Permit CITY TIGARD PLUMBING PERMIT
" I DEVELOPMENT SERVICES PERMIT #: PLM2005 -00119
A 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 3/22/2005
PARCEL: 2S 103 B B -03300
SITE ADDRESS: 12500 SW KAREN ST 3 ZONING: R -4.5
SUBDIVISION: BROOKWAY LOT: JURISDICTION: TIG
Project Description: Installation of 100' of water service.
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: ft
WATER CLOSETS: WATER LINE: 100 ft
DISHWASHERS: RAIN DRAIN: ft
Owner: FEES
GRANT YOZAMP
13732 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 - 3I3pb
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- rough OAR 952 - 0001 -0100. You may obtain copies of these rules or direct questions to OUNC by
callin 03- 246 -66 • e - :,. 0- 332 -2344.
Issu d By: ��9 k Permittee Signatur,,
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.
PARIIIII TUE 9:00 AI\A R. D. P 1 umb i ng, Inc. FAX NO, 503 297 7344 P. 3
Building Vixtures . ••
Plumbing Acv4
cuoin..„\%,•\15) , . ..„, • .:....:[......,;.•,,,...„,;,.,..,...;.„ .4...Vfie
Permit
FOR OFFICE USE ONLY
. .
City of Tigard RAceived c) ,
13125 SW Hall Blvd., Tig g ?... ard, OR 97223 v kl■,, ,
' • ? ' r 1-11 natinsy:
P4X) IEV.•18V1 2g °
pbone: 503,639,4171 Fax: 503.598.1960 V\ * 4 I v`•
.c 1:\C 4,ro Da
itti& Dalc/By: Othar Permit No,: :- • , : • .. :
24• Hour Inspection Line: $03.639.4175 O
Intrn
eet: www:ci,tigard N r .\-- v
.orus i V ' `.*---
. No Ii1te iteaetya iy 2 :
tifiecvmethod: iurla' El See Ilagii , for . - '
$ Dip enkeritL; T07,q0.11/N 0 .
; ...i,'L
. 'T'4 ;ill'il r ; 5 1 k a ir i t i f ory04.:7 1; 41 211 70 7: % Vi''' (A ArriNg^:0M 11, -e,i0
.114) :.• , 4 :: 41.Uth ,,r, 4. 14,‘,,, .,:! ..)- • ,,. , -' • • • ••••.•••: ; •.' „ , 31., , .. ,,,,1 . .
is II 3
0 New construction * 0 Demolition .. For spgcfal inforirtatiort it_se.!At!..plilis:t • Description , I ;;ITz_l___P....L....,:j'
Clditionialteration/replacetnent 0 Other; New 1- 2-farnily dwellings (includes 100 tl. for each' utilitrbeimeeliOn)
:I'l S''....::A .1014;': 5 V.14 7 !:,,,:..,, r —
24.9 20
i. 7-- - , tir , ' ,;=,,.),:',:; t>t,,:,...: SFR (I) bath
[j I. and 2-family dwelling D Cornmercialfindustrial SFR (2) bath 350.00
0 Accessory building ji4 Multi-family SFR (3) bath
.-,--- Each additional bath/kitchen 45,00
D Master builder El Other: -• sprinkler ( , eq. ft.) Pep 2 I
,,,,1,,,: 1.a - ,. . . • iSt t '11,71....AVL • . • ato.. . , , ,,.. A-- V :+., ' ' Site utuitice
IFETRVI64,11-§fYWIPOM:141,V34141/0.414t00,r'llii0.-Rifi' .. , , .
Job sitc address: 1 9D C atch basin or area drain ---- ----,-- -- 1 - 6 .... ..67 --------
City/State/ZIP: - r 10. ,,,. 4 )
0 A Drywell, leach line, or trench drain 16.60 • • .
---
Footing drain (no. linear ft ' ) .• Page 1. • - • ,' -
Suite/bIdglapt. nci..: Project name: y A-w,p
--- manufactured home utilities 119.60 ' •
Cross strect/directions to job site: -
• Manholes 16.60' ., • ' .
Rain drain connector 16.0 . ..
-,- ..
U r‘ ch -f- 3 cr I sanitary ..v,, (ro. linear ft,: )
....---- . .....-_---„.
Storm sewer (no. linear ft.: ) PA v 2
,...,
Subdivision: I Lot no.: Water service (no. linear f 5•511 PiLla 2. • .. 90
• Fixture or Item
• • • - - .
