Permit CITY TIGARD PLUMBING PERMIT
DEVELOPMENT SERVICES PERMIT #: PLM2005 -00356
A l.,- DATE ISSUED: 8/8/2005
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 PARCEL: 1S135CD -06500
SITE ADDRESS: 09720 SW LONDON CT ZONING: R -25
SUBDIVISION: LONDON SQUARE NO.2 LOT: 017 JURISDICTION: TIG
Project Description: Water service replacement.
CLASS OF WORK: OTR GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: 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: ft
DISHWASHERS: RAIN DRAIN: ft
Owner: FEES
ORINGDULPH, LYNN ALLISON Description Date Amount
9720 SW LONDON CT
TIGARD, OR 97223 [PLUMB] Permit Fee 8/8/2005 $72.50
[TAX] 8% State Surcharq 8/8/2005 $5.80
Phone : 503 639 - 3266 Total $78.30
Contractor:
WOLCOTT PLUMBING CONTRACTORS
1075 W HISTORIC COLUMBIA RIVER REQUIRED ITEMS AND REPORTS
TROUTDALE, OR 97060
Phone : 503 - 667 - 1781
Reg #: LIC 23847
PLM 26 - 208PB
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- 9 or 1- 800 - 332 -2344.
Issued By: Permittee Signature: e, r#4.4.
Call 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.
86T/ 2005 10:26 5034912932 JACK HOWK PAGE 01
i
PIumbine Permit ApalIC8 i CEOV L ® • FOR OFFICE USE ONLY
City of Tegard Date /Rjr: I Permit Nn,
0 1 Reci e . ` QD ' S • �L►�1�
13125 SW Ball Blvd.. Tigard, OR 97223 AUG / I . Plan'Revi Other Permit No.;
Phone, 503,639.4171 Fax: 503.598,1960 �,,,01111 . Hotta :
24- Hour inspection Line: 503,639.4175 w Date Rea d B Ei See Pale 2 for
QIN OF Internet: www.ei.tigard,or.us Notified/method: ,.�enao -rn +non Notified/method: Supplemental Information
r .9:1A415115'-AIL..r„•1.V.� F'EF" '.iC'11TLrI)TTT,F
TYPE OF R ORT.
Demolition
_ .... mo For special irrfotmallnn use checklist
❑ k
❑ New construction Description au . Ea, Total
Addition /alteration /replacement ❑ Other: _ New 1- 2- family dwellings (includes 100 It for each utility connection)
CATEGORY OF C 'ON STRTTCTTON SFR(1)bath 249,20
If 1 - and 2•family dwelling ❑ Commercial /industrial SFR (2) bath 350.00
SFR (3) bath 399.00
❑ Accessory building
0 Multi - family
Each additional bath/kitchen 45.00
❑ Master builder ❑Other- Fire sprinkler ( sq. R.) Page 2 -
.TOB SITE TNFORNL ATTON 4ND LOC 1?TON Site utilities _
Job site address: , �` �1 Catch basin or area drain 16,60
City /Stato/ZIP: 0‘1/. / gR - _ Drywall, leach line, or trench drain 16.60
�, /"m' Footing drain (no. linear ft.: _) Page 2
Suitc/hldg. /apt. no,: Project name; ie � P AI
Manufactured home utilities 110.00
Cross strcet/directions to job. site: _ Manholes 16,60
---- Rain drain connector • 16.60
Sanitary sewer (no. linear It.; ) Page 2
• Storm sewer (no, linear ft.: _ ), Page 2
Subdivision;
Lot no.: �— Water service (no. linear ft.: %Agg1 Page 2
Fixture or item —
—
Tax map /parcel no. Absorption valve 16.60
DE CRTPTIC)N OF 'WORK Back El ow preventer Paget
W /i/ 0 r/rr - Backwater valve 16.60
Clothes washer 16,60
- Dishwasher 16.60
Drinking fountain 16.60
iePROPERT1 OWNER _ ❑ 'TENANT 16.60
Name: r��'r Expansion tank 10,60
Address! /e ��,/�`� Fixture /sewer cap 16.60
City /State /ZiP: 11 h 4J_ � r ,, Floor drain/floor sink/hub 16,60
Phone: `/ / �/ fir!/[,,, ( ) Garbage disposal 16.60
Hose bib • 16.60
it APPLiCA,NT 0 CONTACT PERSON
Ice maker 16:60
Business name; Wolcott Plumbing dha Jack Hawk Plumb' g lntcrccptor /grease trap 16 40
Contact name: Medical gas (value: $ ) Page 2
T
Address: 1075 W Historic Columbia River Hwy Primer 16.60
City /State /ZIP; Troutdale, OR 97060 Roof drain (commercial) 16.60
Sink/basin/lavatory 16.60
Phone: (5:03) 235 -8784 , Fax: : (503) 491 -2932 '
Tub /shower /shower pan 16.60
E-mail: Urinal . 16.60
CONTRACTOR Water closet 16.60
Business name: Wolcott Plumbing dba Jack II Plumbing Water hater 16.60
Address: 1075 W Historic Columbia River Hwy • Other:
Subtotal
City /State/ZIP: Troutdale, OR 97060 -
Minimum permit fee: $72.50
Phone: (503) 235-8784 Fax: (503) 491 -2932 _ Residential backfow minimum permit fee: $36.25 e 2,
CCB Lie,: 23847 Plumbing Lic. no,: 26 -208 PB Plan review (25% of permit fee)
c2(=, State surcharge (8% of permit fee) Si /1114, Authorized signature: i �t
gn AA :A.4 a ( TOTAL PERMIT FE :iii
Print name: 1 if �i J , Date; s 1 This permit application expires if a permit is not e - tnln ■ Pr!h"'
180 days after it has been accepted as torn .
- *Fee methodolocv set by Tri- County l3uildine Industry Service Board.
•
•
CITY OF TIGARD
BUILDING DIVISION PERMIT #: PLM2005.00356
13125 SW Hall Blvd., Tigard, OR 97223 `S DATE ISSUED: 8/9/2006
Phone: (503) 639-4171
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 8/11/2005 TIME: 7:09AM PAGE: 82
SITE ADDRESS: 09720 SW LONDON CT CLASS OF WORK:
SUBDIVISION: LONDON SQUARE NO.2 LOT #: 0.17 TYPE OF USE:
PROJECT NAME: ORINGDULPH
DESCRIPTION: Water service replacement.
OWNER: ORINGDULPH, LYNN ALLISON, PHONE #: 503 - 639 -3266
CONTRACTOR: WOLCOTT PLUMBING CONTRACTORS PHONE #: 503 - 667 -1781
Inspection Request Scheduled For: Date: 8/11/200; Pour Time:
Code # Inspection Description Confirm # Contact # . Message
330 Water service 013296-01 503-236-8784
503 - 236.8784 Y
Corrections /Comments /Instructions: r 1 1
rr
Or PV
' ASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Date: [(35) Phone #: (503) 718-