Permit "C ITY OF T PLUMBING PERMIT
�rt,'� DEVELOPMENT SERVICES PERMIT #: PLM2005 -00193
ja1, •I II 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 5/5/2005
PARCEL: 2S102CC -01000
SITE ADDRESS: 13660 SW PACIFIC HWY ZONING: C -G
• SUBDIVISION: FIR GROVE VILLAGE LOT: JURISDICTION: TIG
Project Description: Sewer service repair, approx. 10'.
CLASS OF WORK: OTR GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: MF WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: R1 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: 10 ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Owner: FEES
KU BIN CARON Description Date Amount
520 SW 6TH AVE #400
PORTLAND, OR 97204 [PLUMB] Permit Fee 5/5/2005 $72.50
[TAX] 8% State Surcharl 5/5/2005 $5.80
Phone : 503 639 - 7779 Total $78.30
Contractor:
APOLLO DRAIN + ROOTER SERVICE
2208 NW BIRDSDALE #8 REQUIRED ITEMS AND REPORTS
GRESHAM, OR 97030
Phone : 503- 239 -8801
Reg #: LIC 49418
PLM 26 -533PB
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 -00 I i i ! hrough OAR 952 - 0001 -0100. You may obtain copies of these rules or direct questions to OUNC by
callin:. 503 - 246 -6: • •: 1 - :00- 332 -2344. , 1
Issu • d By: _ �• Permittee Signatu. a ,�l;�l%r�/I/�� ,
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.
FROM APOLL0 DRAIN 503 - 669 - 9568 (THU)MAY 5 2005 15:35/ST.15:34/No.6812889136 P 1
PlumWn Permit A 1 [ ��r� \ \l V r1\'ED I t)I2 1)11 11 1 l `.I ()NI 1
City of Tigard L eived 5 �� "
Plan Review ]�7 ° I 0. s
1 3125 S W 14x11 Blvd., Tigard, OR 97223 (/� I r ��'
Phone: 503.639.4171 Fax: 503.598.1960 Li p 5 200 ,�,:� A i nae/By y Other Permit No.:
24- Hour inspection line: 503.639.4175 i •/ 1 I Mae RetIdY1 la See Pane T fur
t. www.ci.tigard.or.us Y OF T`G
Intern A'I• _" __ Nail'md/Metlud: / 1 1I .. Supplemental reformation
(4irj11ji7c1 � y r,,.:Y� y r f•l'� . ). . �, (� 1 ,� Sri ^�e � �rr`i za . �, a AA; '� J,s y i ��+:y?
• h[ ' - iiw 0 32 ? f r `ti::;an , 1 S N t n t.l ' ° r or t 1 i :, { ' 1 i ,1,`: � l . °1 !. i :
w v •;� , ' - 41 �. ' ty .
!L,W .,,uluux,.. :..rasl.,c N;, ..^. T }' _ 1,�. 1 f•, a.n r SQu;.nt, :.b.il av� !isi �' k . :1 f ':y •'",�, .h... GM �1S r.ti!C, .::u6,rt..wL': , .rr.di:r. 7.a, .1 ,.7 r .
❑ New construction ❑ Demolition _ ForeCal Information use checklist
Description 1 Qty. I P.a. I Total
A Addition/alteration/replacement ❑ Other: New 1-2-family dwellings (includes 100 ft. for each utility connection)
•'JJ X • r •f�'r AIf�TvS: r �e�• ,,W i.J.. 79.6. N ) �r ;y)71 e - .+s.� rn+ sr av
SFR(I)bath 249.20
: ; 'sa r a'f �t L( > 1 )' �' 1 ` 71, 7n 3'
`: i lj : t . dir ; v ;M t . �)r ? /,g, 1' / t " , ; I +ir r i , i �ti 4 VII:Y r y �.a:'
. tc,... .! w;l a-. :�'r n �. a uix,vi. K„ r . c } • .: 9.,.+...• , .J,- . ,i. .. ,
❑ 1- and 2- family dwelling Commercial /industrial SFR (2) bath 350.00
Accessory building SFR (3) bath 399.00
❑ ry g ❑ Multi family .
Each additional bath/kitchcn 45.00
❑ Master budder ❑ Other
a ; ;; a'1 . r$, ar f'.,�. r < 4 tt'a42kr r .. tr r�i' ".
