Permit 1
CITY TIGARD PLUMBING PERMIT
„AN DEVELOPMENT SERVICES PERMIT #: PLM2005 -00196
`�'�' c �' I 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 5/9/2005
PARCEL: 2S103CB -08300
SITE ADDRESS: 12373 SW QUAIL CREEK LN ZONING: R -4.5
SUBDIVISION: QUAIL HOLLOW - EAST LOT: 032 JURISDICTION: TIG
Project Description: Install sump pump.
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:
TUBISHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Owner: FEES
SHIN, DONG -EUN
12373 SW QUAIL CREEK LN Description Date Amount
TIGARD, OR 97223 [PLUMB] Permit Fee 5/9/2005 $72.50
[TAX] 8% State Surcha 5/9/2005 $5.80
Phone : Total $78.30
Contractor:
APOLLO DRAIN + ROOTER SERVICE
2208 NW BIRDSDALE #8
GRESHAM, OR 97030 REQUIRED ITEMS AND REPORTS
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 - 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:, ®v p. e
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 APOLLO DRAIN 503 - 669 -9568 (MON)MAY 9 2005 13:07/ST. 13:06/No. 6812889152 P 1
°� Building Fixtures . e D
Plumbing Permit a G
City of Tigard R0CC;ed T V)-- Permit No.: \ �+
1 3125 SW Hall Blvd., Tigard, OR 9722% l 1 0 9 2.C1 1� piss Review ' 7 � O � ` �
Phone: 503.639.4171 Fax: 503.598.1 • 0 Da g Other Permit No.:
24 Hour Inspection Line: 503.639.41 TY OF T IG �� � . i 1 Date Ready/BY luris ® see Page 2 for
Internet: wvnv,ci- tigtud.or.us ' , DIVISI t • Nob6ed'Metbod: j 1i Supplemental Inreretatioe
� ', i , .'w r e ' 616' rq '. • ". t, 1;'Vrii:: . ^ r... i.5 �,.r r r.,,.+ . - i 7.....
,.'7r �.S: •vl•T . 1 .4alti.. :r: ... 'tl''it•.. . pev7• w Kn :..i �. -. ,• "",�! " i ..
New construction ❑ Demolition For special in ormarion use checklist.
Description I Qty. I Ea, I Total
/4 Addition/alteration/replacement ❑ Other: New 1.2- family dwellings (includes 100 ft. for each utility connection) •
r ,.,', , +�i � -ri n i� : �I 1 . if' Z ro[11kF 7�� S}eR (1) bath 249.20
rdi 1- and 2 -family dwelling ❑ Commercial/indu5trial SFR (2) bath 350.00
❑ Accessory building 1:1 Multi-family SFR (3) bath 399.00
Each additional bath/kitchen 45.00
Q Master builder • ❑ Other: .
Fire sprinkler ( sq. ft.) Page 2
.. : : v. cm. - ' n l: • • ° ..$ ;`- t a rp • .1 -- - • � , . � .,. " x I Fd, r ,1 1 Site utilities
lob site address: I B C,L4 Q uCl l C r Lin Catch basin or area drain 16.60
.
City /State/LIP: Q 9-172,5 Drywell, leach line, or trench drain 16,60
Suite/bldg. /apt. no.: rQ Project name:
Footing drain (no. linear ft.:, ) Page 2
t\ JJ Manufactured borne utilities 110,00
Cross street/directions to job site: Manholes 16.60
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 ft.: , ) Page 2
- Fixture or item
Tax map/parcel no.: •
Absorption valve 16.60
i q k ,: •r ...r ' Y
- ' 1 y , 4..,...-•. ( fi t y":'t,�..•,a -1 P FM",..,,,,
•
; I' 1.% . ' . li'104y,. 41. '.: 0 . .a a . :i 4 e !' � .1 . � • �,.4 a i:l• k, r.sz- � Backflaw preventer ' Page 2
In &4 a 11 Ski wk.() (1 u-kn l' • Backwater valve . 16.60
V t' N Clothes washer 16.60 .
