Permit If
.CITY OF TIGARD PLUMBING PERMIT
A DEVELOPMENT SERVICES PERMIT #: PLM2005 -00402
A11 DATE ISSUED: 8/22/2005
13125 SW Hall Blvd., T igard, OR 97223 503 - 639 -4171
PARCEL: 2S 111 AC -02500
SITE ADDRESS: 09110 SW PINEBROOK ST ZONING: R -4.5
SUBDIVISION: PINEBROOK TERRACE • LOT: 066 JURISDICTION: TIG
Project Description: 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: 45 ft
DISHWASHERS: RAIN DRAIN: ft
Owner: FEES
MAYER, JAMES C E J Description Date Amount
9110 SW PINEBROOK ST
TIGARD, OR 97223 [PLUMB] Permit Fee 8/22/2005 $72.50
[TAX] 8% State Surchari 8/22/2005 $5.80
Phone : 503 639 - 9594 Total $78.30
Contractor:
WOLCOTT PLUMBING CONTRACTORS
1075 W HISTORIC COLUMBIA RIVER REQUIRED ITEMS AND REPORTS
TROUTDALE, OR 97060
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 - 246-66 or)-800-332-2 4.
Issued By: �� ��e4 .4 776/ J Permittee Signature 4
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, :
FAX NO. :5036679891 Aug. 21 2005 10:13AM P1
Pc
- .. A •
'C •
Plumbin . Permit A • c.ii ' .ati NED FOR 01.1 ; I,S1:. ONl.1'
City of Tigard R , 202 / 0 , 5 t g . parini,Nok 2 , 01 _ o
13125 SW Hall Blvd., Tigard, OR 97223 ' p 2, 2. 20 A Plan Review
Phone; 503.639.4171 Pax: 503.598.1960 /1,49.N, Dan/fly: (Mar Pcnnit No.:
24 - I lour Inapection Line: 503.639.4175 b Ready/13y: •
Internet www.ci.tiord.or.us v"/ Of 11G A r. 014 ' '
Notified/Method: d . rupplem f lZformatian
,.. DNISION
T1TE 131$111Mit: PPP SC't e• VIM
0 New construction 1:1 Demolition For s edit! 1 ormation me checklist
,Roscrirrtion 9 Na_ Total - .. - .
Od d ition/altoration/rcplaccmcnt 0 Other: - I - 2 dwellings (includes 100 It. liar each utility connection)
............, _____ ...„........ ...... -- _.....
CATEC.:ORY OF C.'ON.STItliCrilON SFR (1) bath 249.2(1
2-family dwelling El Commercial/industrial PR (2) bath 350.00
SFR (3) bath 399.00
0 Accessory building 0 Multi-family
Each additional hath/kitchen 45.00
0 Master builder 0 Othcr.
Fire sprinkler ( sq. ft.) Page 2
JUR Srfft thiFORALATION AND 1A/CX1'10Pi Site utilities
Job site address: q 1 c u.) ..k... Catch biotin or area drain 16.60
- ---
City/Suite/ZIP: . . Drywall. leach line, or trench drain 16.60
. --
Suite/bldg./apt no.: P ; t . no. roux ,
- --. name. ke;(2.__ tooling drain (no. linear ft.: ) Page 2
Manufactured home utilities
Mea
110.00
Cross street/directions to job site:
Manholes 16.60
Rain druin connector 16.60
141 ( 10ki ' Sanitary sewer (no. linear IL: ) Page 2 , ..... •
Storm aewer (no. linear ft.: Page 2
- .
Subdivisinn: Lot no.; • Water service (an, linear tt.:
Pogo 2
Fixture or Item
'fax map/paroe pSS--.66, ,. -
Ahsnrption valve 16.60
DESCRIP'r1ON OF WORK -
Backnow prevatter Page 2
L IS P ±vvxLuk - ce. ji„
Backwater valve 16.60
Clothes washer - ..,
Dishwasher 16.60
OPERT V ( MN Elt
Nome: ) 01 . A. ..a‘ D
*
31-J
.. I 1:1 TENANT
. .. .,..
rinking tbuntain 16.60
illectorskuma
Pxpansion tank
16.60
16.60
. -
Address: i...1 VP
ed II, ( ... .. Fixture/sowor cap 16,60
City/State/ZAP; k 4 ■ 6 • Floor drain/floor sink/hub 16.60
• esi v
dr Garbage disposal . 16.60
Phone ip (P.I_ - Fax; ( )
)7. APPLICANT 0 C Hose bib 16.60 PERSON -„
Ice maker 16.60
Business name: Wolcott Plumbing dba Jacic Howk Plumbing -' --
Inter
Contact name: ia1 Aea ceptor/greane Imp 16.60
Medical gas (value: $ ) El
Page 2
Address; 1075 W Historic Columbia River Hwy Primer 16.60
-_.,-
_.
City/S(ndZIP: Troutdale, OR 97060 Roof drain (commercial)
16.60
Phone: (503) 235 Fax: : (503) 491 • Sink/basin/lavatory 16.60
Tub/shower/shower pan 16.60
17,-mail: .
Urinal 16.60
,. .
CONTRACIOR Water closet 16.60
Business name: Wolcott Plumbing dba Jack Howk Plumbing Water heater 16.60
. .. .
Address: 1075W Historic Columbia River Hwy Other
- - - -....... . .-- . . . Subtotal "
City/State/7P; Troutdale, OR 97060 __
-, - • Minim= permit fcc; $72.50
Phone: (503) 2354784 Fax: (503) 491-2932 Residential hackflow minimum permit foe; $36.25 44 11,
CCB Lic.: 23847 r Plumping Lic. no.; 26.208 PR Plan review (23% of permit fcc) 11111111”1111_
State surcharge (8% apt:emit fee)
Authorized signature; '
TOTAI. PF,RMIT FE t - 10
. , II. `4....-
[y' natne:efbn t t&fyr1 i Datee)-2 Thia.permit application expires if a permit is not °triable
180 days after it has been accepted as complete.
*Fee methodoloav act by Tri.County Building Industry Service Board.
.
CITY OF TIGARD ,_
BUILDING DIVISION PERMIT #: PLM2O05 -00402
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 8/22 /2005
Phone: (503) 639 -4171 lei
Inspection Requests (24 Hrs.): (503) 639 -4175 .- ° 'I I�
INSPECTION WORKSHEET FOR DATE: 8/24 /2005 TIME: 7:08AM PAGE: 48
SITE ADDRESS: 09110 SW PINEBROOK ST CLASS OF WORK:
SUBDIVISION: PINEBROOK TERRACE LOT #: 066 TYPE OF USE:
PROJECT NAME: MAYER
DESCRIPTION: Water service.
OWNER: MAYER, JAMES C E J, PHONE #: 503 - 639-9594
CONTRACTOR: WOLCOTT PLUMBING CONTRACTORS PHONE #: 503- 667 -1781
Inspection Request Scheduled For: Date: 8/24/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
330 Water service 014197 -01 503-235-8784 Y
Corrections /Comments /Instructions:
•
14 PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Q"d 1 xA--A• kI rt---a- Date: 3'121-0.3r Phone #: (503) 718-