Permit A:.
ff ill! CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT PERMIT #: PLM2008 -00016
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 1/18/2008
PARCEL: 2S104CA - 04000
SITE ADDRESS: 13623 SW MICHELLE CT ZONING: R -7
SUBDIVISION: HILLSHIRE LOT: 040 JURISDICTION: TIG
PROJECT: TERRY
Project Description: shower pan installation
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: 1
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Owner:
FEES
TERRY, ALAN & ANNE
13623 SW MICHELLE CT Description Date Amount
TIGARD, OR 97223 [PLUMB] Permit Fee 1/18/2008 $72.50
[TAX] 12% State Surch 1/18/2008 $8.70
Phone : Total $81.20
Contractor:
MARK WHITED PLUMBING
10625 NW LOST PARK DR
PORTLAND, OR 97229 REQUIRED ITEMS AND REPORTS
Contact # : FAX 503- 626 -9693
Reg #: LIC 34752
PLM 37 -163PB
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: �/ NM. Permittee Signature: �CcG ��-✓
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.
.
- . >F'Iumbin Permit A lication FOR Oli l(:I.:. 11:S F, ()NIA
City of Tigard EC EIVED
I II `41 13125 $W Nall Blvd., Tigard, OR 9 2
A LU nRcview
Phone; 503,639,4171 Fax: 503.598,196r N 1 ll Date/By: 01'hcr Permit 1 r.,,;
Inspection Line: 503,639.4175 Date Rcad B Ju ris: 65 See Page 2 for
T I G A R (1 T n t cmct: www.ti and -1r. ,ov ITV ® F `�G' Ready /By: k
F Notified/Method: Supplemental information • ,��, � 1 �11��f1 1111 ��ll I lf€� l �f � ;l >�� TI !; iii►!. ►►,,, Wi!► i a11 1 ' .1 M. lag 14 1 k a, 6; ,4 1, 1 '. i�` 111 111111111111N
Q New construction El Demolition For spec1al fWormat use checkllisx
Description I Qty. 1 Ea, 1 Total
OAddition/alteration/replaccmcnt ❑ Other: New 11 -2- family dwellings (includes 100 ft. for each utility connection)
I° ) t1� �; ffl! . .111 i1,m hiliii t ) l lflt�l,'I it i1`t£ +A, tattc ;' ti i re aryl 1 I ! ; 11 I ) : MIN SFR (I) bath 249.20 .
d - and 2- family dwelling ❑ Commercia l /industrial SFR (2) bath 350.00
—
❑ Accessory building 111 Multi SFR (3) bath 399.00
Each additional bath/kitchen 45.00
❑ Master builder ❑ Other: Fire sprinkler ( sq, ft) Page 2
1 N' illf1 n d —
Y 9� Irl 1 Ira
l d, nil6t tin '; 1 GII " - iii i 4„i n' brit ��hnic�, :' ! ►� 1I ",, Site utilities
Job site address: # 7 i. Catch basin or area drain 16,60
City /Statc /ZTP: '-'r• ..t ' Drywell, leach line, ar trench drain 16.60
�� Footing drain (no. linear fl.: _) Page 2
Suite/bldg./apt. no.: Project name: l
Cross street/directions to job site:
Y Manufactured home utilities 110.00
Manholes 1 6.60
Rain drain connector 16.60
'/) e "." .k a si.. Cjb kv--\ Sanitary sewer (no. linear ft.: _ ) Page 2 IIMMI
Storm sewer (no. linear ft.; _) Page 2
Subdivision: I Lot no.; Water service (no.
linear _) Page 2
Tax map /parcel no.;
Fixture or item
{ { t Absorption valve 16.60
I11111 '101 I ! ► 11 it ml'Hli 1 :.. n ' “ . Ni. i„ �
1z��h � � ,ktlf �,.ltlif�fl . i. M d �11111iF'311 BackFlnw presenter Page 2
.:1.1/-t� Backwater valve 16.60
Clothes washer 16,60
Dishwasher 16.60
�
Drinking 3 "' 1 ' li ca' fountain
, om ,,, — 3 , , `n lrr i` d 1 1m c l 1tll11fi 111 „1 11111! ,,., j r; fir �lfi �i� ' ,'i � 111111]1 E $ 1 6.60
Name: j_'� t ,t/" 1 , h �, _ L'jcolvrslsump 16.60
+J " \ f/` Expansion tank 16.60
Address:
�� 1 LA.., , I tit.e- .1 f /sewer cap 16,60
City/State/ZIP: `- 1 Floor drain /floor sink/hub 16.60 _,„
Phone; ( r F ax: ( ) Garbage disposal 16,60
y' I xtnm , l; I r , u��r tom l Hose bib
1 I �ii 1 �� q i,'i� I ;, I ), '� d. [,0
j.' 111d 1 zr +m
I
�9 .. ififli 141, v � `�li �IR � li , ��. ..,, q�`;�I flflll)QIFtF„ t
Icc maker + 16. 16,60
Business name: �/ /'�� _
Ott ` V� � � Interceptor/grease trap 1(,, (,p
Contact name: A 3ci . .. y /�' y Medical gas (value; ) Page 2
Address : A f A t 4v V it +, , . 1 Pr 16
eee/// lmcr 16,60
City/State/71P; � / 1 2_ Roof drain (commercial) -
/State /7IP;
y �� .91 16.60
Phone: (t ) @9it , j ( Fax:: ) e 51 S / lavatory 16,60
E-mail: "_ue� 10 Tub /shower /shower pan ` 16.60 A , 1
i it �,41'i PE'tt : 1`'Malt l n q Urinal �- I6.60 'V
,,,� i a; � t t � i �I� �'r:; I g " ,"" —
�. ,�' -, d, " 1, „ •�� I � �1 � 1� � 1 I1 I i;�:.
