Permit • t+
CITY TIGARD PLUMBING PERMIT
'ilk DEVELOPMENT SERVICES PERMIT #: PLM2005 -00118
II 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 3/22/2005
PARCEL: 2S103BB - 03300
SITE ADDRESS: 12500 SW KAREN ST 1 ZONING: R - 4.5
SUBDIVISION: BROOKWAY LOT: JURISDICTION: TIG
Project Description: Installation of 100' of water service.
CLASS OF WORK: NEW 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: 100 ft
DISHWASHERS: RAIN DRAIN: ft
Owner: FEES
GRANT YOZAMP
13862 SE 129TH AVE Description Date Amount
CLACKAMAS, OR 97015 [PLUMB] Permit Fee 3/22/2005 $72.50
[TAX] 8% State Surchan 3/22/2005 $5.80
Phone : 503 - 481 - 0240 Total $78.30
Contractor:
R D PLUMBING INC
13900 NW SPRINGVILLE RD REQUIRED ITEMS AND REPORTS
PORTLAND, OR 97229
Phone : 503- 297 -7422
Reg #: LIC 73913
PLM 26 -313pb
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 505'246 - 6699 o 80 - 332 - 2344.
`� l)
Issued Bys, LL4y1/k.}0Q1--/ Permittee Signature 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.
MAPi=22 - 05 TUE 8:58 AM R. D. Plumbing, Inc, FAX NO, 503 297 7344 P. 1
�3ui n ;I ° :Fq;;.r C g �ryixt.ures
Plumbing Permit Appiica ` 'i •
City Of Tigard � � �0 FOR OFFICE I1SE (ONLY
R A ^� F Received .
13125 Full Blvd., Tigard, OR 97223 \ ,`I\ •• Date/l3 Permit No.. 6 1_10a25%4"0//q ■ Phone: 503.639,4171 Fax: 50 3,598.1960' --w• _
/2 '�r,7! . R.ev,ew
24" Hour inspection Line: 503.639.4175 „0. / 1 ' P^it •'' � Sl `� 13 bate/By Other permit No �
Jntetnet: www /+I� 1 a'T' hriS. l J r bate Read y :
Y. )a " J'+/:lr., ,(.;i r r-i v • .Y �i.Nk Notified/Methed; tiff sea t'u;+e a For
9 :11 �'�� i,i{ , * ' r p ?tic 3 1 4 i 1 p r. ``� .t " "' `. i r f $' "� < ` ' }e g � Sunptcrnealai tnrarenaN,.n
, 'i 4' .5 K.tF d�si, ; , ;1 = . -e 'y '.'t 'i , r.' ',4:t5� '.'4•4''Jt..i. :�' .`.� Cir ;-r• »- M• «...- ........,,...�.
0 New construction a S�IrF D.i[! fa '
❑ Demolition For specieri in ermines use' deem is ,
b
ddition/alteration/replaccmcnt cscriprion - - r
�. Other: J .fit E w _
1 2-family w x fo � ' 7 ow
t 9t �l , r,i - ;6g1;z` : 'p r'7h' Ifi � , . {t , ,;,, New y d ellings (incude; I - R. (hr ._.. utility edit _ ,
9..,.: r,.. , !"1 10 n ,t,,?}', '? , 3 „ 1 ! '", �rA, 1' i _ commend %)
and 2-family !" ,T y' : . ,.r. • SFR (1) bath _..
0 - family dwelling zay 20
C ommercial /ittdustrial SFR (2) bath --- ^` §50,ViJ _ -
Cl Accessory building g Multi - ;family SFR (3) bath 340
"�— - 0 0
` .00�
Li Master builder ❑ ° -- _,_,_ --
bath/kitchen �
AJ ,y ,,.. Other:
t: additio ba � s
s1, / ,1 ` `r; 'AMA a ' , i:I 6N 6 t ' > e 4 - p , 1i l �Fa, F e sp r i nkler ( `-. sq , ft - ._ - �,.. � i ,
Job site address: ' ' Site utilities ••., .--
�r* ' f p� . /� Dryw
A „ - .1. s
tch basin or area drain
______ �'' 1 A MCP b r - - ^ l G.60
ell, le line h drain , or trench y 1 60
S uite/bldg. /apt. no,: _ Project name: Foot i
y yY� Footing drain (n linear ft.:
_ - .) Page l
Cress street/directions to job site: Manufactured home utilities 10.C�0
(� Manholes - w w — 16 6t)
— Rain drain Connector
1.6,60
" Sanitary sewer (no. linear ft, mmf ) - -- pyg 2
Storm sewer (no, linear ('t,: _ m
_) Page 2 •
Subdivision: Lot no.: Water service (no. linear t3.:11 ) ", . - ,, ,.�
Tax snap/ no.: Fixture or item - � " - " e � ° 2 `` yG7"
9 u Prj:�� it.'1 t';•5 � ' c c
"i si } , .A ,:, •t r -ge Absorption valve
1 ..t' Eary { { / �lJ r ' ( Y'�'V & t:
i ri; , .'�gi'It," -- — • 1 0 fir}
a-. • 7 4T by 4 Af ^f '' N.• J . 1'_.' 9: .1 ';i i ' ' . i ii �'YM' .,.. ,. __.. —,
�" 4 t , , t :•r . " Back prevei1 [cr -- t' agc „ -.,...
