Permit r - CITY OF TIGARD
PLUMBING PERMIT
' COMMUNITY DEVELOPMENT PERMIT #: PLM2007 - 00255
DATE ISSUED: 6/19/2007
TtCARD, 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 2S 111 DB - 09100
SITE ADDRESS: 15510 SW OAKTREE LN ZONING: R -
SUBDIVISION: SUMMERFIELD NO.10 LOT: 552 JURISDICTION: TIG
PROJECT: UPRIGHT
Project Description: Replace 60' 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: 60 ft
DISHWASHERS: RAIN DRAIN: ft
Owner: FEES
UPRIGHT, COLLEEN M
15510 SW OAKTREE LN Description Date Amount
TIGARD, OR 97224 [PLUMB] Permit Fee 6/19/2007 $72.50
[TAX] 8% State Surcha 6/19/2007 $5.80
Phone : Total $78.30
Contractor:
CASEY'S PLUMBING INC
PO BOX 30075
PORTLAND, OR 97294 REQUIRED ITEMS AND REPORTS
Contact # : PRI 503- 253 -0030
FAX 503 - 262 -8251
Reg #: LIC 147298
PLM 26 -725PB
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: i' / '' , Permittee Signature: 6 /97( 77/ 2.
Cali 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.
Jun 18 07 02:28p Casey's Plumbing 5032628251 p.2
Plumbing Perrnit Application ! of Tigard JUN y r:oR OFi,10E LISA -ONL
City Q 7 7 AJ� , -
1 V 200! j Ric n-d / 9 � / �[- ' / 01,2 ea2D ,0O,J�
Y I D UuBc (p ,Z1ll� t' Trail Nu.'
1312 Slt,' ):ail Blvd.. Tigard. OR 07223 _°ter �
���+ �' p� /� P?;m t�il Kcviesv
Other Per
I
., hone: 5f13.639 d! ?! I' s i0.i.i9S I slit ITV OF TIGARD �:l3 Permit No.: Line: 503 639.4175 BUILDING DIV 1
TIGARD; Dal:: KecJ }'ri3). ;Tie' I ®Sec enid svwwti_ard- or.gov Notified/method: Notified/method:
. upplcment:d hd nrma tion
Internet:
TYPE. OF WORK FEE* SCHEDULE
❑ New construction ❑ Demolition
For special iufin- union If Se. checklist.
p� - 1 Description i Qty. ; Ea. J Total
f\ dditiol >rsltcraiiol�rcpiacentcnt ❑Other: New t- _- family dwellings (includes 100 0. tier each utility connection) 1
CATEGORY OF C:ONSiRt!CTION 1 SFR (I) bath l 249.20 " 1 j
1 -and 2- 11nkly its +e)lit ❑ Com ;nercial. %indusiriai SFR (2) bath
J 350.00 ( -�
❑ .Aeccssory building ❑ Multi-family SFR (3) bath i 399.60
❑Plaster builder Each additional hath /kuchen I 4'5.00
❑ O t h er:
Fire sprinkler ( sq. It.) PIt' -c 2
.IOI3 SITE 1NFORIIA•I AND LOCATION
Site utilities
Loh site address: / 55 /0 S iA.) Project name: 0a�L4-r�� La r -e . ; Catch basin or area drain 16.60
City /Stale /1-.! I': I .� a rG 1 0 c` G -7 g 0- � J Dr)•well, leach line. or trench drain 16.60 ft.: ' ! Footing drain rno. linear .: ) P age
Suite. bldg. /apt. no.: I I 1
C'ross street/directions to job site: Ylamlfacntred home utilities 110.00
Manholes 16.60
Rain drain connector i 16.60
Sanitary, sewer (no. linear ft.: ) Page 2
Storm sewer (no. linear II,: ) P age 2
f
Subdivision: Lot no,: I Water service (no. linear lie: a2,) i P age 2 ( G'S - i
r
J
( :nap /pare l no.:
Fixture or item
Absorption valve i 16.60 DESCRIPTION OF WORK
iet4 13acktlow pi P age 2
e/r S f ✓tG-e- Backwater I6.60
1 Clothes washer 16.60
____a
S Dishwasher 16.60
A ❑ I'ROP OWNER Drinking fountain I 16.60
TENANT I I
/ /
Ejectors/sump ' i 16.60 1
Name: .O e44 , -c
/[J / Expansion tank ( 16.(:0 ( 1
Address: 15 5(�/ I
l r� �� Fixture ess'er cap 16.50 I!-
/ Q
CilyiState /LIP: J ; e r .� J Q�• / 7 a~ l't. e 7 L I Floor drain!floorsink/huh 16.60
Phone: ( _5D3 ) 2.0 - y Fe 7 1 Fax: ( ) i Garbage disposal 16.61)
Iluse lib !
