Permit . t-- w
C ITY OF TIGA PLUMBING PERMIT
I� DEVELOPMENT SERVICES PERMIT #: PLM2005 -00291
, .� I � 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 7/5/2005
PARCEL: 1 S134DB -07300
SITE ADDRESS: 11100 SW NORTH DAKOTA ST ZONING: R -4.5
SUBDIVISION: TORLAND ESTATES LOT: 011 JURISDICTION: TIG
Project Description: Water service replacement.
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
TORLAND, MARY HANSON Description Date Amount
11100 SW NORTH DAKOTA
TIGARD, OR 97223 [PLUMB] Permit Fee 7/5/2005 $72.50
[TAX] 8% State Surchari 7/5/2005 ' $5.80
Phone : 503 639 - 2635 Total $78.30
Contractor:
CASEY'S PLUMBING INC
904 NE 57TH AVENUE REQUIRED ITEMS AND REPORTS
PO BOX 30075
PORTLAND, OR 97294
Phone : 503 253 - 0030
Reg #: PLM 26 - 725PB
LIC 147298
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: 277
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.
RECEIVED
Plumbing Permit Application FOR OFFIC l'sr ON IN
City of Tigard JUN 3 0 2005 'J'd5 . ii Permit No.. _ h _Lip - oaa9 /
13125 SW Hall Blvd., Tigard, OR 97223 _
Phone: 503.639.417I Fare 503.598.1960. I Y O r T I G A R' ;., ., I P DatriBy: Other Permit No_:
Hour 24- Ho Inspection Line: 503.639 -41758 U I LD I N G D IV I :! ,,- ! l _ Date Ready/By: : B See Page 2 for
Internet www.citigard.or.us Notified/Method: 7 /C Supplemental rnfiarrnadan
TYPE OF WORK FEE SCHEDULE
El New construction ❑ Demolition For special infona�on use checklist
Description I Qty. I Ea. I Total
)1ir Addition/alteration/replacement ❑ Other: New 1 - 2 - family dwellings (includes 10011 for each utility connection)
CATEGORY OF CONSTRUCTION SFR (1) bath 249.20
,a,1- and 2- family dwelling ❑ CommerciaUmdus vial SFR (2) bath 350.00
❑ Accessory building Multi-family SFR (3) bath Multi-family
Each additional bath/kitchen 45.00
❑ Master builder ❑ Other.
Fire sprinkler ( sq. R.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities
Job site address: OD g. 16,01 A. R _ Catch basin or area drain 16.60
City/State/ZIP: - t ‘ C of Drywell, leach line, or trench drain 16.60
Suite bldg /apt. no.: I ect name:
Footing drain (no. linear R : Page 2
Cross street'directions to job site: NC --� H- Manufactured home utilities 1 10.00
Manholes 16.60
il Rain drain connector 16.60
Sanitary sewer (no. linear ft.: _) Page 2
Storm sewer (no. linear ft.: ) Page 2
Subdivision: I Lot no.:
Water service (no. linear R: ) Page 2 5 C.,,
Fixture or item
Tax map/parcel no.: -
Absorption valve 16.60
DESCRIPTION OF WORK , Badcllow preventer Page 2
r 'f. p `.t -e_ W e / 5 Y .- Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
0 PROPERTY OWNER I ❑ TENANT Drinking fountain 16.60
Ejectors/sump 16.60
Name: m ILY q I • Cl � Expa
� tank 16.60
Address: U • / lo_ / Fixttae /sewer cap 16.60
City /State/ZIP. f 3\9O' . .03 Floor drain/floor sink/bub 16.60
Phone: ( j) I'IJ c 24 1;. 3 s-" Fax: ( ) Garbage disposal 16.60
rgf APPLICANT ❑ CONTACT PERSON Hose 16.60
Ice maker 16.60
C o
Business name: s % S P l (2...14410 /1j�'
iil.G
\/ � . Lrterceptorlgreasetrap 16.60
Contact name: Medical gas (value: S ) Page 2.
Address: (' I f N E 157 Primer 16.60
City/State/ZIP: D1r�1, V I! 9 - a 3 0 Roof drain (commercial) 16.60
Phone: (50 3) a 5 3_ 04, 3 I Fax: : (566) 210 Z - sic 1 Sink/basin/lavatory 16.60
Tub/shower /shower pan 16.60
E-mail:
Urinal 16.60
CONTRACTOR Water closet 16.60
Business name: pl. L , n -,
Q S � is p J Water heater 16.60
Address: Po g ) e 3 00 75 Other:
City/State/ZIP: City/State/ZIP: a r 4 4 D 7 9- subtotal
Minimum permit foe: $72.50 1 .
Phone: ( 51;3 / 2 S 3- 0 o 3 0 Fax: ( ) 0 - I '04' Residential bacidlow minimum permit fee: $36.25
CCB Lie.: / 4 1 7 a 7 g' Plumbing Lic. no.: a (,_-4,25 pe Plan review (25% of permit fee)
State surcharge (8% of permit fee) _ V
Authorized signature: 9 -�-y ,, �( TOTAL PERMIT FEE . . 2 C
Print name: l r en. crQ. / ! Date: �[ I TLis permit application exphra it a permit is not ob
_( r 180 daps after It has been accepted as complete.
l 15Z8 - £09 6uigwnld s i(eseQ dgt7: l0 50 0£ unr
Case Activity Listing 7/24/2006
2:38:55PM
TIDEMARK Case #: PLM2005 -00291
COMPUTER SYSTEMS, INC.
Assigned Done Updated
Activity Description Date I Date 2 Date 3 Hold Disp To By By Notes
PLM2330 Water service 7/5/2005 7/6/2005 7/6/2005 None PASS MRS 7/6/2005 010779 -01 — 503- 253 -0030 — VM -
STI N
PLM1010 Application received 7/5/2005 None RECD FAX 7/5/2005
BB
PLM1020 Permit created 7/5/2005 None DONE BB 7/5/2005
BB
PLM1030 Check for parcel tags 7/5/2005 None DONE BB 7/5/2005
BB
PLM1270 Ready to issue permit 7/5/2005 None REDY BB 7/5/2005
BB
PLM1280 Issue permit 7/5/2005 None DONE BB 7/5/2005
RCP
PLM 1740 Case fmaled 7/6/2005 None PASS MRS 7/6/2005
MRS
PLM 1740 Case fmaled . 7/6/2005 None DONE MRS 7/6/2005
MRS
Page 1 of 1 CaseActivity..rpt
CITY OF TIGARD
BUILDING DIVISION PERMIT #: PLM2005.00291
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 7/512005
Phone: (503) 639 -4171 .,ntiv'� �Ii,l
Inspection Requests (24 Hrs.): (503) 639 -4175 . -�-61■ `__..
INSPECTION WORKSHEET FOR DATE: 7/6/2005 TIME: 7:12AM PAGE: 70
SITE ADDRESS: 11100 SW NORTH DAKOTA ST CLASS OF WORK:
SUBDIVISION: TORLAND ESTATES LOT #: 011 TYPE OF USE:
PROJECT NAME: TORLAND
DESCRIPTION: Water service replacement. ,
OWNER: TORLAND, MARY HANSON, PHONE #: 503- 639 -2635
CONTRACTOR: CASEY'S PLUMBING INC PHONE #: 503-253-0030
Inspection Request Scheduled For: Date: 7/6/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
330 Water service 010779-01 503-253-0030 N
Corrections /Comments / Instructions:
/ /"'i - (
S4--PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: t �i79 Date: Phone #: (503) 718-