Permit CITY TIGARD PLUMBING PERMIT
DEVELOPMENT SERVICES PERMIT #: PLM2005 - 00135
��� - 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 4/7/2005
PARCEL: 2S 103DA -06300
SITE ADDRESS: 10920 SW PARK ST ZONING: R -4.5
SUBDIVISION: MIRA PARK LOT: 001 JURISDICTION: TIG
Project Description: Replace water service.
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: 60 ft
DISHWASHERS: RAIN DRAIN: ft
Owner: FEES
WOLFRUM, J T DELANE AND
ALICIA Description Date Amount
10920 SW PARK ST [PLUMB] Permit Fee 4/7/2005 $72.50
TIGARD, OR 97223 [TAX] 8% State Surcha 4/7/2005 $5.80
Phone : Total $78.30
Contractor:
WOLCOTT PLUMBING CONTRACTORS
1075 W HISTORIC COLUMBIA RIVER
TROUTDALE, OR 97060 REQUIRED ITEMS AND REPORTS
Phone : 503- 667 -1781
Reg #: LIC 23847
PLM 26 -208PB
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: SQ (�\n
Y�
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.
04/07/2005 07:39 5034912932 JACK HOWK PAGE 01
P1umbin2 Permit A m ! 11Cation Fait Ol H 1(: 1`. uSE taf\ t.l
City of Tigard j i' ,- 7 - Permit No 1 � 8 '� 13125 SW Hall Blvd, Tigard, OR 9 Phase: 503.639.4171 Fax 503.598.1' . 1 ; ±; Plug Reviser
{ Date/BY: Other Permit No.:
24- Hour Inspection Line: 501639.417 J ( Dale Ready/By: p1 Page 2 for - --
Internet www,ettigard.or.us NatifedlMetbod: / Sa pleutente In
Th •E OF WORK FRE* SC'RF.DLTLF
❑ Now construction ❑ Demolition Forspeclallnfnnmmaliomm use checklist.
,�✓ Descri . on 00. tea. Total
�7 Addition /altcrotion/replacement ❑ Other: New I- 2- family dwellings (includes 100 ft. for each utility connection)
C,'ATEGORI' OF CONSTRUCTION SFR (1) bath 249,20 I
g 1- and 2- 11anity dwelling ❑ Commercial /industrial SFR (2) bath IIII 350.00
❑ Accessory building ❑ Multi - family SFR (3) both 399.00
El Master builder w ❑ Other
Each additional bath/kitchen 45.00
Fire sprinkler (_ , sq. it) Page 2
JOB SITE iNFO • LATION AND LOCATION Site utilities MEM
lob site address: a0 /„q i 4 / -. _ Cntah basin or area drain MIMI �
City/State/DR /1 64,20 Gf ,70 Drywall, leach line, or trench drain _ 16,60 I=
Suite/bldg./apt no Proj name: i/Vd � / Ai Footing drain (no. linear ft: _ _) lin Page 2
I
Cross street/directions to job site: Manufactured home utilities 110.00
Manholes 16.60
MINIMIIIIIIIIII r Rain drain connector 16.60
��` Sanitary sewer (no. linear ft.: - ) Page 2
Storm sewer (no, linear R.: Page 2
Subdivision; Lot eo.: Water service (no. linear (1.7 '0 Page 2 1,
Tax map/parcel no -: r'. 5 � .-- Fixture or item
Absorption valve 16.60
DFSC • ON OF WORK Hnckflowpresenter Paget
— , titse / — 4 y Backwater valve 16.60
Clothes washer 16.60
Dishwasher .,
11123=31111.1 ❑ TENANT Drinking fountain . � 6.60
L/ / I��G �iectors/sttrnp . $gir y 16.60 MIMI
Name: Pie be Expansion �� r 16.60 r -
Address: P /,. 0 W 1, i : s r' Fixture/ • • W r ri 0 ff r '.60
Cit -ti e - / / 0 07p?0 i Floor drain/ sink/hub ` �O r 16.60
Phone: ( Jj �� r / : ( ) Garbage disposal = l / V� 16.60
