Permit CITY TIGARD PLUMBING PERMIT
i� DEVELOPMENT SERVICES PERMIT #: PLM2005 - 00630
b, 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 11/9/2005
PARCEL: 2 S 102AA -03400
SITE ADDRESS: 12375 SW HALL BLVD 15 ZONING: CBD
SUBDIVISION: TIGARD TOWNE HOUSE APARTMENTS LOT: JURISDICTION: TIG
Project Description: Repipe water lines. Other fixture: Hose bib.
CLASS OF WORK: OTR GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: SFA WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: R3 FLOOR DRAINS; TRAPS:
STORIES: WATER HEATERS: 1 CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: URINALS: GREASE TRAPS:
LAVATORIES: 3 OTHER FIXTURES: 1
TUB /SHOWERS: 1 SEWER LINE: ft
WATER CLOSETS: 2 WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft •
Owner: FEES
MERRELL HODGES
PO BOX 19418 Description Date Amount
POULSBO, WA 98370 [PLUMB] Permit Fee 11/8/2005 $132.80
[TAX] 8% State Surcha 11/8/2005 $10.62
Phone : Total $143.42
Contractor:
POWER PLUMBING CO
PO BOX 19418
PORTLAND, OR 97280 REQUIRED ITEMS AND REPORTS
Phone : 503- 244 -1900
Reg #: LIC 52378
PLM 34 -150PB
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: t Permittee Signature: Se ,
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.
Nov 09 2005 11:06RM POWER PLUMBING CO,. 503 244 8825 p.1
Pliumbine Permit Application FOR 'OFFICE USE ONLY
City of Tigard hmuEIVEDA Received
Date.By : l1 L V $ #7(i Permit )\\\_21;05 c fo
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review `ni
Phone: 503.639.4171 Fax: 503.598.1960 pp a G r.� t h y Other Permit No.:
24- Hour Inspection Line: 503.639.4175 INV t L - _ _ , J J,_ i D ate R '
Internet: www Y
ct.hgard.or.us Page 2 for
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New con s truction dul�u l` � Demolition ;: ; µ For specia Y use „
❑ information u se checklist
Description Addition/alteration/replacement O Other: Qty. r Ea. Total
: _.., I 1 - 2-family dwellings ( eludes 100 ft. for connection)
1 2 -fami[
':',.:::.;::::;:].:;':2:::.5,'X'=": i rare+ : -f t� '.ij5;
"^ to each utility c nnec
. •: ;,, l : i,_. ') � 's1i rt:. 1 t _ €P _ 14,- �.: ,) SFR (1) bath 24
, .. _.�. n. �:- --.__. _s.....:_ a�.,.:.= �E:,�,.:.IL -- -:: 9.20
tjit 1-and 2-family dwelling 0 Commercial/industrial SFR (2) bath _ 350.00
❑ Accessory building ❑ Multi- family SFR (3) bath 399.00
❑ Master builder Each additional bath/kitchen 45.00
❑ Other:
l ; =:• ;:: ::e:..' ::r, _:n. r ...;.� .,i.- : Fire sprinkler ( sq. ft.) Page 2
): a... = r ' IT E;i'1 f 4 f iE Qr w.v 4`'Y : -
: �' * Site utilities
Job site address: 1231 K[.l..LL Blvd Catch basin or area drain 16.60
City /State /ZIP: i a , OY 6 1 .. 1 � Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: 1 Project name: l Y l' rte. l' -"`g S Footing►drain (no. linear ft.: ) Page 2
Cross street/directions to job site:
Manufactured home utilities 110.00
Manholes 16.60
•
Rain drain connector 16.60