_Clothes
16.60
�., y � }g'[���"r(t,• � .v,,^ ,. f•' •� Drinking fountain j•
IG -60
;: Y.yr 7 4r�:. .,.J •1 li , '}i�{lrT'i�7ar�cc 7rC 'yam �.. ,v, E j ectors /sump l 16.60 M-ZA0
Name: S\,...: ' , r\q (._,44,,..„,„,,,..5 J , Expansion tank (6.60
Address: J Fixture/sewer cap 16.60
City /StawZrP: Fluor drain/floor sink/hub 16.60
-
Phone: (• ) . , . � Fax: ( ) Garbage disposal 16.60
,.•.,p 'or '. x a�t v S�lt' r � W A s; ,: Hose bib 16.60
I !.' i. t'.. -- - ,.. ^ _ ` _ ! fi b ? .. � - ; . y ► , .: , fi , - - a , Ice maker 16.60
Business name: interceptor /grease trap 16.60
_ -
Contact name: Medical gas (value: S ) Page 2
Address: Primer 16.60
Roof drain (commercial) 16.60
City /Statc/ZIP; _ Sink/basin/lavatory • 16.60
Phone: ( ) Fax: : ( )
Tub /shower /shower pan 16.60
'
E -mail: Urinal 16.60
",icy t; Q'`):.'J: . •r1,.a'i. .; v- �' a i �, , r _ :
•;,: ,��.i....;...• ��'���' � � • � � :.,e.,. � � � ��:�.A,: '., is Water closet iG.tiO
Rosiness name:
Apo l to 1)� in Water heats 16.60
�. Other:
Address: . 2 'Z U 1 �� D�( t�sci Q lc 4 g
City /State/Z)P: C --yes h (-w Om- c1- 10 30 .CC 'I ri-Co 04 t1ck1 Subtotal -
Minimum permit fee: $72.50
Phone: (%3) 13q- 3-Fs I Fax: ( ) Late 1, -CIS (0 6 V Residential backflow minimum .omit fee: $36.25 7_
CC13 Lic.: 4 co Plumbing Lic. no. :Zip - r 3 3 P Q Plan review (25% of permit fee)
State surcharge (8% of permit fee) 10
Authorized signature: 1 L ' ,1,ithrl t„ TOTAL PERMIT FEE -7 3d
reri nl name: 1 4 () 1 fl r I Date: -, This permit application expires if a permit is not obtained within
180 days after It has been accepted as complete.
'Fee methodology set by Tn- County Building Industry Service Board
i.•.Duildine.PtrnuuU'L Permi/4ppAix: I 2JO1 440.461611te/02/COM/WGa)
• CITY OF TIGARD
BUILDING DIVISION PERMIT #: LM2005 -00196
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: P 5/9/2005
Phone: (503) 639 -4171 / ,usi�„Il ` i t
Inspection Requests (24 Hrs.): (503) 639 -4175 . -!!�i °'�
INSPECTION WORKSHEET FOR DATE: PAGE:
6/1W2005 TIME: 7 :16AM
SITE ADDRESS: CLASS OF WORK:
SUBDIVISION: 12373 SW QUAIL CREEK LN LOT #: TYPE OF USE
PROJECT NAME: QUAIL HOLLOW - EAST 032
DESCRIPTION: SHIN
Install sump pump.
OWNER: PHONE #:
CONTRACTOR: SHIN DONG -EUN PHONE #:
APOLLO DRAIN + ROOTER SERVICE 503-239-8801
Inspection Request Scheduled For: Date: 5/10/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
395 Misc. inspection 006498-01 503. 239.8801 N
Corrections /Comments /Instructions: S,'l
/
1
4 ,1fi (
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
b
Inspector: ! D GS Date:'2) Phone #: (503) 718 -