Tax trap/parcel no.:
Absorption valve _ 16 60 •
,... 7,-..., or,57??..i up Rieg.mmyrd .•,-; ...)^83MANOMIN.11.S1;40
' . ,,I.i•„„:41.4 A44,Y,K, :e, vtii,16' .K.Ve • epESp1Ph „ ,, TIOAV)Tor WNW,V,MlipalVfirliplp. A
,i;;•'=*,-.21!,16 ', Ace ff. Jr ;I . , . .:` - 1..A. P 0. , • .'Si.,W.' A.,: ■ ,.$.1A •,* /i1••■ mti'i?'0 , r• •••••• '''-' ,.. • '`,. , .1 ' • , n, 0 Backflow preventer — _ ,...„-....--,_
Page 2
A (..Ac,„:ii-er• ( Se y 01ci Backwater valve ' 16.60. : , • •
- '--- -`,--- -
Clothes .washer 16.60.2. •
—..-_—
Dishwasher - • 16.60
•cll.:17:77-rtii.fAiNgb*iiiiIii.hiviiiiieli5,.:5p.';,:•,;.:*(.-•.::.;,.i-',:,',Q(;i5 3,04j,we,,,;: ,ti,:,,,,,„)).:m Drinking fountain 16,60 :iJ • 1:4, ••• ik%7 ■9*VP,.it `-:. rag.1
'' Ejectors/sump 16 60
Name: Expansion tank
---
A,ddtesS: Fixture/sewer cap . 16.60 •
City/State/ZIP: Floor drain/floor sink/hub 1.6.0 • • '
Phone; ( ) Fax ( ) Garbage disposal 1.6,60
.V. i z t.' i '''...,•••' i'rdil ,f..• . El - . ',1',.. A. ;..t•' ..:...t 4 , , ,,!;i t tir ar,- Hose bib — _ 36,60
it.ii' ' ' - , '. . • " t' 0 • '?;:.:' ,,4 .}, : . f'',' ;+ ...,1-*tal ••• .. .. . -... 1. , i',,,. : , .... A it,' ,r l,61,
Ice maker 1.6 60
J3 nante: 0 i Cl 1.4A 0 ----
-.-..._. , Interceptor/grease trap ..„,.......,. '
Contact name: -- t .4 e j,.) . 5 • Medical gas (value: S ) Page.2 -
_
' I t el
Address: I 3gab AA, 4 ) s p f bnic) i i v V Primer 1
--________
aly/State/Z1P: , __Ir=2 1- 04 q 7-,.,a 7 _Roof drain (commercial) 16,60 .
Sink/basin/lavatory 16.60 . '
Phone: (SI> ) 3q , Fax: : ( ) .29 . 7 3 (,./ ' -------- ,-----,—,-,----
, - .
.................,,.. Tub/shower/shower pan 16.60
E-mail;
• Urinal
; /,'FA,TOT,„AMi.kfifipt ;0,01,40FigILititiv,:t!4jrrrt!,,,::i N,,,,...to,,..,,;,..,,.;:•.,
il. :, ;',,f0 r Nii''Ar,q1";o:,-.'21i.i;',1?l 'll'ilv i: •: Water closet
__.. ...„. ....
Business name: R dr) _pi ,,,, b: ,,, Water heater 1,6.0 • :
' I i ...
Address: J O
• 00 tt) , C.1, p/ri hei I ) L
c ie 90 Other:
City/StatC/ZiP: Po l i , f- rf q7j i 2 mini Su VotO
--.....,-- 7 permit.f.ct, 15 i,,,. :3
Phone: ( ) ''? 0 7 7 LI P,A Pax: ( ) <>I - 7- 7 lti" Residential backflow minimumscernit fur $36:25.
..... _
CCU tic.: - 7 A Plumbing tic. no.: .._ „ - 3) , 1 review (25% of penpic fee), : ,
C IIP A Ad State surcharge (8% of permit fes)1., 5 0
Authorized signature:
MiliA--.A . ..■ A ..■ A ..Aldf TOTAL PERMIT,ME' 1 •11. 0 j
F r KI,t DA like:i • 1-•,..). b-e t..) to \ Date; 3 J - ) This permit application expires Ite'l) liqt
--_--- • 180 days after it has beers accepted al
*Fee methodology set by Tri-County Boildittglod uetty.Servlen Board
I: \Building\Parrnits\PLMF-PermitApp.doc 12103 440 6 5 ISI( 1 0.102/COMMn)
CITY OF TIGARD
BUILDING DIVISION PERMIT #: PLM2005 -00118
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 3/22/2005
Phone: (503) 639 - 4171
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 3/23/2005 TIME: 7:08AM PAGE: 71
SITE ADDRESS: 12500 SW KAREN ST 3 CLASS OF WORK:
SUBDIVISION: BROOKWAY LOT #: TYPE OF USE:
PROJECT NAME: YOZAMP
DESCRIPTION: Installation of 100' of water service.
OWNER: YOZAMP, GRANT PHONE #: 503 - 481 -0250
CONTRACTOR: R D PLUMBING INC PHONE #: 503 - 287 -7422
Inspection Request Scheduled For: Date: 3/23/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
330 Water service 002558-01 503-297-7422 N
Corrections /Comments /Instructions: •
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
L_I FAIL n CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: CAci-t 1 ' Date: "V Phone #: (503) 718 -