Permit f a a CITY OF TIGARD PLUMBING PERMIT
° • COMMUNITY DEVELOPMENT PERMIT #: PLM2007 -00279
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 6/29/2007
PARCEL: 1 S 134AD -01600
SITE ADDRESS: 11375 SW LAKEWOOD CT ZONING: R - 4.5
SUBDIVISION: ENGLEWOOD LOT: 056 JURISDICTION: TIG
PROJECT: REYNOLDS
Project Description: Replace 40' of underground 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: 40 ft
DISHWASHERS: RAIN DRAIN: ft
Owner: FEES
KERRY REYNOLDS Description Date Amount
11375 SW LAKEWOOD CT
TIGARD, OR 97223 [PLUMB] Permit Fee 6/29/2007 $72.50
[TAX] 8% State Surcha 6/29/2007 $5.80
Phone : Total $78.30
Contractor:
CHRISTIAN PLUMBING INC
DBA CROWN PLUMBING
5429 SE FRANCIS REQUIRED ITEMS AND REPORTS
PORTLAND, OR 97206
Contact # : PRI 771 -9449
FAX 503- 771 -9454
Reg #: LIC 42671
PLM 34 -70pb
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.
r
— - Issued -:
• -ti / //i// y - -.' %/ P_ermittee_Signature__ __ % j
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.
06/29/2007 09:36 5037719454 CROWN PLUMBING PAGE 02/02
Plulmbing Permit ADnlicatio ECEIVED l'ORC OFrl(i 1 I ,. ONM,M
City of Tigard Received //� - Ner,n;t No,; I LM
■ 131.25 SW Hall Blvd,. Tigard, OR 97223 U N 2 9 2007 �mc/By: l0 ,� p� —06271 ®, P Review
Phone: 503.639.4171 Fax: 503.598. WOOI Di Ie/BV: O ther Permit No.:
Inspection Line: 503,639,4175 Of � ����®
T I U A R iP BUILDING DIVISION ��� 113(0 Re�(I rim
! ® Sec Page 2 for
Internet: www.tigard- or.gov NocifledlMethOtl: -fter supplemental Information
• TYPE OF WORK fEIHAS E... • FEE*: SC
❑ New construction ❑ Demolition For special information use checklist
Description L9LJ Fa. I Total
® Addition /alteration /replacement ❑ Other: New 1- 2- family dwellings (includes 100 R. for each utility connection) • c ATEGO.RY OF CONSTRUCTION ' :i,' SFR (1) bath 249,20
® 1- and 2- family dwelling ❑ Commercial /industrial SFR (2) bath _ 350.00
III Accessory building ❑ Multi- family SFR (3) bath 399.00
Each additional bath/kitchen 45.00
❑ Master builder ❑ Other: Fire sprinkler ( sq, :ft.) Page 2
isOF1 SOT INFORMATION' AND LOCATION ' � Site utilities
,lob site address: 11375 SW LAKEWOOD COURT Catch basin nr area drain 10,60
City /State /ZIP: TIGARD, OR 97223 pry, well, leach line. or trench drain 16.60
Suite/bldg. /apt. no.; Pmjeet name: Footing drain (no. linear ft,; _ Page 2
Manufactured home utilities 110.00 •
Cross street/direetion!s to job site: CROSS STREET: SW IRONWOOD LOOP ,-
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 ft.: Ml) i Page 2 55.00
Tax map /parcel no.: Fixture or item Absorption valve 16,60
DESCRIPTION OF WORK. 13ackflow preventer Page 2
REPLACEMENT UNDF.RC:ROUNI,) WATER SERVICE Backwater valve 16.60
Clothes washer 1 6.60
Dishwasher 16.60 • ❑...PROPERTY • OWNER Cr TENANT Drinking founl:ain 16,60
Ejectors /sump 16.60
Name: MS. KERRY REYNOLDS _ Expansion tank 16.60
Address: 11375 SW LAKEWOOD COURT Fixture /sewer cap 16.60
• City/ State /ZTP: TiGARD, OR 97223 Floor drain /floor sink /huh 16.60
Phone: ( ) Fax: ( ) Carhagc disposal _ 16,60
• •®s ..PLICANT .� 'CC�1'P . . .... . N
ileac bib 16.60
lee maker 16,60
Business name: CHRISTIAN PLUMBING, INC. DRA CROWN PLUMBING lnterceptorlbreaac trap 16.60
Contact name: D.ENNIS UNDERWOOD _ — Medical gas (value: S ) Page 2
Address: 5429 SE FRANCIS STREET Primer 16,60
City/State /Z1P: PORTLAND, OR 97206 Roof drain (commercial) 16.60
Phone: (503) 771-9449 T 1 Fax: : (503) 771-9454
Sink/basin/lavatory 16,60
Tub /shower /shower pan 16.60
E -mail;
Urinal 16.00
. CONtRACTOR Water onset 16,60
Business name: CHRISTIAN PLUIMBiNG, TN D.BA CROWN PLUMBING Water heater 16.60
Address: 5429 SE FRANCIS STREET Other;
•
City/State/ZIP: PORTLAND, OR 97206 Subtotal
Minimum permit fee; 872,50 72.50
Phone: (503) 771 -9449 Fax: (503) 771 -9454 Residential backflow minimum permit fee: 536.25
CCB Lie.: 42671 Plumbing Lic. no.: 3�' 'B Plan review (25% of permit fee)
/ — — State surcharge (8% of permit fee) 5.80
Authorized signature: ` TOTAL PERMIT FEE 78,30
Print name: DENNIS T.JNDERW000 Date: 06/29/07 This permit application expires if a permit is not obtained within
180 days after it has been accepted as complete.
'Fee methodology set by Tri- County Building Industry Service Board.
I:\ Guild ina\Pcrmit,WL.M- PcrmliAnn,rioc nsP76/06 440- 4616T(10 /02 /COM/W1?A)
' CITY OF TIGARD
. Aho
BUILDING DIVISION PERMIT #: PLM2007- 00279
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 6/29/2007
Phone: (503) 639 -4171 u4 UI al\
Inspection Requests (24 Hrs.): (503) 639 -4175 „,14- °' I
INSPECTION WORKSHEET FOR DATE: 7/6/2007 TIME: 7:06AM PAGE: 27
SITE ADDRESS: 11375 SW LAKEWOOD CT CLASS OF WORK:
SUBDIVISION: ENGLEWOOD LOT #: 056 TYPE OF USE:
PROJECT NAME: REYNOLDS
DESCRIPTION: Replace 40' of underground water service.
OWNER: REYNOLDS, KERRY PHONE #:
CONTRACTOR: CHRISTIAN PLUMBING INC PHONE #: 503 771 - 9449
Inspection Request Scheduled For: Date: 7/6/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
, 330 Water service 0515355 -01 503- 771 -9449 N
Corrections /Comments /Instructions:
cart- 'tip
A PASS n PARTIAL APPROVAL n CANCEL r n NO ACCESS
I, FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: (111 Date: , J d / b Phone #: (503) 718-