , I' ��m, �'�!���I6 V tf qq ° " i 'S g I� 1ct; m
1 16,60
I3ttaitte It name: IA r ' • • # i'/ L M A,'"1 lutetc / uup 16.60
Contact name:
i1 r . L Medlaal gas (value; S ) Puge 2
Address:] owir 7 .,-t f' tech h li 'I, g Primer 16.60
City/State/4P: /y'. It 7„R hoof drum (commercial) 16.60
Phone: GO) (o _ _3- J3 Fla :: ( ) 51nWliaslnnavatory 16,60
Tub /shower /shower pan 16,60
E -mail:
i a I ������ � � � " l 'RI Urinal 16.60
In tuff: 4 1-6, i . t a � . ��! W? ' � I ` Vin : rt.IV , LA Water elanet 16.60
Business name: / Water heater 16,60
Manton Manton ' J � Other:
City /StaIJZIP: Subtotal
Minimum permit fee: 572.50
Phone: ( ) Fax: ( ) Residential bnckflow minimum permit tee: $36,25
'''CI3 Lle.: 9y /� fllumbing Lie. no.:3Z/3 f /D1.a Plan review (25 oroermlt rce)
'Authorized trignut e: Suite surcharge (8 of permit fee)
�� ^ ! TOTAL PERMIT FEE
Print name: / e Q fill tt: /, / /C/ / ) > Tbl$ permit application expires if u permit ie out obtained within
TT / 180 days after It has been accepted as complete,
'Fee methodology pct byTri•County Building industry Service Board.
1 :% M ulldlnp■Pmwit04$44'crmitwptw4na tool 4 e0•014r(1 JCOMJWHn)
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CITY OF TIGARD
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1 BUILDING DIVISION ' PERMIT #: PL12005- 00691
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 12/19/2005
Phone: (503) 639 -4171 anoiliqpiot (if, g /
Inspection Requests (24 Hrs.): (503) 639-4175 * '__I..
INSPECTION WORKSHEET FOR DATE: 1 TIME: 7:01AM PAGE: 75
SITE ADDRESS: 11575 SW FAIRVIEW LN CLASS OF WORK:
SUBDIVISION: HOLLYTREE LOT #: 003 TYPE OF USE:
PROJECT NAME: DUNCAN
DESCRIPTION: Replace 50` of water service. 6 4 ; vrE
OWNER: DUNCAN, PA PHONE #: ' 503- 620 -6593
CONTRACTOR: MR ROOT OF PORTLAND PHONE #: 503- 653 -5301
Inspection Request Scheduled For: Date: 12/21/2005 Pour Time:
Code # Inspection Description Confirm # Contact # v e- sage
330 Water service 023802 -01 503 - 119.04855
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Correctio /Comments /In ctions:
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PASS U PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL [l CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Date: �� Phone #: (503) 718- 1 1,D - D.-