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Permit CITY OF TIGARD PLUMBING PERMIT = COMMUNITY DEVELOPMENT PERMIT #: PLM2008 - 00358 TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 9/2/2008 PARCEL: 1 S134CA -00705 SITE ADDRESS: 11915 SW SUMMER CREST DR ZONING: R-4.5 SUBDIVISION: BURLWOOD NO.3 LOT: 040 JURISDICTION: TIG PROJECT: WAGONER Project Description: Replacing 45 ft. of water service. 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: ft WATER CLOSETS: WATER LINE: 45 ft DISHWASHERS: RAIN DRAIN: ft Owner: FEES WENDY WAGONER 11915 SW SUMMER CREST DRIVE Description Date Amount TIGARD, OR 97223 [PLUMB] Permit Fee 9/2/2008 $72.50 [TAX] 12% State Surch 9/2/2008 $8.70 Phone : 503 -524 -5912 Total $81.20 Contractor: ARS RESCUE ROOTER PO BOX 2830 CLACKAMAS, OR 97015 REQUIRED ITEMS AND REPORTS Contact # : PRI 503- 235 -8784 FAX 503 -491 -2932 Reg #: LIC 127325 PLM 34 -168PB 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 B / , Permittee Signature a�>) 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. FEB -04 -2004 15:18 P.001 Pl Permit Aaalication Building Fixtures $ C� R eceived C/ FOR OFFICE 11SF, ONLY of Tigard 1`� " Date/By' l '� Pennn No.: I q 13125 SW Hall Blvd.. Tigard. OR 9 n IA4_1i 403 , s Phone: 503.639.4171 Fax; 503,598.1960 2 `�O� Plan Review Date/By: Other Permit No.: Inspection Line: 503.639.4175 S - .0 T I C A R D �Qn Date Ready / ■ -- 0 See Pep for I nternet: www,tigard or.gov _ OP P. ` Notilcd/Method: .i ' Supplemental Information TYPE OF WORKC • FEE * SCHEDULE New construction ©�nn . For special information use checkli Descnption 19ty. I Ea. I Total Addition/alteration/rtplacemcnt ❑ Other. New 1- 2- family dwellings (includes 100 ft. for each utility connection) CATEGORY OF CONSTRUCTION SFR (I ) bath 249.20 I. and 2- family dwelling ❑ Commercial/industrial SFR (2) bath _ 350,00 El Accessory building ❑ Multi - family SFR (3) bath 399.00 El Master builder Each additional bath/kitchen 45.00 ❑ O ther Fire sprinkler (_,__ sq. ft.) Page 2 JOB SITE EYFORMATION AND LOCATION Site utilities • Job site address: a 5 Catch basin or area drain 16.60 City /State/ZIP: - 47i ..._ Drywell, leach line, or trench drain 16.60 Suitelbldg. /apt. no.: Project name: G Footing drain (no. linear ft.: ) Page 2 Cross street/directions to job site: Manufactured home utilities 110.00 - Manholes 16.60 Rain drain connector 16.60 Sanitary sewer (no. linear R; ,_) Page 2 Storm sewer (no. linear ft. ) Page 2 Subdivision: [Lot no.: Water service (no. lineal "t D, Page 2 Tax map /parcel no.: Fixture or item - RR Absorption valve 16.60 Pr . DESCRIPTION OF 0 ' • - 8 ackflo w pt4venter p g DESCRIPTION ae 0 n backwater valve 16.60 �T Clothes washer 16.60 Dishwasher 16.60 PROPERTiF O�VNEI TENAtNT Drinking fountain 16.60 Name: Ejectors/sump 16.60 �� � 1 i' ' xpansion tank Address: /T T -rZ.I� ��r P 16,60 . Fixture /sewer cap 16.60 City/State/ZIP: 697 , .: 0 Floor drain/floor sink/hub 16.60 a / ., ( ) Garbage disposal Phone: ( 16.60 APPLICANT' ... CONTACT PERSON Hose bib 1 Business name: ARS dba JACK HOWK IQe � 16.60 Rescue Rooter Interceptor /grease trap 16.60 Contact name: JOYCE DENNIS Medical gas (value; $ _) P age 2 Address: P.O. BOX 2830 Primer 16.60 City /State/ZIP: CLACKAMAS, OR 97015 Roof drain (commercial) 16.60 Phone: (503) 235 -8784_ Fax: : (503) 491 -2932 Sittk/basiMavutory _ 16.6 -- • Tub /shower /shower pun 16.60 E -mail: Urinal 16.60 CONTRACTOR .. .. _ . , Water closet 16.60 Business nimte: ARS dba JACK HOWK /Rescue Rooter Water heater 16.60 Address: P.O. BOX 2830 Other. City/State/ZIP: CLACKAMAS, OR 97015 Subtotal , r Minimum permit fcc: 172.50 � Phone: (503) 235.8784 Fax: (503) 491 -2932 Residential backtlow minimum permit fcc: 13625 -f•40 CCB Lie.: 127325 Q,lumbing Lie. no.: 34-168 P Plan review (25 % of permit fee) �+ Authorized signature: 6�� / State surcharge (12% of permit fcc) 0• M A TOTAL PERMIT F Elm.; I /1)8 Print name: D ate 4/' This permit application expires If a permit is not ub ale r) ! i iil 180 days after It has been accepted as comp *Fee methodology set by Tri- County Building Industry Service Board. r,&olld4Ia Please FA .HACK t 503 - 491 = CITY OF TIGARD BUILDING DIVISION PERMIT #: PLM2008 -00358 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 9!2110+18 Phone: (503) 639-4171 Requests (24 Hrs.): (503) 639 -4175 INSPECTION WORKSHEET FOR DATE: 9/4/2008 TIME: 7:02AM PAGE: 26 SITE ADDRESS: 11915 SW SUMMER CREST°DR CLASS OF WORK: SUBDIVISION: BURL WOOD NO.3 LOT #: 040 TYPE OF USE: PROJECT NAME: WAGONER DESCRIPTION: Replacing 45 ft. of water service. OWNER: WAGONER, WENDY • PHONE #: 503524.5912 CONTRACTOR: ARS RESCUE ROOTER PHONE #: 503235 - 87134 Inspection Request Scheduled For: Date: 9/4/2008 Pour Time: Code # Inspection Description Confirm # Contact # Message 330 Water service 075018 -01 503-235.8784 Y Corrections /Comments /Instructions: C?a,re, Jt�.JG -,% y1/. PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS ❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: c1\" ) COT11.14 --4.- Date: i (4 ) Phone #: (503) 718-