Permit CITY OF TIG.0 ARD PLUMBING PERMIT
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III
° COMMUNITY DEVELOPMENT PERMIT #: PLM2008 -00272
►i DATE ISSUED: 6/17/2008
T I G A
1 3125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 1 S135CC -01400
SITE ADDRESS: 10305 SW MEADOW ST ZONING: R-4.5
SUBDIVISION: THE MEADOW LOT: 011 JURISDICTION: TIG
PROJECT: SORENSON
Project Description: Repairing 5 ft. of sewer line.
CLASS OF WORK: ALT 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: 5 ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Owner:
FEES
JANICE SORENSEN
2680 E NOB HILL ST SE Description Date Amount
SALEM, OR 97302 [PLUMB] Permit Fee 6/17/2008 $72.50
[TAX] 12% State Surcha 6/17/2008 $8.70
Phone : Total $81.20
Contractor:
ENVIRONMENTAL SERVICES
DBA SOIL SOLUTIONS
3540 SE 28TH AVE REQUIRED ITEMS AND REPORTS
PORTLAND, OR 97202
Contact # : PRI 503- 234 -2118
FAX 503- 331 -7133
Reg #: PLM 138344 •
This permit is issued subject to the regulations contained in the Tigard Muniapal 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 : . .- •99 or 1.800.332.2344.
Issue By: K. • // L / , ,. :/ ./ Permittee Sig if) :t i/lvoy.- _ _
Call 503.639.4175 by 7:00 a.m. for an inspection th 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.
•... . . From:Soil Solutions 55 331 7133 06/16/2008 11:54 #305 P.001/002
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Plumbine Permit AWiriatipifItt FOR 011 ICE USE ONI.l.
City of Tigaid • IP, Received
S‘3% l‘Clj Date/By
13125 SW Hall Blvd., Tigard, OR 97223 : /6 01577 No.:
Cif Al '\ 0 Plan Revi
Phone: 503.639.4171 Fax: 503.598.19611414 _ ." DIM '1 • .. i'at i CI '1'‘ DabgBY: SW Other Permit No.: ,
24- Hour Inspection Line: 503.639.4175 %Ol te*, „AI ' :•11 D ate R ea d y B y:
•h:„ ,,,i* RI See Page 2 for '
Internet: www.ci.tigard.or.us 1 IOW Notified/Method: • /...412 Supplemental Information
• '.•.'• ::-:".: ':;' tiiki**00 ::: '411: ".;.:,;:::: ;:-.",-,...::•:;: FtE!: SCI
0 New construction 0 Demolition For :pedal Information use checklist
Description 1 Qty. J Ea. I Total
ritLAdditirm/alteraticm/replacement 0 Other: ' New 1-2-family dwellings (includes 100 ft. for each utility connection)
'•'-::'•;6'1C;•-4'.4:`,:-;iO4t.-fre-0.0k0:ti3O0....:..NOw..04:0,47q2(2..,.;.ii:::,:gcsi,,.,,4:: -.;::: SFR (1) bad' . ' 249.20
1- and 2-family dwelling : 0 Commercialfindusirial : :SFR (2) bath 350.00
399.00 , -
Accessory building 0 Multi-family : SFR (3) bath
Each additional bath/kitchen 45.00 . .
0
Master builder 0 Other:
Fire sprinkler ( sq. ft.) . Page 2
''''•••:; : '• ,i ':':' ' ''' -•: ' ,• :- : : : •-':: • • :: ''''' . :itiii r §ifilii,tiiiiii`kiii)ii'. : ',igiittiekiiiiiiii" , :n 1 " . T' . ' :- . ' SIte utilities
Job site address: 10305 1 3 (A) Maa,60,0 S 4" Catch basin or area drain . 16.60 •
City/State/Zip: 'Vick ,.1 0 c Drywell, leach line, or trench drain 16.60
Suite/bldg./apt. no.: (...)1 Project name:
rd , : Footing drain (no. linear ft.: ) Page 2
Manufactured home utilities
110.00
Cross street/directions to job site: - 51,0 Tic mc ( . 1 4),v. Manholes 16.60
Rain drain connector 16.60
Sanitary sewer (no. fines]. ft.: _ J Page 2 as-. -
Storm sewer (no. linear ft.: __) Page 2
•
Subdivision:
Water service (no. linear ft.: ) Page 2
. I Lot no.:
Fixture or Item
Tax map/pared l no.:
Absorption valve 16.60
. ' ' • '::-..: . : :.:1. • ; : •:: : PEK:W. 1 19Nc:9Y-, , TRW. C•,:•:.'.' :••••,'.- '. ••-••; BackfloW preventer Page 2
0 • ,
d
s' ' a. 02t-tier- oc on pitcp2)- Backwater valve - 16.60
1!4' A 0-/ Al A CIA"R, Clothes washer 16.60 -
. ., Dishwasher 16.60 .
