Permit •
CITY TIGARD • PLUMBING PERMIT
PERMIT #: PLM2006 -00384
DEVELOPMENT SERVICES DATE ISSUED: 8/14/2006
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 PARCEL: 2S103DA - 06800
SITE ADDRESS: 10935 SW MIRA CT ZONING: R-4.5
SUBDIVISION: MIRA PARK LOT: 006 JURISDICTION: TIG
Project Description: Replace 40 ft of sewer line.
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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: 40 ft
WATER CLOSETS: WATER LINE: ft •
DISHWASHERS: RAIN DRAIN: ft
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Owner: FEES
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JUANITA MUNTZ
10935 SW MIRA CT Description Date Amount
TIGARD, OR 97223 [PLUMB] Permit Fee 8/14/2006 $72.50
[TAX] 8% State Surcha 8/14/2006 $5.80
Phone : 503- 620 -3914 Total $78.30
Contractor:
RESCUE ROOTER
28655 SW BOONES FERRY RD
WILSONVILLE, OR 97070 REQUIRED ITEMS AND REPORTS
Contact # : PRI 503 869 - 2260
FAX 503- 685 -9185
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Reg #: LIC 127325
PLM 34 -168PB
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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: stk s , c ,,, w
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.
Aug X 14 06 09:1la Accounting Department 503 -685 -9381 p.1
Plumbing Permit Application.. 1E0 FOR OFFICE USE ONLY
Cit • of Tigard V Recei • _ Pem 1\.._.i b -'6065'51 :4
13 125 SW B all Blvd., Tigard, OR 9722 C Date/By: , - t . Q r Plan Review
Phone: 503.639.4171 Fax: Q t1. c'I I ax: 503.598.1960 6 1 4 2 �i' w ;; �; � A Date/By: Other Pemti No.:
24- l lunt Inspection Line: 503.639.4175 � Date Ready/By: Ju ® See Page 2 for
Internet: www.ci.tigard.ur.us coN Or j 1 • Notified/Method: ) I& Supplemental Information
TYPE • O b .. FEE. SCHEDULE
❑ New construction ❑ Demolition For special information use cbeckiist
Descri • tion • t . Ea. Total
$] Addition /alteration /replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
CATEGORY 'OF CONSTRUCTION • . SFR (1) bath 249.20
NI I- and 2- family dwelling ❑ Commercial/industrial SFR (2) bath 350.00
❑ Accessory building ❑ Multi- family
SFR (3) bath 399.00
Each additional bath/kitchen 45.00
❑ Master builder ❑ Other: Page 2
Fire sprinkler ( sq. ft) 8
.1011 SITE INFORMATION AND LOCATION . Site utilities
Job site address: I 0 c( 5 5VV M.(_ 4 (x- Catch basin or area drain 16.60
City/State/ZIP: �i )0titt0( -. 11' Drywell, leach line. or trench drain 16.60
Suitcihidg./apt. nu.: Project name: Footing drain (no. linear ft: ) Page 2
Manufactured home utilities 110.00
Cross sircct/dircctions to job ste:
Manholes 16.60
Rain drain connector 16.60
Sanitary sewer (no. linear ft.: 40 ) Page 2
Storm sewer (no. linear ft.: ) Page 2
Subdivision: I Lot no.: Water service (no. linear fi.: ) Page 2
Fixture or item
Tax map/parcel no.:
Absorption valve 16.60
DESCRIPTION O F WORK • • • Backflow preventer Page 2
/� "
' f f ate. , go t J'� 0•t s e ii(��- Backwater valve 16.60
" Clothes washer 16.60
Dishwasher 16.60
.
, n fountain Drinking fo 16.60
❑ I'RUI'Eirry OW1V :• .!. . • I: . .. El TENANT_ .
Ejectors /sump 16.60
Name: IA Sko.N r n &&M4)T Expansion tank 16.60
Address: J 0 q ✓5 S iN to le...4 e— Fixture/sewer cap 16.60
City/State /ZIP: 1 j t • I #-/ 223 Floor drain/floor sink/hub 16.60
Phone: (605) 67 • - C( 14 Fax: ( ) Garbage disposal 16.60
Hose bib ■
❑ •
:tP1'I.IC:AN'T 0 CONTACT. PERSON
Ice maker
Business n :u,tc: AILS 1- Li: d loci,C.l.Zi, i2, , t
Interceptor/grease trap
Contact name: Ma +i fi t 1 (LAW Medical gas (value: $ ) Page 2
Address: Z gip 55 'j(/i.) "ccirl es fc-rlr (/` Primer •'
City!Statc&ZII': WI I& j J (((,� c q-70-7 ✓ p Roof drain (commercial) ■ •
(, 3) ie gG 1750 (5;13) (p g 5 ,g Sink/basin / lavatory
Phone: Fa :
Tub /shower /shower pan 16.60
E Urinal 16.60
CONTRACTOR I. : • : . Water closet 16.60
Business name: p ' > t.. W Cl SPAA.Q— 12,G Water heater •'
Address: 2. s L �I,4) '?fx�.�S ce.r-ct Other
Othe ' ^ Subtotal
`
City/Slate/ZIP: W (15[ Y) e
( I l _ C Ch 07 C) Minimum permit fee: $7150
Phone: ( Fax: ( ) Residential backflow minimum permit fee: $36.25 / .4...60
CCB Lie.: 1 V7 32, Plumbing Lic. no.: 3 . -/ (G roe Plan review (25% of permit fee)
State surcharge (8% of permit fee) 5. Si'
Authorized signature: � �� TOTAL PERMIT FEE " J 2 .3 0
'�
,�,,_ Y
' Print n :ntic:l5 4f j4) u 41 fie/ I- I Date: 8-/1, D , Thls 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:%1St.ileine%Ycriiiirv.I'LNA- reillth A ; •Y due 06/05 440-0616T(10102/COM: WEB)
C O GA
BUILDING DI RD - >w' PERMIT #: PL.M2000.00384
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 0/14/2006
Phone: (503) 639 -4171 � u II I
Inspection Requests (24 Hrs.): (503) 639 -4175 _. ' �_ ..
INSPECTION WORKSHEET FOR DATE: 8/16/2006 TIME: 7 :05AM PAGE: 9
SITE ADDRESS: 10935 SW MIRA CT CLASS OF WORK:
SUBDIVISION: MIRA PARK LOT #: 006 TYPE OF USE:
PROJECT NAME: MUNTZ
DESCRIPTION: Replace 40 ft of sewer line.
OWNER: MUNTZ, JUANITA PHONE #: 503620-3914
CONTRACTOR: RESCUE ROOTER PHONE #: 503 - 669.2260
Inspection Request Scheduled For: Date: 8/16/2006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
395 Misc. ins ection sr 035083-01 L
/hi I
503 - 209-3756 Y
Corrections/Comments/ Instruc ns: / V
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... ......."711 . i
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eitX \ /,,t-e 9
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: tVi 0.7"0 Date: Phone #: (503) 718 -170)