Permit CITY T I G D PLUMBING PERMIT
COMMUNITY DEVELOPMENT PERMIT #: PLM2007 - 00283
T[GARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
DATE ISSUED: 7/2/2007
PARCEL: 2S111CC - 17800
SITE ADDRESS: 10360 SW HIGHLAND DR ZONING: R -
SUBDIVISION: SUMMERFIELD NO.4 LOT: 229 JURISDICTION: TIG
PROJECT: GREWENOW
Project Description: Replace bath fixtures and add water line to refrig.
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: 4 OTHER FIXTURES: 1
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Owner: FEES
MELISSA GREWENOW
2338 HILLSIDE LN Description Date Amount
LAKE OSWEGO, OR 97034 [PLUMB] Permit Fee 7/2/2007 $83.00
[TAX] 8% State Surcha 7/2/2007 $6.64
Phone : 503- 803 -2385 Total $89.64
Contractor:
GRAVITY PLUMBING
14935 S GREEN TREE DR.
OREGON CITY, OR 97025 REQUIRED ITEMS AND REPORTS
Contact # : PRI 503- 490 -0763
FAX 503- 650 -3866
O
Reg #: LIC 171 135
PLM PB173
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 9 2 -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
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.
Jul 02 07 07:39a Jon Hinkle 5036503866 p.l
CAitt b j i k Plumbing Permit Application
• Inspection Request: 503 -846 -3699
; . 7 mr ti 503- 846 -3 470 , Fax: 503 - 846 -3993
t � 155 N. 1 ' AV, Suite 350 -12, Hillsboro, OR 97124 www.co.washington.or.u
oR "o4 Land Use Approval: Project # Permit # Pi-v , a C2 07 _ 0 ? 3
TYPE OF WORK FEE* SCHEDULE
For special information use checklist.
❑ New construction I ❑ Demolition Description I Qty. I Ea. i Total
❑ Addition/alteration/replacement ❑ Other: et f) C FYc lire New 1.- 2 family dwellings (includes 100 8. on
for each utility connection)
CATEGORY OF CONSTRUCTION \ SFR (1) bath 318
Co mmercial/industrial SFK (2) bath 408.00
I- and 2- family dwellirtg 49800
❑ M ulti - family SFR (3) bath
❑ Accessory building Each additional bath/kitchen 90.00
❑ Master builder 0 Other. Fire sprinkler (# sq. R) 'BOO e.
JOB SITE INFORMATION AND LOCATION Site utilities
Job site address: r i n 3 ( p Q � ipr - y'_ 02 Catch basin or area drain 14.50
T ( � l(i \ NI ei -422 Dry well. leach line. or trench drain 14.50
City/State/ZIP: « �(� /rtA/\4 ter \ f ^ ` .
Project / Footing drain (each 100 ft): 8 nfft. 42.00
ect name:
Suite/bldg./apt. no.: I J Manufactured home utilities 96.00
Cross street/directions to job site: -
Manholes 14.50
Ad. ittn.`, + r 2 - / 0 • Rain drain cnanector 14.50
` Sanitary sewer (each 10011.): 8 of ft. 42.00
Storm sewer (each 100 ft.): it of ft_ 42.00
Water service (each 100 ft.): 11 of ft. 42.00
Subdivision: Lot no.: -
Future or Item
Tax map /parcel no.: Absorption valve 14.50
DESCRIPTION OF WORK Backflow prevcnter 14.50
( _ 1 N \[) (\Gly Backwater valve 14.50
Z S- I ( f )( Z/ Clothes washer 14.50
Dishwasher 14.50
l -C-1 Drinking fountain 14.50
Ejectors/sump 14.50
ROPERTY OWNER I ❑ TENANT Expansion tank 14.50
Name: �1� L 15 5 Pc- � V-E - 1 A- tAJ Vft/ Fixture/sewer cap 14.50
j , Floor drain /floor sink/hub 14.50
Address: Z--- �Ul/tSl� 2'C
Garbage disposal 14.50
City/State/ZIP: �� 1
//��� ( )
Phone: (� Lp Z3�> Fax: Hose bib 14.50 Ice der ' 14.50
❑ APPLICANT ❑ CONTACT PERSON Interceptor /grease trap 14.50
Business name: Medical gas (value: S ) nyvtu:
Contact name: Primer 14.50
Address: Roof dram (commercial) ! 14.50
Sink/basin/lavatory 14.50
City /State /ZIP: 14.50
Tublshovcr /s)mwer pan
Phone: ( ) Fax: : ( ) Urinal 14.50
E -mail: Water closet 14.50
CONTRACTOR Water heater 14.50
Business name: C: k Other.
Other
Address: t`4q 3 . . G-.-we a v.�r1 ti) : ,
Subtotal �
City/State /ZIP: 'vJ .e�j14 C... - u, I) e... 1 704{' S Minimumpemtit fee
Phone:( 3 ) =lei 0 -r�Zly f Fax: (C9 ) b5 j c -32 Plan review (65 °/n of permit fee) 5 /,,
CCB lic.: j'1 t ( 3S Z / 3 a� Lic. no.: 1 , I /-» State s tachatge (3 %of permit fee) S . (y
TOTAL PERMIT FEE 5
Authorized � .aa7� 'v This petit application expires it a permit is not obtained within
I signature: 1 �+ 180 days after it has been accepted as complete. r if,/ Print name: �J �,�/1 �' to t"4 4y1 I Date 1_1 • Fee methodology set by Tri- County Building Industry Service Board x I J 440 -4616T (7/03/COM/W
T►J �( u
CITY OF TIGARD
BUILDING DIVISION • PERMIT #: PLM2007 -00283
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 7/212007
Phone: (503) 639 -4171 r ': 'l
Inspection Requests (24 Hrs.): (503) 639 -4175 !Il
INSPECTION WORKSHEET FOR DATE: 7/3/2007 TIME: 7:03AM PAGE: 57
SITE ADDRESS: 10360 SW HIGHLAND DR CLASS OF WORK:
SUBDIVISION: SUMMERFIELD NO.4 LOT #: 229 TYPE OF USE:
PROJECT NAME: GREWENOW
DESCRIPTION: Replace bath fixtures and add water line to refrig.
OWNER: GREWENOW, MELISSA PHONE #: 503.803.238
CONTRACTOR: GRAVITY PLUMBING PHONE #: 503-490-0763
Inspection Request Scheduled For: Date: 7/3/2007 Pour Time:
•
Code # Inspection Description Confirm # Contact # Message
320 Plu►nbinq rough -in 051335 -01 503 -803 -2385 N
Corrections /Comments/ Instructions:
ASS ❑ PARTIAL APPROVAL ❑ CANCEL I 1 NO ACCESS
FAIL I 1 CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED
Inspector.Oil / Date: , Phone #: (503) 718-
•