Permit CITY TIGARD PLUMBING PERMIT
4 DEVELOPMENT SERVICES PERMIT #: PLM2005 - 00680
DATE ISSUED: 12/8/2005
'- - 13125 SW Hall Blvd., Tigard, OR 97223 503- 639 -4171
PARCEL: 2S 104AD -03501
SITE ADDRESS: 12820 SW WALNUT ST ZONING: R -4.5
SUBDIVISION: LOT: JURISDICTION: TIG
Project Description: Installation of 400 ft. of 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: 400 ft
DISHWASHERS: RAIN DRAIN: ft
Owner: FEES
CHRIS JAM
12820 SW WALNUT ST Description Date Amount
TIGARD, OR 97223 [PLUMB] Permit Fee 12/8/2005 • $194.20
[TAX] 8% State Surcha 12/8/2005 $15.54
Phone : Total $209.74
Contractor:
RESCUE ROOTER
28655 SW BOONES FERRY RD
WILSONVILLE, OR 97070 REQUIRED ITEMS AND REPORTS
Contact # : PRI 503- 869 -2260
FAX 503- 685 -9185
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 By: �� Permittee Signature: (
' cJ7
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.
RESCUE ROOTER 5035859185 12/08/05 12:30pm P. 002
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Plumbing Permit Application roll oI•�ricI; llsi: ONIA
City Tigard O� R �dOMa''04'
/�/ f� .
)' f; �S I Y Date/lly: !v ' I 1 �� Permit Nor \v � W
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13125 SWIIaHIISIvd.'1'iltard,OR 07223 Vi - Ills" Plan Review u. 0�!
Phone: 50).634.4171 1 ax: 5113.59%.19(x0 ® q DV ' -a 1 /,, Oita* l'rr
. Olber No:
24- Hour Inspection Line: 503.630.4175 ,04— r` I j Date Ready /I!y • twist El See rage I for � — --
I Internet www.ci.tigard.ar.us Nadi/ad/Method: U Supplemental Information
i Yrr':( F :`WoRK - , ': ._,,,f;+. F R a,••, N "4 —" DUL.E
. ❑ New construction 0 Demolition For spedallnformar/aa use checklist.
i
Description I Qty. I Ea. i 1 alai
I 7..' Addition/al tcration0eplaccitrcnt ❑ Other: New I- 2 - family dwellings (includes 100 R. for each utility unmcetu,+u
I
CATEGORY OF CONSTRUCTION SFR (1) bath ( ( 244 20
0. I - and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 150 00
❑ Multi- family SFR (3) bath 399 00 I
CI Accessory building _._-.
Each additional bath/kitchen 45 00
❑ Master builder ❑ Other. - . - _ _ --
Fire sprinkler ( u lit. :c l- ) r – - --
10lt SITE INFORMATION ANI) LOCATION - - -
Site utilities
Job site address / ; a v S ,-• 4-ti4't. I„ ti. -I- •S +- Catch basin or arca drain i I (' 60 •__ -__
City /State /ZIP: T y . i, Q f' c -) a a 7 Drywell, leach line, or trench drain 16 60 -_
I \ Footing dram (no. linear ft.: ) l'age 2
Suue/bldg /apt- no - I Project name.
. / f 4- Manufactured home utilities 110 0(1
Cross street/directions to job site G ., A (ft { 4 , 4- Q -I-- Vc4- )i Manholes 16 60
I_� d LI r.:; . .54- r Ce. 4- la 1, Rain drain connector 16 60
I Sanitary sewer (no. linear ft.. ) Page 2
` • Storm sewer (no linear It - ) I'age
- ---' - Water service (no. linear ft.. 1 .40C)) I'a =c 2 I /Cr./. ,Z(
Subdivision. 1 Lot no.: _ - -
- - _ - -- Fixture or item
Tax map /paxccl no _ -- Absorption valve i I (. 1,u
DESCRIPTION OF WORKC f ( l3acktlow preventer 1'• tic 2
-
Armen C-! C r) • c.-"- d C t,.�.4.71- I C 12.0.1' + v t, „,, T i l l e,A, Backwater valve __ — 1600
Clothes washer 10 00 Dishwasher 16.60
- .:. - , L Drinking fountain 10 - 00
_• PROE'F ili*NER - NI' T E PI ANT ' ', - •�k,.3
Ejectors/sump 1 6.60
Name: L. 1.5 '- -t Expansion tank 16.60
Address: j A a , O 5 1,../'4 L r\ ti 4. 4--(( . Fixture/sewer cap 1 0.00
City /State/ZIP: i , y ,. t r C, op, (I7 .)•�.2 Floordrain/floorsink/hub L_ 16.60
d Garbagc'disposal 16.00
Phone: ( ) Fax: ( ) —
, . Hose bib 16 Oil —
. - • APPLICANT , <. t _ _ ❑ CONTACT PERSON . ': >; -
Ice maker 16 aU _
Business name. P. •QJ L'5 ('. le_60-I -(r+ Interceptor /grease trap 16 tin _
Contact name: I 1 I ma Medical gas (value $ ) Pai'c 2 _ - -
Address: _ �C [l t,r r • I Primer 16.00 '
�Ca��: 5 t 1/ l5 Ch tis - J'' / R.
Roof drain (commercial) l b 601
City/State/ZIP: (..� . 140 ,v + 4,0 6, °t ') (U "7G -- " --
Sink/basin/lavatory 16
Phone: (;yc'CI I SS(r. , - ,) 3 CO Fax' : ( ) (....,C&.)-_,=t I t� . y - - --
- fuh /shorter /shower pan 16.60 ._---
E-maul: Urinal 16 6(1 _
T C ON'CRACTOR - , '„ Water closet I b.60
Business riatl /� �� r Water heater ib 60 , -
.CJc,4C C/U Other: I
Address: Subtotal J 9"1 • a
• 1 City /State/ZIP: Mininiumpcmui 1i r: S72.c0
- - --
Phone: ( 1 Fax: ( ) Residential hackllaw minimum permit (cc: S3a.2 .. - -__-
Plumbing Lie, no.: Man review (25% of 1 s rmit Iit•1 _
CCU Lie.: b
Stale Surcharge BIN. of permit /eel /. Y ( -I
Authori/ed si �_ - / Tom' I'l KiviIT l l t c>' {.7 (
Print name: /J /r-; . Q r e/' Dato. /a /8 j- This permit application expires Ica permit Is not obtained + +iu,in
h _- _ ._ _ IRO Onyx after it has been accepted us complete.
*lee niethodnloet• set by Tri-County Iruildnic Industn St IA ice I tri ,i
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CITY OF TIGARD
•
BUILDING DIVISION PERMIT #: PLM2005 -00680
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 12/8/2005
Phone: (503) 639 . -4171 - 4 Inspection Requests (24 Hrs.): (503) 639 -4175 ..
INSPECTION WORKSHEET FOR DATE: 12/9/2005 TIME: 7:04AM PAGE: 29
SITE ADDRESS: 12820 SW WALNUT ST CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: JAM
DESCRIPTION: Installation of 400 ft. of water service.
OWNER: JAM, CHRIS PHONE #:
CONTRACTOR: RESCUE ROOTER PHONE #: 503 - 869
Inspection Request Scheduled For: Date: •12/912005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
330 Water service 023210 -01 503-793-5156 N
Corrections /Comments /Instructions:
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4 ,j2b ' SS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: / 1 7 2 7 7 I Date: - ' Phone #: (503) 718-