Permit •
. A CITY OF TIGARD PLUMBING PERMIT
DEVELOPMENT SERVICES . PERMIT #: PLM2005 -00483
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 9/26/2005 PARCEL: 1S135CA -00301
SITE ADDRESS: 09645 SW NORTH DAKOTA ST ZONING: R -12
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SUBDIVISION: LOT: JURISDICTION: TIG
Project Description: Re - pipe 100', upgrade drain to 2 ".
CLASS OF WORK: OTR GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: SF WASHING MACH: 1 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: 1 SEWER LINE: ft
WATER CLOSETS: . 1 WATER LINE: ft .
DISHWASHERS: RAIN DRAIN: ft
Owner: FEES
KATHY EVANS
1335 BICKNER ST Description Date Amount
LAKE OSWEGO, OR 97034 [PLUMB] Permit Fee 9/26/2005 $104.80
[TAX] 8% State Surcha 9/26/2005 $8.38
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Phone : 503 699 - 3045 Total $113.18
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Contractor:
MP (MILWAUKIE) PLUMBING CO
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P.O. BOX 393
CLACKAMAS, OR 97015 REQUIRED ITEMS AND REPORTS •
Phone : 503- 655 -9161
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Reg #: LIC 5002
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PLM 3 -17PB
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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.
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Issued By: Permittee Signature: � cs.\c
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.
09- 22 -'05 09:02 FROM -MP PLUMBING CO. 5036507050 T -902 P02/03 U -909
a • ,:Building Fixtures RECEIVED ' . •
Plumbing Permit Application FOR OFFICE USE ONLY
SEA
5 of Tigard P 2 2 2 received 9 ;7, O q` 0.5 - . Pernik N0.. hruv . 5190 � 3
I3
131225 SW Hall Blvd., Tigard, OR 97223 DatdBy;
-- - Phbrie: - Fax: 503398:1960 - • o r • ear - . .^ -. .
' ; ` � � • .. OtAer 1'cmiit No:;
24- Hour Inspection Line: 503.639.4175 tR "r.' i Date BUILDING :►_1!' . �!� �� Da�,dyBy. ® See Page zfor
J
Internet www.ciligard.or.us
Notified/Method: Supplemental Information
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0 New construction ❑ Demolition _ For special information use y checklist
Drscription - 1 Qty. f Ea. j Total
V, Addition/alteration/replacement q Other: New 1- 2- family dwellings (includes 100 ft. for each utility connects,
A''''.1-•' '. r kS,I s •r'. i, n - `, r i J 1J r/,., • }_ ( c. t .r::i� n i- a o ? re t a r •,,:, {.,: r+ . ., 1 l F r 1 _%t u .r ,. w h'n 5 ' ( SFr(1)bafi l 249.20
Pi 1- and 2- family dwelling . ❑ Commercial/industrial SFR (2) bath 350.00
❑ Accessory building . ❑ Multi - family SFR (3) bath 399.00
Each additional bath/ldrehcn 45.00
❑ Master builder ❑ Other:
L I' Piro sprinkler ( s . ft
r rr•ry err .1F :f. � Z ,, s y i "ate r r 4 (- .' s' s'S "t ' ' ' '' S`"
m=2-1/=/'1,'•• 9 ft.) I f Page 2 I
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a'_ i z sI .._ ._� J _ r 5_ - ., . had Site utilities
site address: 9`i*° , 4,711P7 , , : Catch basin or area drain 16.60 - -
City/State/Z, LP: t*rile '4 ' 3 Dtywell, leach line, or trench drain 16.60
Suite/bldg.apt. no.: . Project name: a .,/ i/ Footing drain (no. linear ft.: ) Page 2
Cross street/directions to job site:
Manufactured home utilities 110.00
-- 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.: ) Page 21
Tax map /parcel no
"' Fixture or item
�� - "Y"� t : s,. � '. r; , �.. r Absorption valve 16.60
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. ..., . ✓s_ ,.� r���• ' B8Ckflow reverter
/��� B ackwater valve
�, /: � � l� l.�>� %�/ ..' a 16.60
_,� L �, , IM Clothes washer 16.60
Dishwasher 16.60
r' r r , "( , � . , ,.x r .a r , � t " " u J z t , e u � 1 Er Drinki fountain 16.60
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` ,��`` Ejectorsls 16.60
Name:
�` Y� Expansion tank 16.60
Address.
1 r .4_ _ . / I . ' d p 16.60
Fixture/sewer cap
/ " Floor drain/floor sink/hub - 16.60
Phone ( ) 'ly r .�f�i • A •`P Garbage disposal 16.60
�" , a ° '�S g :314 _ ( `. VY. a 1� . r f✓ 1 1 :s,� � 'ia _ Hose bib 16.60
Business Haase: / !` Ice maker l 6.60
/t i !/ % ! Interceptor /grease trap 16.60
Contact name' me, _Medical gas (value: $ ) Page 2
Address: Primer 16,60
City /State/ZIP: 1 if t Roof drain (commercial) 16.60
Phone: ( ) d Fax: : ( ) Sink/basin/lavatory 16.60 ��
E-mail: -- -- Tub /shower /shower pan 16.60 ,�p , o"/
y ( «� Urinal 16.60
r; i 1n , 'q { r r u•� �" "N 't •01.'$ '. ti:ni R` I'4 r4 79 . ..
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P riF' „i ��ti`11OS�a�Y�z9sy�d 1 h rt ,, m oT� �✓at 1
- `j ,�n;Eli.>�e.,-- ,.,_...�....�'�' �':�f< .� _.aiat"k�;. er c oset � 16.60
Business name: /J A i s Water heater m 16.60
J� mi .. Address: /v `i y Other: //` �� 7
City/S[ate/Z1P: / B� Ir ! Subtotal • Q . - 9Q
/ %!_/ • Minimum permit fee: $72.50
Phone: ( ) .06/Zr1 Fax: ( ) - .7.05✓0, Residential backflow minimum permit fee: $36.25
CCB Y.ic.: Plumbing Lic. no.: 1 14/7,0 . 6 _ Plan review (25% of permit fee)
Authorized si tat ire:
State surcharge (8% of permit fee)
" T OTAL PERMIT I :Y:E � AA, Print name:'
ame: / / ` f , ,/ / Date: , 4 i t? ,d05 This permit application expires [fa permit is not obtained within
180 days after it has been accepted as complete.
'Fee methodology set by Tri- County Building industry Service Board
MuildariperrnitriPLMF •PermitApp.doc 12/03 440.4616T(10/02/COM/WEB1
CITY OF TIGARD
BUILDING DIVISION PERMIT #: PLM2005 -00483
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 9/26/2005
Phone: (503) 639 -4171 A
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 10/7/2005 TIME: 7:05AM PAGE: 62
SITE ADDRESS: U9645 SW NORTH DAKOTA ST CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: EVANS
DESCRIPTION: Re - pipe 100', upgrade drain to 2 ".
OWNER: EVANS, KATHY PHONE #: 503 - 699 -3045
CONTRACTOR: MP (MILWAUKIE) PLUMBING CO PHONE #: 503 -655 -9161
Inspection Request Scheduled For: Date: 1Q/7/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
320 Plumbing rough -in 017728 -01 503-655 -9161 Y
Corrections /Comments /Instructions:
(1/\
4SS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: r in/ Date: P/W Phone #: (503) 718-