Sanitary sewer (no. linear ft.: } Page 2
Storm sewer (no. linear ft.: ) Page 2
Subdivision: I Lot no.: Water service (no. linear ft.: ) Page 2
Tax map /parcel no.:
Fixture or item
Absorption valve 16.60
DESCRCP -,.,.. \I , -.- 'OR7 • . . Backflow preventer Page 2 •
21_11 414 per( , Lo .i.- ..i ce Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
® `e4. , e4 . rYH'.. 10.,vLFEIt''':'.: • :.' .'.: - ,:_., Drinking fountain n ing f �n 16,60 • I Ejectors/sump I6.60
Name: �rr -C_. I I Ian Expansion tank 16.60
Address: Po 6 r)` � �q a7 Fixture/sewer cap 16.60
City/State/ZIP: p(i 0 q s---3-1 3 Floor drain /floor sink/hub 16.60
Phone: ( ) ) Fax: ( ) Garbage disposal 16.60 rr�
Pi f:[ - ; i.. .,:; ... Hose bib 16.60 /tp. to O
�`��.. �� . .. "'�� ' - - ` C�l.�, FERSQL •
'�, t j ,, Ice maker 16.60
Business name: PV w P� ((�� m h l Interceptor /grease trap 16.60
Contact name: r Da..0 4 --3 I Medical gas (value: $ ) Page 2
Address: P O S I Gi J I ' Primer 16.60 i
City /State /ZIP: P � A - a- Q . Roof drain (commercial) 16.60
Phone: .,.,4‘..‘__ Sink/basittilavatory 3 16.60 Li • -O
( ) '� C( Fax:: (' ) l -. Tuh/shower /shower pan I 16.60 go ,t, o i
E -mail:
Urinal . 16.60
EQ1 * R`.:�" ,i = ::,`.� _ Water closet
y, 16.60 33.24
Business name: P.4- -lo Water heater ' 16.60 Jl'p , loU
Address: � 1' LAD w\ Q 4- n D 1111 l v Other:
Cit /State/ZIP: ' ' (N 01 � ae ).33 Subtotal 3,Z, SO
( ) � `' 1 t I 1 `[ Fax Minimum permit fee: $36.5
Phone: ' � Q Q �,�
( ) 4 -2. g-,..1._.., Residential backflow minimum permit fee: $36.25
CCB Lic.: 5a . 3 7 Plumbing Lie, no.: 4-1 56.p 6 Plan review (25% of permit fee)
Authorized signature:
✓, State surcharge (8% of permit fee) IQ. (eL
Print name:
01) Thi TOTAL PERMIT FSE I ���. �,2,
l� ,i (, ,J�� C -Q�1 I Date: f 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\Pcrmils\P it App doe I Zf03 440 4616T( I 0 /02 /COM/WEB)
CITY OF TIGARD
BUILDING DIVISION ' r " PERMIT #: PLM2005- 00630
13125 SW Hall Blvd., Tigard, OR 97223 - , r.-• DATE ISSUED: 11/9/2005
Phone: (503) 639 -4171 %ui�Pulli�dfll III'
Inspection Requests (24 Hrs.): (503) 639 -4175 . JAI � ......
INSPECTION WORKSHEET FOR DATE: 11/10/2005 TIME: 7 :02AM PAGE: 83
SITE ADDRESS: 12375 SIB! HALL BLVD 16 CLASS OF WORK:
SUBDIVISION: TIGARD TOWNE HOUSE APARTMENTS LOT #: TYPE OF USE:
PROJECT NAME: TIGARD TOWNHOUSE
DESCRIPTION: Repipe water lines. Other fixture: Hose bib.
OWNER: HODGES, MERRELL PHONE #:
CONTRACTOR: POWER PLUMBING CO PHONE #: 503 -244 -1900
Inspection Request Scheduled For: Date: / 05 o
p q 11 10F20 Pour Time: P u
Code # Inspection Description Confirm # Contact # Message
395 Misc. inspection 020932-01 503. 244 -1900 Y
Corrections /Comments /Instructions:
re, -Pip_,, G( 3 rle i ot, 3 6 06,(4/6
LL
.-., 4/- ; / ( e''' '
ir
PASS ❑ PARTIAL APPROVAL ❑ CANCEL n NO ACCESS
I FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED (} r/ Inspector: Date: ( / / Phone #: (503) 718 -