�#1'Pi.!wANT ❑ CONTACT PERSON Hose bib • V � � ;,
ice nmker F jr
Business name: Wolcott Plumbing d . Jack Howk Plumbing tut or/ Trifr F.I!Mill 16•60
Contact name: if /r 4190 ^) S Medical gas (value: $ ) Page 2 IIII
Address: 1075 W Historic Colombia'' Iver Hwy Primer 16.60
City /State/ZIP: Troutdale, OR 97060 Roof drain (commercial) 16.60
Phone: (503) 235-8784 ( Fax: : (503) 491-2932 Sink/basin/lavatory 16.60
Tub/shower/shower 16.60
E -mail' Urinal 16.60
CO • (TOR Water closet 16.60
Business name: Wolcott Plumbing d . a Jack Howk Plumbing Water heater 16.60
Address: 1075 W Historic Columbia fiver Hwy Other,
City/State/ZIP: Troutdale, OR 97060 Subtotal Was`
Minimum permit fee: $72.50
Phone: (503) 235 -8784 Fax (503) 491 4932 Residential bsdcflow minimum 't feu $36.25 IIMM
CCB Lic.: 23847 Plumbing Lie. no.: 26-208 PB ' ' "
'' State surcharge (8% of permit fee) I �j ��
Authorized signature: _ � I TOTAL PERMIT FEE . �` %��+/�
- Print name: 149 ' Date: D4) / 7G. This permit application expires if a permit is not o , :' ,, , •
180 days after it has been accepted as cons ., M.
*Fee methodology set bv'Tri .County Halldina industry • ervice Board.
CITY OF TIGARD
BUILDING DIVISION A � ! PERMIT #: e li os-ao1
13125 SW Hall Blvd., Tigard, OR 97223 D ATE ISSUED:
Phone: (503) 639 -4171 b rpolryir �Y �
Inspection Requests (24 Hrs.): (503) 639 -4175 -.1.4- I I
INSPECTION WORKSHEET FOR DATE: L /A/IS c TIME: 11 PAGE:
SITE ADDRESS: i O _ l vU ' Pie t CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME:
DESCRIPTION: In J ��
OWNER: I ' D 1 C ( � KA 1 `� i b-A �1'� PHONE #:
CONTRACTOR: Vu D I G6'� PHONE #: L p67) - 1 1
Inspection Request Scheduled For: Date: Pour Time:
Code # Inspection Description Confirm # Contact # Message
33 D U.1 Pte- cOr ui
3ci G - t- 1`sa.'
Corrections /Comments/ ns ructions:
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PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Date: 4 /O O � Phone #: (503) 718-
CITY OF TIGARD
BUILDING DIVISION 7 PERMIT #: PLM200500136
I 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 4/7/2005
Phone: (503) 639 -4171 :!v�tlh ��bkp ijh'I
Inspection Requests (24 Hrs.): (503) 639 -4175 W %.!.. / 6 51
INSPECTION WORKSHEET FOR DATE: 4/8/2005 TIME: 7:10AM PAGE: 85
SITE ADDRESS: 10920 SW PARK ST CLASS OF WORK:
SUBDIVISION: MIRA PARK LOT #: 001 TYPE OF USE:
PROJECT NAME: WOLFRUM
DESCRIPTION: Replace water service.
OWNER: WOLFRUM, J T DELANE AND, PHONE #:
CONTRACTOR: WOLCOTT PLUMBING CONTRACTORS PHONE #: 503.667 - 1781
Inspection Request Scheduled For: Date: 4/8/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
330 Water service 004104 -01 603-236 -8784 N
Correct ns/Comments/Inst uctions: 1
71 � J� �=✓ Cre--x..---t- C� W \ krS 6.-0
1ti a S cam- C' (N/‘ a"----A-/ 0 ✓&-
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to C 3 R_S2_ ,:mac •
❑ PASS [.PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: \\ Lk_ Date: 4/ " 1 Phone #: (503) 718 - (f-2_, Z