,. Drinking fountain . 16.60
: :.:::
Ejectors/sump • 16.60
Name: t- ( -0-( ( Zn 1 6^ Expansion tank 16.60
.
Address: ac fro & p 1 ,4,.. 1 1 s4_ S6 Fixture/sewer cap 16.60
City/State/ZIPizy ( 4 .3 . 1",73°Z. Floor drain/floor sink/hub 16.60 "
• Phone: ( ) Fax: C' ) ' Garbage disposal 16.60
: V • ',Y 1• 7:::,;: l .'-.:. :• ; • , . :;: ifil• :. ' r iiiiPEEC.iilf- . ..,7::.:::•' 7 ; : :::;f ;'..•:-?;=::ig.:.,•;.itiSikef,'.,..pg4g014.:"'-'••:,.-. Hose 16
bib .60
' • • Ice niaker 16.60
Business name: D i k (30‘,(A4-ioy . . interceptor/grease trap 16.60
Contact name: Sk43.,,rov.- ZpEL1/4.Te__ k,k Medical gas (value: $ _ ) Page 2
Address: SS-to S F - a gies l iczi o . Primer
.
City/State/ZIP: pox oR c7*-9-Ao-Z Roof drain (commercial) 16.60 '
Sink/basin/lavatory . 16.60
Phone: (613) a2 .. Q I ( e I Fax : (6b3 331 - 1- (33
Tub/shower/shower pan 16.60
E-mail:
Urinal 16.60
CONTRACTOR
" : • , • .. . - ;- , • . . . . .. . „ ,
, : '• - ::: :. I' :',.. - - s.: '-: ,-.: •---:: -: '!..- ..,:::: .. ', ! :• T' ; '"; '..: :: •:: , ::'.'. '::' •• :::-. : ' .: :. .: . ; Water closet 16.60
Business name: ,3 D 0 jbak.c, . Water heater 16.60
Address: •
City/State/ZIP: • - - . Subtotal ob. Cro
- Minimum permit fee: $72.50 ...-7
Phone: I Fax: ( ) Residential backflow minimum permit fee: $36.25 /
CCB Lic.: I --, " y Plumbing Lic. no. -,-;•'‘• Plan review (25% of permit fee)
PP- State surchazgeM/0 of permit fee) -. 10
Authorized signature: -- - .
AI...A-. Aim ' TOTAL PERMIT FELtiik,41:7-171 rap
..... ---
,
I Print name: V, exris- Date: • 1 ( I 0? 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.
MuildinipermitAPI/v1-PerrnhApp.doe 06/OS 440-4616T(10/112/COMAVE13)
i
CITY OF TIGARD , •
BUILDING DIVISION PERMIT #: PLM200 8-00272
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 6/17/2008
Phone: (503) 639 -4171 l''°µ'41 i I
Inspection Requests (24 Hrs.): (503) 639 -4175 -_
INSPECTION WORKSHEET FOR DATE: 6/25/2008 TIME: 7:00AM PAGE: 24
SITE ADDRESS: 10305 SW MEADOW ST CLASS OF WORK:
SUBDIVISION: THE MEADOW LOT #: 011 TYPE OF USE:
PROJECT NAME: SORENSON
DESCRIPTION: Repairing 5 ft. of sewer line_
OWNER: SORENSEN, JANICE PHONE #:
CONTRACTOR: ENVIRONMENTAL SERVICES PHONE #: 503-234-2118
Inspection Request Scheduled For: Date: 6/25/2008 Pour Time:
Code # Inspection Description Confirm # Contact # Mes ge 1 ?/
399 Plumbing final 071817 -01 503- 234-2118 '
3-
Corrections /Comments /Instructions:
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PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASS ED
Ins ector: /'v Date: `e — ' O Phone #: (503) 718 - vsfVf