Permit 1 GI
It oc
CITY OF TIGARD
PLUMBING PERMIT
I DEVELOPMENT SERVICES PERMIT #: PLM2005 -00610
'� 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 10/28/2005
PARCEL: 1 S 134AA -01200
SITE ADDRESS: 11350 SW IRONWOOD LP ZONING: R -4.5
SUBDIVISION: ENGLEWOOD LOT: 019 JURISDICTION: TIG
Project Description: Repair sewer in row.
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: 100 ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Owner: FEES
PEACH, DOUGLAS C /DENI SE Description Date Amount
11350 SW IRONWOOD LOOP
TIGARD, OR 97223 • [PLUMB] Permit Fee 10/28/200E $72.50
[TAX] 8% State Surcharp 10/28/200; $5.80
Phone : Total $78.30
Contractor:
ROOT EXCAVATION
10824E OAK ST REQUIRED ITEMS AND REPORTS
MILWAUKIE, OR 97222
Phone : 503- 638 -3447
Reg #: LIC 134498
PLM 3 -433PB
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes
and all other applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is
not started within 180 days of issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law
requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 - 0001 -0010 through OAR 952 - 0001 -0100. You may obtain copies of these rules or direct questions to OUNC by
calling 503 - 246 -66 9 or 1 00- 332 -2344.
Issued By: C_J,(/� Permittee Signature: I / / `
Call 503 - 639 -4175 by 7:00 a.m. for an inspection that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
1;
,,, 1 vV '.. FOR OFF I( 1. 1 SE O \1.1
P Permit App7>f - too
City of Tigard ( � 2005 Received o Peril No. U41 5 1)04010 13125 SW Flail Blvd., Tigard, OR 97223 OCT 2 8 200 Date/By
Plan R'view ether Permil No_:
Phone: 503.639.4171 Fax: 503.598.1960 n* •
a ' i • Date/By: 24 -How Inspection Line: 503.639.4175 CITY OF T(GAR�'' " . ' 1 Dal` Re �y ri� R1 Se Page2 for
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Internet: ww.ci.tigard.or.us t F ^ n . Notifed/Mahod: Supplemental
T...!!!_ =Cs... r v ,'. ;'SOON
TYPE OF WORK FEE* SCHEDULE
❑ New construction ❑ Demolition For special infornaa$iorr use checklist
Description I Qty. I Ea. I Tot
❑ Addition/alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility comet
CATEGORY OF CONSTRUCTION SFR (1) bath 249.20
P- and 2- family dwelling ❑ Commercial/industrial SFR (2) bath 350.00
❑ Accessory building ❑ Multi - family
j SFR (3) bath 399.00
Each additional bath/kitchen 45.00
❑ Master builder ❑ Fire sprinkler (__ sq. IL) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities
Job site address: 4191011 1 ,) IA.,z1 di G Catch basin or area drain 16.60
City / State/ZIP: Drywcll, leach line, or trench drain 16.60
Suite/bldg./apt. no.: I Project name: Footing drain (no. linear ft: _) Page 2
Manufactured home utilities 110.00
Cross street/directions to job site: Manholes 16.60
Rain drain connector 16.60
Sanitary sewer (no. linear 11: ____) Page 2
Storm sewer (no. linear ft.: ) Page 2
Water service (no. linear ft.: ) Page 2
Subdivision: I Lot no.:
Fixture or item •
Tax map/parcel no.: ,
Absorption valve 16.60
DESCRIPTION OF WORK Backflow preventer Page 2
if Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
Drinking fountain 16.60
❑PROPERTY OWNER I ❑ TENANT Ejectors/sump 16.60
Name: Expansion tank 16.60
Address: Fixture/sewer cap 16.60
City /State/ZIP: Floor drain/floor sink/hub 16.60
Garbage disposal 16.60
Phone: ( ) l Fax: ( ) Hose bib 16.60
❑ APPLICANT I ❑ CONTACT PERSON
lee maker 16.60
Business name: Interceptor /grease trap l 16.60
Contact name: Medical gas (value: S ) Page 2
Address: Primer 16.60
Roof drain (commercial) 16.60
City / State/ZIP:
Sink/basin/lavatory I6 60
Phone: ( ) I Fax: : ( ) Tub/shower /shower pan 16.60
E -mail: Urinal 16.60
• CONTRACTOR Water closet 16.60
Business name � � E ^ V > `tom Water heater 16.60
Address: ` Ct" ` der
Subtotal
City /State/ZIPt�� , L g.. R J4 _sk, w /I Minimum permit fcc: $72.50
Phone: ' ) 441 Fax �(.0 ce t a' Residential backftow minimum permit fee: $3625
I Plan review (25% of permit fee)
CCB Lie.: \ Plumbing g Li . no: AS 1�
State surcharge (8% of permit fee)
Authorized signal t _ TOTAL PERMIT FEE
A ^ Date + \a permit a lication ex res if a permit is not obtained w
, ��� �� �1����n , � ��
Print ram This 180 days alter it has been accepted as complete.
;Fee methodoloev set by T ' , . un Building Industry Servi cc 1
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I
- CITY OF TIGARD
BUILDING `DIVISION PERMIT #: PLM2005-00610
13125 SW 'Hall Blkd., Tigard, OR 97223 DATE ISSUED: 10/28/2005
Phone: (503) 639-4171 1,
„, 40,116
Inspection Requests (24 Hrs.): (503) 639-4175 JA 1
INSPECTION WORKSHEET FOR DATE:__ 11/22/2005 TIME: 7:02AM PAGE: 27
SITE ADDRESS: 11350 SW IRONWOOD LP CLASS OF WORK:
SUBDIVISION: ENGLEWOOD LOT #: 019 TYPE OF USE:
PROJECT NAME: R.O.W.
DESCRIPTION: FL__IsietLi rcrui=vv,
OWNER: PEACH, DOUGLAS CIDENI SE, PHONE #:
CONTRACTOR: ROOT EXCAVATION PHONE #: 503-638-3447
Inspection Request Scheduled For: Date: 11/22/2005 Pour Time:
Code' # Inspection Description Confirm # Contact # Message
505 Sanitary sewer 022258-01 503-3145547
Corrections/Comments/Instructions:
A0r _ -4/
J/L..
•
/
PASS LII PARTIAL APPROVAL ri CANCEL n NO ACCESS
I I FAIL CALL FOR INSPECTION [7 ADDITIONAL FEES ASSESSED
Inspector: Date: ) Phone #: (503) 718-