_ W r i C r J Backwater valve _,.^
Clothes washer
1(7 00
+ a Dishwasher -�” _. __ 10. 00
r
R « - I'ili t ?i;i f�I -
Ejectors /sump 1h t. " i 3m t 0',, ;il . s" ' i,» 1 1 i i ;' Drinking fountain - -- -- • 1G:G0 w. _ -..
Nitric. --- ---- • -.___.
`. I �� �a. 1 6:89.
Address: /_ _ 9 �7
Ass: t -7 Expansion tank ----`_ l d.6f1
City/State/ZIP: ddre / , / 0 - Fixture/sewer cap ^YT 10;60
' OP Floor drain/floor sink/hub 16,60 •
b Phone ( -- 0?_.-ID Fax; ( ) Garbage disposa 16,G
�, 0 • i , �, t 'k r � 4 " .r k` 1 , • , I� ' ` •A "t ., Hose bib 1 •
Business name: b f u 01 , ,"
Ice maker 16.60 •
ar(�_ Interceptor/grease
, trap _ 16.004 ^✓
contact name: -
• Address: 13g OD Nth ///' Medical gas (value: S ) _ - Page - a
l/ ✓1 () / ! lQ / Primer 16 (:� 4, City/State./ZIP: , - --
wI y f- 14 • ..), • Roof drain (commercial) 16.130
Phone: (,7) .2e? 7. Fax: ( ) e2 q • 73 s / Sink/basin/lavatory O ..,
F "mail: t6,6ry -... __..
Tub /shower /shower •
pan
5 °'" yg; ? ri " ,.,.« a p Urinal `..,
H k..1 x ' i , g c y*f i 1"'r,,` " ` ,e ' iira.:. - it .v,iiwwt; .. : k,, . 7 , { 16.60 J
ws.imoo, ° t ,Ad. 'p..1,'. �4. no:-.. 1 , ; , wA l 1.«,114, r: is "j
n / } Water closet
Business netne: J - l' i1,4 0,1 h t , _� l5 t}t) -
h • Water heater
1 ,..,_ ___-.
Addr s:
e$ • e�) t � Other. - _ _..._ - ,
city/Statt pc, j (>4 9 , � l
b
S
--- - --
_ _ ) Subtotal
Phone: ( - ^^i� �y -° -_ - -. ._ . „ -.._-
O` / Fax: ( ) �Gi �_ `� Residential Minimumperm)r, fee; $'2,50 - �,. -`
I backilow minirnwern,it fee: 5 � 5 • fj
CCU Lic.: -
• lun3bin I~ic. na.: — n "
i � 8 , . �� �/ Pl an review (25113 ofpcimit fee) •
St
Authorized signature: State surcharge (8%
____ .Q ( o c f erin't �l'b.,.� '!' (h,7
Print natne; ` TOTAL PERMIT FEE "' )
-- 1 Q N' ti - C n.) 1 Date: 3 -..2 . This permit application expires if a permit Is`not nbtaitr i 'within
L s
� 1
180 days after it has been accepted av complete.
L \ B¢ Ildinglper 'sslits�PLMF- Pcrmilppp.d 12/03 'Fee methodology set by Tri- County l3uilding industry , curvi e r t3osrtl
440- 4616'x{ 1 0/02/CO MJw2 g)
CITY OF TIGARD Mr Aga (10 0 `r �C 2 E 5)
u 3 �P Y� N
BUILDING DIVISION PERMIT #: PLM2006.00118
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 3/22/2006
Phone: (503) 639 -4171 ! irN yivi ill
Inspection Requests (24 Hrs.): (503) 639 -4175 _..'
INSPECTION WORKSHEET FOR DATE: 3/23/2006 TIME: 7 :08AM PAGE: 72
SITE ADDRESS: 12500 SW KAREN ST 1 CLASS OF WORK:
SUBDIVISION: BROOKWAY LOT #: TYPE OF USE:
PROJECT NAME: YOZAMP
DESCRIPTION: Installation of 100' of water service.
OWNER: YOZAMP, GRANT PHONE #: 603 -481 -0240
CONTRACTOR: R D PLUMBING INC PHONE #: 503 -297 -7422
Inspection Request Scheduled For: Date: 3/23/2006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
330 Water service 002558 -01 503 -237 -7422 N
Corrections /Comments/ Instructions:
•
•
•
0 PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: yrl'+ 0468 LA Date: 31 231 d Phone #: (503) 718 -