111! U1Yilic ill Waror closet 16.60
Business name: . i I• : r - Water heater 10,60
W _
Address: i 04,,Z . Ii , rp � a` Other;
�
City /State /71P: YLL� 1 � t _.• _ Subtotal
Phone /� Minimum permit feu: $72,50
`_3 4 . e6 Fax: j ,11 I / Residential backflow minimum permit fee; 536.25 1I
CCB Lie.: ./41 ,,, 2 t 7 o Plumbing Lic. no.: 31-1(03 Plan review (25% of permit fee)
Authorized signature: J 41 State surcharge (12% of permit fee)
/ � . �r TOTAL PERMIT FEE + ..
Print name: `�LL.1 / �� pa te: la O • This permit application expires If a permit is not obtained with
150 days after it has been accepted as complete.
*Fee methodology set by Tri -County Building Industry Service Board,
1 :\ RVildinX \Pcrmlla \PLM- POrmitApp.dne nri /7,15106 440.4516T( 1 0/02 /COM/WM:i)
CITY OF TIGAR.D pc.ri
BUILDING DIVISION PERMIT #:,;2120E-e)00/ ,'
13125 SW Hall Blvd., Tigard, OR 97223 , i],l� DATE ISSUED:
Phone: (503) 639 -4171 . v� ' u1m�ii�9� " f/
Inspection Requests (24 Hrs.): (503) 639 - 4175 111.
INSPECTION WORKSHEET FOR DATE: TIME: -*; PAGE:
SITE ADDRESS: / 3 &D_3 � CL WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME:
DESCRIPTION: pe , da l_
OWNER: PHONE #:
CONTRACTOR: PHONE #:
Inspection Request Scheduled For: Date: / to 2 - O k Pour Time:
Code # Inspection Description Confirm # Contact # Message
3 2 2 iit.41- ,..0kA row a 36, 7c k- o, 5 - - p - s.sq - 86 o r
Corrections /Comments /Instructions:
- /
- L i
P ASS ` ❑ PARTIAL APPROVAL ❑ CANCEL I I NO ACCESS
FAIL n CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
g (1 i /z2--/d e ai-f 2,_
Inspector: Date: Phone #: (503) 718- i
-
CITY ������M .. . ^ ' ti.. f,. �ww n m OF w wn� amwmm��m�v '^
BUILDING DIVISION PERMIT #: PLKA2O(K�C0O16
13125SVV Hall B�d..Tlgmd.ORA7223 DATE ISSUED: '111812000 Phone:(503)630-4171 ^ ,
Inspection Requests �
o4Hra.):(5U3)G30��175 ,,,,14- n:.
INSPECTION WORKSHEET FOR DATE: 4/712008 TIME: 7:01AM PAGE: 32
SITE ADDRESS: 13623 SW MICHELLE CT CLASS OF WORK:
SUBDIVISION: M|LLSH|RE LOT #: 040 TYPE OF USE:
PROJECT NAME: TERRY
DESCRIPTION: xhmwpr installation
OWNER: TERRY, ALAN & ANNE, PHONE #:
CONTRACTOR: MARK WHITED PLUMBING PHONE #: 503-361'5905
Inspection Request Scheduled For: Date: 41712008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
399 Plumbing final 067965-01 503-.554-8501 Y
Corrections/Comments/Instructions:
»� ` '/ .^ w * �"
'�� ��.mm� ' " • .. .
Ccti ick �,-,,t t 94,..)
X R�S ��|ALAPP�� �� ��EL | | NO A��S
H �� I I
|l FAIL CALL FOR INSPECTION El ADDITIONAL FEES ASSESSED
|nopectmr6 Date: / ~] )1 =-* Phone #: (503) 718-
L
_ — ~ �