Permit Y �i •
k' CITY OF TIGARD PLUMBING PERMIT
. ., ,,. l DEVELOPMENT SERVICES PERMIT #: PLM2005 -00188
81- 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 5/4/2005
PARCEL: 25111 CC -15300
SITE ADDRESS: 10065 SW HIGHLAND DR ZONING: R -7
SUBDIVISION: SUMMERFIELD NO.4 LOT: 204 JURISDICTION: TIG
Project Description: Replace tub /shower.
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: 1 SEWER LINE: ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: • RAIN DRAIN: ft
Owner: FEES
GOTTLIEB, EDWARD F Description Date Amount
10065 SW HIGHLAND DR
TIGARD, OR 97224 [TAX] 8% State Surcharl 5/4/2005 $5.80
[PLUMB] Permit Fee 5/4/2005 $72.50
Phone : 503 620 - 1297 Total $78.30
Contractor:
CRAFT RITE PLUMBING INC
4812 SE MELDRUM AVE REQUIRED ITEMS AND REPORTS
MILWAUKIE, OR 97267
Phone : 503- 327 -4975 •
Reg #: LIC 162040
PLM 3 -526PB
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 -000 . i I hrrugh OAR 952 - 0001 -0100. You may obtain copies of these rules or direct questions to OUNC by
calling 03- 246 -669 - - 332 -2344. ��
Issue By: Permittee Signature; Cam R- <
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.
Ma_ 05 08:22a Bran Nelson 5036573622 p.1
,. 7
Piu Permit Appli °' ii. i FOR OFFICE USE. ONLY
� �� �: EWE"
City of Tigard DReceived ate/By. 5 ,�Q5 % il ? � l Permit No.: , �.Ji _at
13125 SW Hall Blvd., Tigard, OR 97223 MAY Phone: 503.639.4171 Fax: 503.598.1960 MH 1 Plan Review
201, ' , (re '' � , : a Date/By: Other Permit No..
24 Hour Inspection Line: 503.639.4175 .
` Date Ready/33y: ��.
y: 0 See Page 2 for
Internet: www.Ci,tigard onus CITY OF TIGABD Notified/Method: r Supplemental Information
TYPE atviems DIVISION FEE* SCHEDULE
New construction ❑ Demolition For special information use checklist
Description i Qty. I Ea I Total
Addition/alteration/replacement ❑ Other. New 1- 2- family dwellings (includes 100 ft. for each utility connectio
CATEGORY OF CONSTRUCTION SFR (1) bath 249.20 t
I
21 and 2- family dwelling Q Commercial/iindustrial SFR (2) bath 350.00
❑ Accessory building ❑ Multi- family SFR (3) bath 399.00
Each additional bath/kitchen 45.00
❑ Master builder 0 Other:
Fire sprinkler (_ sq. R) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities
Job site address: 1 ]) ; (,p(5 fl la V1 Catrh basin or area drain 16.60
City/StatelZlP: - 11 (LY 1 / &.. t - 2 �t 1 Drywell, leach line, or trench drain 16.60
SuitefbldgJapt. no.: " 5.\
Projectname: ""TT _1 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: Lot no.: Water service (no. linear IL: ) Page 2
Tax map /parcel no.:
Fixture or item
Absorption valve 16.60
DESCRIPTION OF WORK
•
Backflow preventer Page 2
k Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
PROPERTY OWNER I ❑ TENANT Drinking fountain 16.60
Ejectors/sump 16.60 •
Name: 2 c\ - Si n4-` C \ ! '\ e Expansion tank 16.60
Address: l _ Fixture/sewer cap 16.60
City/State/ZIP: Floor drain/floor sink/hub 16.60
Phone: () (0,9,0_. / a9 7 Fax: ( ) Garbage disposal 16.60
El APPLICANT dCONTACT PERSON Hose bib 16.60
Ice maker 16.60
Business name: _ r- 1 \ G - P1 , Ai 0 , I Interceptor/grease trap 16.60
Contact name: y � C �� p
Yl3, �l A .\ Jy `n Medical gas (value: S ) Page 2
Address: Primer 16.60
City /State/ZIP: Roof drain (commercial) 16.60
Sink/basin/lavato 16.60
Phone: (5C.)3) 32`1 - q q�=� [ Fax:: ( ) ry
E mai(s(5 L� C Tub /shower /shower pan I 16-60 ) I 0 J a(,
@I t7�) Urinal 16.60
CONTRACTOR Water closet 16.60
Business name: ( -n.,ci , 1�� / 1 uji\ n l V\ ( . ' . Water heater 16.60
Address: -1 1 ? ` rCe ; �y 1 I Other. PC\
Cit t t rz u y_ t p �- . ' Th 7 - � 2. ` 1e . ` Subtotal I 10
^-�� '1 Minimum permit fee: $72.50
Phone: ( 3Z7_ Fax: (5 ) � -�22
- 7 Residential backflow minimum permit fee: $36.25 11
CCB Lie.: I ( � (-j � Plumbing Lic. no.: 2 (.P Plan review (25% of permit fee)
iI ' Slate surcharge (8% of permit fee) 5,<, c Authorized signature: �1 , l ' /�v e TOTAL PERMIT FEE
Print name: �/ I fj , itj • 1 �Lr t t J) +I L �J -7 3(
1 X D ate : This permit applirs6on expir+cs if permit is not obtained within
180 days after it has been accepted as complete.
*Fee methodology set by Tri- County Building Industry Service Board
CITY OF TIGARD " { -
1
BUILDING DIVISION PERMIT #: PLM7005 00188
I 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 5/4/2005
Phone: (503) 639 -4171 m
Inspection Requests (24 Hrs.): (503) 639 -4175 .. ' � i ..
INSPECTION WORKSHEET FOR DATE: 5/13/2005 TIME: 7 :12AM PAGE: 101
SITE ADDRESS: 10065 SW HIGHLAND DR CLASS OF WORK:
SUBDIVISION: SUMMERFIELD NOA LOT #: 204 TYPE OF USE:
PROJECT NAME: GOTTLIEB
DESCRIPTION: Replace tub/shower.
OWNER: GOTTLIEB, EDWARD F, PHONE #: 503.620 -1297
CONTRACTOR: CRAFT RITE PLUMBING INC PHONE #: 503 -327 -4975
Inspection Request Scheduled For: Date: 5/13/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
399 Plumbing final 006708-01 503-327 -4975 N
Corrections /Comments /Instructions:
'PASS _ PARTIAL APPROVAL El CANCEL n NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: 17 7 ! Date: — / Phone #: (503) 718 -