Fire sprinkler (_ sq. R•) Page 2 -
, vo• X ,.i�1,.�iuli. i r.ik r ii:ze' < " xralgro . s:i.. t i n±!eati`trf";C:4 '. : 3a iit.e,itew � 'v w: ..aldi Slte utilities
Job site address: I y u,Q , pax_14 0 p'SJ1.71 1 7 Catch basin or area drain 16.60
City /Staie/ZIP: Pa -l4.vl of 012 ql 22 3 ' Drywcll, leach line, or trench drain 16.60 _
Footing drain (no. linear ft.: ) Pagc 2
Suite/bldgJapt. no.: I Project name:
Manufactured home utilities 1 10.00
Cross strcet/directions to job site: I Manholes I6.60
Rain drain conncctnr 16.60
Sanitary sewer (no. linear ft.: LO._) ( Pagc 2 5 5 , -
Stonu sewer (no. linear ft.: ) Page 2
Subdivision: I Lot no.:
water service (no, threat ft,: Pagc 2 I ----
'1 ax map /parcel to Fixture or item
� r
[ > �"a t a r to , y .� u n X 11 AL , , t•r r hr x ,ra r,- 7r n - , ' w fA ryy Absorption valve 16.60
. ,17,-,-. ` .. •3 ' f �` . h r nr : ..: S ......'... M . 1 • ) l. ' , • � T;; / . $ c ,,; ';.•'0' t il. I, ,:'. 1 ^F} "•, ,:":,..,e,,, r :) r 1 s liackfluw preventer Page 2
Sewer s es%1 i"( r, rt pc .. ( Backwater valve 16 -60
Clothe.+ washer 16.60
Dishwasher 16.60
Q �*ln7 ^'+ • r r^ rtu 7•+s.r1a ! w 1 . rs . ^''itl K ""• SIPL^ "�,p� I. : i : g tf il, ;t,,�," : ntrin 16.60
M9 r { ∎ � 4 r i ri r r 5 );• r .. "l. , ` rI i.F 4? rr1 ul , r � . ..w
':�..oT. ^:r..::l...rark._n rts , {! 1 ! >xtx. ti iii; iw` tsd , '
4 .'�as4 +.r.rt�s,;annr d. ,.. G.��,..).+,. hAU, �� }rt ' Drinking fuue F..je tolsfeump 16.60
Name; f.1 1r9 rt�V G V 1 (l ()lq � - 1-k tf k N 5 "\ _ Expansion tank 16.60
Address: Fixture/scwcr cap 16.60
City/ Statc /ZIP: Floor drain/floor sink/hub 16.60
Phone: ( • ) , 9 - 7 ' Fax: ( ) Garbage disposal 16.60
EMI, { f; )I � : { �')rt 1i�1i+�� Yo111'V'�•t;0 ro y, 1 ' t , ' e P r . r. ti .,:tP ?p: Hose bib 16.60
7 �.�r. .. r`rs.n�, . 'v:.✓ Lr: r5�.l . et + � 1 l ; +., 4� . ;.r„c.,L „n.t o 7 , a rkxreu.... !cc maker 16.60
business name: Interceptor /grease trap 16.60
Contact name: Medical gas (value: S ) Pagc 2
Addre55: Primer 16.60
Ci ty /Sta;c/ZIP: Roof drain (commercial) 16,60
Sink/hasin/lavatory 16.60
Phone: ( ) I Fax:: ( ) Tub /shower /shower pan 16.60
E -mail: --
r r Urinal 16.60
Q •: •Si niy�� y� �� �^�4 �` 'n�i" txT6",N , �B•�•f cf' �I,j �.,.�t l�il�s � ` 7�+'�i [ i °i +: '3 ,
? ,, .. zk::�k..:iit ..:i g ^ k'17!2 -Ii : . SRS. "t gaTis e,,.l0s; : i - pim a closet 16.60
Business name: Q (.0 OrQA1 - Watcr heatcr 16.60
Address: . 1: ,L _SdCLIG °1}7er.
Subtotal
City /State &vc Sh0..w 910 30
Minimum permit fee: S72.S0 - 2. s�
Phone: ('50 31 2,3Oi - g b3 1 Fax: (503) (3q -q 5io si - Residential backtlow minimum permit fee: 536.25 .
CCB Lic.: 4°t4 I. % Plumbing Lk. no.: u4. 533 P)3 Plan review (25%ofpermit fcc) r �
Authorized signature: ♦� ,J�Q,IIyQf.. State surcharge (8% of perrnit fee) 5 . b v
TOTALPERMITFEE 2
Print name: (1 V) iskue to he r Date: 5 - 5_1 This permit application expires if a permit is not obtained within
180 days after ii has been accepted as complete.
•Fcc methodology set by Tri - County Building industry Service Bo.
is u„,,.„IL \PCmina\PL.M- HtanrtilA , „,.. 1201 440.4616T(10/02COM/WED) 78 v
• CITY OF TIGARD ''
BUILDING DIVISION PERMIT #: PLM2005 -00193
, 13125 SW Hall Blvd., Tigard, OR 97223 D ATE ISSUED: 6
Phone: (503) 639 -4171 Insection Requests (24 Hrs.): (503) 639 -4175 - :_..
INSPECTION WORKSHEET FOR DATE: 5/16/2005 TIME: 7 :09AM PAGE: 65
SITE ADDRESS: 13660 SW PACIFIC HWY CLASS OF WORK:
SUBDIVISION: FIR GROVE VILLAGE LOT #: TYPE OF USE:
PROJECT NAME: FIRGROVE VILLAGE
DESCRIPTION: Sewer service repair, approx. 10'.
OWNER: KUBIN CARON; PHONE #: 503- 639 -7779
CONTRACTOR: APOLLO DRAIN + ROOTER SERVICE PHONE #: 503- 239 -8801
Inspection Request Scheduled For: Date: 55/16/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
505 Sanitary sewer 006893 -01 503-519-8488 Y
Corrections/Comments/Instructions:
,GAL 0/ A ft
/ 4 r
.A , f • // Wi t/
V
. C a'2'rj7 ■
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Date: l /� 11/ Phone #: (503) 718- E
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