Permit CITY OF TIGARD
PLUMBING PERMIT
DEVELOPMENT SERVICES PERMIT #: PLM2006 - 10059
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 6/27/2006
PARCEL: 2S112CC -09100
SITE ADDRESS: 08312 SW LANGTREE ST ZONING: R -12
SUBDIVISION: LANGTREE ESTATES LOT: 023 JURISDICTION: TIG
Project Description: Installation of 50' of water line.
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: 50 ft
DISHWASHERS: RAIN DRAIN: ft
Owner: FEES
JARVIS BURNELL
8312 SW LANGTREE Description Date Amount
TIGARD, OR 97223 [PLUMB] Permit Fee 6/20/2006 $72.50
[TAX] 8% State Surcha 6/20/2006 $5.80
Phone : 503- 624 -0306 Total $78.30
Contractor:
CASEY'S PLUMBING INC
PO BOX 30075
PORTLAND, OR 97294 REQUIRED ITEMS AND REPORTS
Contact # : PRI 503- 253 -0030
FAX 503- 262 -8251
Reg #: LIC 147298
PLM 26 -725PB
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: Permittee Signature: S___,c2
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.
Jun 26 06 04:42p Casey's Plumbing 503 - 262 -8251 p.1
Plumw ` Permit A l i c a t i o n FOlt of. I. U S I 0
City Tigard gard E ® d Ptrnrit Na �� �7 0�0 (� %DOS9
13123 SW T Halt Stvd, Tigard, OR 97223
Phone: 503 639.4171 Fax 543.59519 N q !d �/ 2 o O ,:. ,;", Other Permit No.:
24- Hour Inspection Line: 503_639.4175 I U
Internet: www,ai.tigard.or.us � '� l � Daft Ready/8y. Iu'ii: El
CITY OF TI(�ARf Nu6fied/MeU S od. e nt err
opplementat 7nrartnatlon
TOW la /WNWSION mop SCHEDULE
❑ New construction ❑Demolition For vacua ktut
Additionlaltt nation/ Descri replacement ❑ Other: Qty. E Total
New 1- 2 -faadly elweR (includes 100 R. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (1) bath 249.20
Jai- and 2- family dwelling ❑ Commercial/industrial SFR. (2) bath - 350.00
❑ Accessory building ❑ Multi -family SFR ( bath 399.00
Q Master builder El Other
Each additional bmlh/kilchen 45.00
JOB SITE INFORMATION AND LOCATION Fire
mrink
ler (____ s9 ft) page 2 I
Site utilities
Job site address: g31,... S w ) e. Cateh baste orareadrain -
16.60
City/State/ZIP: -- a yd 0 C 7 3 3 Drywell, leach line, or trench drain 16.60
Suite/bldg./apt. no.. Project names Footing drain (no. linear ft: ) Page 2
Cross street/directions to job site Manufactured home utilities 110.00
r V oSS Si 'e--e F �k 0 SQ-s. Mandolin 16.60
P Resat drain connector - 16.60
, Sanitary sewer (no. linear ft ) Page 2
Storm sewer (no. linear ft.: ) Page 2
Subdivision: 1 Lot no.: Watt service (no_ linear R: $o ) 1 Page 2 II 5 cry
Tax map/parcel no.: Fixture or item
Absorpti
DESCRIPTION OF WORK on valve 16.60
Barrow pueventer Page 2
Backwater valve 16.60
Clothes washer 16.60
Dishwashe 16.60
[a PROPERTY OWNER f ❑ TENANT Dr fouaeain 16.60
Name -, A- f V t S r 1,1(rl 11 E rs/atr�r
� / 16.60
Address: (1 3 l s w 1 ..ai IN 9 -- tr�sz won teak 16.60
Cit J Fixture/sewer 1640 �o j 0 IZ ' 7a5L 3 Floor dram/floorsink/huh 16.60
Phone- ( ) to ( 4 . - 0 3 ((, I Fax: ( ) Garbage disposal 16.60
❑ APPLICANT ❑.CONTACT PERSON Hose bib 16.60
maker
Business name: CO t 5 e k T ILL vvi l0 bl.iaj ice a n/gr 16.60
Contact name: J 16.60
Medical gas (value S ) Page 2
Address: P a Bo - 30075 V Primer
+� 16.60
City /State/ZIP: PO Y A Q A eQ O ? 7094 Roof drain (commercial) 16.60
Phone: (50 3) ,q 5 • - d o 3 O I Fa= : (5 95 ) ,',26 a - ?a 5 I Smk/haarn/la.irfory 1660
E-mail: Tub/shvwalshowrrpan 16,60
Urinal 16.60
CONTRACTOR Water closet
Business aama J} / J 16.60
5 T / l_/ ivt. a i>t-f Water heater
Address: _ 2 ` DO other- I6,60
City /State/ZIP:
<I r
5:6
Phone: ( ) Fax ( ) Minimum permit fe S72.50
Residential back low minimum p it fee: 4c
CCB Lie.: 1 7-. f 7 g' Plumbing Lic. no.: a A -1 of 5P,J Pion review (2554 (*permit fee)
Authorized signature: ('� State e S%of permit fee) 111 MO ,4 0
G _ TOTAL PERMIT FEE c� �'L
Print name: .8 tr e IA. ha C� Date: & & / I T4is permit appllsatian ` B
expires ifs Permit Is not ubtalncd within
190 days alter H bas been accepted as complete.
CITY OF TIGARD 1 rn
BUILDING DIVISION PERMIT #: P Iwo- ®0 �'o ®s`"
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED:
Phone: (503) 639 -4171 ,
Inspection Requests (24 Hrs.): (503) 639 -4175 I
INSPECTION WORKSHEET FOR DATE: TIME: PAGE:
SITE ADDRESS: Q?;) J CLASS OF WORK:
SUBDIVISION: � LOT #: TYPE OF USE:
PROJECT NAME: �"- , - � �,� 4-tr
DESCRIPTION:
OWNER: ✓ _ _ J ; PHONE #CS`D3 ),53- 00 3
CONTRACTOR: -"." PHONE #:
•
Inspection Request Scheduled For: Date: (a -- 'OGQ Pour Time:
Code # Inspection Description Confirm # Contact # Message
33°
Corrections /Comments /Instructions:
f
_ ►e SS I_ _I PARTIAL APPROVAL 7 CANCEL _ - NO ACCESS
FAIL n CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED
l
Inspector:' V Date: , - Phone #: (503) 718-