Permit 4 6 0 - CITY OF TIGARD PLUMBING PERMIT
PERMIT #: PLM2005 -00296
1I,L''�i� DEVELOPMENT H BMEN9 Tigard, -639 -4171 DATE ISSUED: 7/7/2005
PARCEL: 1S134DB-07300
SITE ADDRESS: 11100 SW NORTH DAKOTA ST ZONING: R -4.5
SUBDIVISION: TORLAND ESTATES LOT: 011 JURISDICTION: TIG
Project Description: Replacing water piping for all fixtures.
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: 100 ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Owner: FEES
TORLAND, MARY HANSON Description Date Amount
11100 SW NORTH DAKOTA
TIGARD, OR 97223 [PLUMB] Permit Fee 7/7/2005 $72.50
[TAX] 8% Statc Surchari 7/7/2005 $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 -246 699 or 1- 800 - 332 -234 /
Issued B Pe rmitt ee Signature: /1-1 GAO_ c �t T�
Y� Gtr .�iz� � g —
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.
, .
4 RECEIVED'
Plumb' Permit lication i O ut O rr1( E'. t Si. OO\i
Q�
City .'Tegard U1 ' • < 2005 / oS Pcn 1111 - 0D -
Plan ' 13129 SW Hall Blvd., Tigard, OR 97223
Phone: 503.639.4171 F 503;9? t�,60 T I ' .- _
24- Hair Inspection line: 503 9 N ''''.44:' 1 Date Rod 1 ° 14 : ® See Page 2 for
ratan= www.citigerder us Tg i N G DIVIS C' A arouse mod:
\ I Suppinuental Information
TYPE OF - WORK FEE . SCHEDULE
❑ New constmction ❑ Demolition For special `r formation sae checklist.
Description I Qty. j Ea I Total
,.i Additio &alterationheplacement ❑ Othcr. New 1- 2 -6mdly dwellings (includes 100 it_ for each utility connection)
CATEGORY OF CONSTRUCTION SFR (1) bath 249.20
Tali- and 2- family dwelling ❑ Commercial' /industrial SFR (2) bath 350.00
❑ Accessory building ❑ Mufti-family SFR (3) bath 399.00
Each additional bath/kitchns 45.00
Q Master builder ❑otter
Foe sprinkler (_ sq. ft.) Page 2
JOB SITE INFORMATION AND LOCATION - bits utilities
Job suit address: i l 1 00 ' r) 3 i l � - D] Catch basin or area drain [6.60
CayiState/z>P: - 1'( n • C) R O -1 2,' �u leach fine, or trench anon 16.60
Suite/bldg./apt. no.: Project name: Fogg dram (ma linesrfL _� Page 2
Manufactwed home utilities 110.00
Crass street/directions to job site:
Maahobea 16.60
Rain drain connector ' 16.60
Sanitary sewer (no. linear ft.: ___) Page 2
Stoma sewer (no. Sneer ft.: ) Page 2
Subdivision: no.: service (no. linear ft.: J ) Page 2
Fixture or item
Tax map/parcel no.:
Absorption valve 16.60
DESCRIPTION OF WORK Baddlow precentor Page 2
,_AJ {' Q C./2 LOatSA LitAk.00 - b Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
0 PROPERTY OWNER I 0 TENANT' Ong fountain 16.60
-TOY I 1 e) E E to 16.60
Names Expansion teak 16.60
Address: 1 1 1 r _ • r ".. � " Fixture/sewer e/sewer cap I6.60
City/State/ZIP: "---7 1 £ r •
t G 1 - 1QD - Floor drain/floor siak/hub 16.60
Phone: ( ) (p 3' i 2(03s- Roc ( ) Garbage disposal 16.60
0 APPLICANT ❑ CONTACT PERSON
Hose bib 16.60
I. , Ice maker 16.60
liminess name: ( l S u , I I' n /,. l I nr ��/r� y �� c. _ ImQ, odgease trap 16.60
Contact Dame: ( rnp b cam,++ Medral gas (value: S ) Page 2
Address: r ,PU ! j Primer 16.60
City /StateZIP. "Prn/i n/nd 6 e �i "1 aci <4 Roof drain (oamomerasl) 16.60
Smk/lmam/lav�ory 16.60
Phone ( OS ) Z 3 -. ()C) - 0 : e Tub/shower/shower pan 16.60 I FEE
E -mail: - i - Z [9 - 32,S I lhiaal 16.60
CONTRACTOR Water closet 16.60
Business name , Waterbeater 16.60
Address: Other: 1
City/State/ZIP: Sri
Minimum permit fee:
Phone: ( ) Fret: ( ) Residential baddlaw maxi® permit fee: S362.5 ! 3625 j - -
141 G �S 2 �9� 12 P G Plan review (25% of permit fee)
OCR Lic.: Plumbing Luc na: !" D State sumbarge (8% of permit fee) J a g
S. fix/
Authorized signature' - 4 . -, . / / ` TOTAL PERMIT FEE `7 . "7
Print name: Date: 7 rl Ug � permit application expires if a penult is not obtained within
1//7� I Iy7/ { a ��/J // 180 days after It has been accepted as complete.
f
. v // /1
Z 'd L9Z8 39Z - O09 6uigwnid s .(ese0 eLV :60 90 LO Inf
Case Activity Listing 7/24/2006 2:38:41PM
TIDEMARK Case #: PLM2005 -00296
COMPUTER SYSTEMS. INC.
Assigned Done Updated
Activity Description Date 1 Date 2 Date 3 Hold Disp To By By Notes
PLM2399 Plumbing final 7/7/2005 7/8/2005 7/8/2005 None PASS MRS 7/8/2005 011017 -01 — 503- 253 -0030 -- VM -
STI N
PLM1010 Application received 7/7/2005 None RECD FAX 7/7/2005
BB
PLM1020 Permit created 7/7/2005 None DONE BB 7/7/2005
BB
PLM1030 Check for parcel tags 7/7/2005 None DONE BB 7/7/2005
BB
PLM1280 Issue permit 7/7/2005 None DONE BB 7/7/2005
BB
PLM1740 Case fmaled 7/8/2005 None PASS JW 7/8/2005
JW
Page 1 of 1 CaseActivity..rpt
CITY OF TIGARC
BUILDING DIVISION PERMIT #: PLM2005 -00296
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 7/7/2005
Phone: (503) 639 -4171 /Ng' �4P;�� lit
Inspection Requests (24 Hrs.): (503) 639 -4175 °`'I ..
INSPECTION WORKSHEET FOR DATE: 7/8/2005 TIME: 7:10AM PAGE: 70
SITE ADDRESS: 11100 SW NORTH DAKOTA ST CLASS OF WORK:
SUBDIVISION: TORLAND ESTATES LOT #: 011 TYPE OF USE:
PROJECT NAME: TORLAND
DESCRIPTION: Replacing water piping for all fixtures.
OWNER: TORLAND, MARY HANSON, PHONE #: 503 -639 -2635
CONTRACTOR: CASEY'S PLUMBING INC PHONE #: 503 - 253 -0030
Inspection Request Scheduled For: Date: 7/8/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
399 Plumbing final 011017 -01 503-253-0030 N
Corrections /Comments/ Instructions:
, , l j
i
'7; PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: l i fi l.4 Date? - 0 Phone #: (503) 718 -