Eel AAPPLICANT � ❑ CONTACT PERSON
( I 16.60 �
Business name:
ice maker (6.60 f j
- -- -- C -c ,5.(:::t. S / 1 I✓ Li : %I r % ( r 1 Interceptor/grease tr 1 _-
j 1 P 16.60
Contact n ups: / r c .. i
.8; 1 L 5= ' -:-.t Medical gas (value: S ) P age 2
Address: y G FJ C) x- 7 (-jc) 7 5 Primer (6.60
(0' :Sr teif_!l': ) t C ! •
I .: ti I Roof drain (commercial) 1
I 16.60
' ', i - / I Sink , oasin /Iavatory ( 6.60
[hone:( ' ) �"�7 j_ id.'� =�J[; Fax: 2 -�- �
0-111a11; ( Tub/shower/shower pan 16.(:17
(:-_CZ 'Sg s r.-6;0=a e-O j?ice:s i? :�
�r ; Urinal 16.60
CONTRACTOR _ Water closet
I 16.60
Business name: ' �, t .. !' / /r
C S'" J r r Gr. i- A j �" - il t� . Water heater 16.6U
`� ij i
Address: ✓`�c'�' f .f ;. .3� c' Other:
�
�t/t L% �-
a
n
v
/ / f Subtotal
City/State/ZIP: r t
. , : / CL r'1 C/ j/ �� j' %
!'hna:c: (k =.3) L'' i ' o = Minimum penis lee: S 7 , 50 0
3- -0t : 3 1 'a`: (543) 7' �5 / Residential backllow minimum permit fee: 36.25 - 7 0c ,
CC13 Lie.• r 4 7 U j Plumbing Lie. no.: x`74.,. 7„...:.:( � � j flan review (25/ ofper fee)
'� . 7- -Cc.J State surcharge (8% ofpermit tee) 5 Yo
Authorized signature: f :
/ _ .47,...e:___. �7
TOTAL PERMIT 1T 7 S 3
•
Print name: l ,
,-.1.-F1/1 Lt �-< L< -ice -� {/ ate: 1 This permit application expires an permit is not obtained within
180 days after it has been accepted as complete.
*Fee methodology set by Tri- County 13uildina industry Service l3oard.
At ;iilJiaglPetetit tPLto- ?c:mitApp clot oca2o;'' 1%u-- 161 /wEts)
CITY OF TIGARD
BUILDING DIVISION PERMIT #: PLM2007.Qfl255
13125 SW Hall Blvd., Tigard, OR 97223 . ' DATE ISSUED: 61 1912007
Phone: (503) 639 -4171
Inspection Requests (24 Hrs.): (503) 639 -4175 $'L_= ..'I"
'INSPECTION WORKSHEET FOR DATE: 6/2912007 TIME: 7:O0AM PAGE: 39
SITE ADDRESS: 15510 SW OAKTREE LN CLASS OF WORK:
SUBDIVISION: SUMMERFIELD NO.10 LOT #: 552 TYPE OF USE:
PROJECT NAME: UPRIGHT
DESCRIPTION: Replace 60' of water service.
OWNER: UPRIGHT, COLLEEN M, PHONE #:
CONTRACTOR: CASEY'S PLUMBING INC PHONE #: 503 0030
Inspection Request Scheduled For: Date: 6/29/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
399 Plumbing final 051196-01 503 - 253-0030 Y
Corrections/Comments/Instructions:
411
/A1 I 1 r , I I IWIMM rd Mr
/-" i / ; _ - i Ni‘ Ire'
Al
i ,-limppy - . -IPPF/ 4' .--. 4 /
_AL 4 /A /410 Z:ALINt -°.' _ 41E7, . !_ P'
Al\ ' '
.\..' /7 #,/ 0- Ar" / Mar _� W
/ ....--
-- 2176 1. _ __L, , ,_______
k/i , 4 Li_ _ANAN.--.J.Ear .
-g--A=P •_,' ' -
I mo ,, ,./ � 1
S-
O
Ira ' ASS ARTIAL APPROVAL n CANCEL I I NO ACCESS
•
FAIL CALL FOR INSPECTION 1 1 ADDITIONAL FEES ASSESSED
e l f 'a l
Inspector: l " I Date: 1 Phone #: (503) 718 -c /, , .)
CITY OF TIGARD
BUILDING DIVISION PERMIT #: PLM2007 -00255
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 61/9/2007
Phone: (503) 639 -4171 I 1e;v, ( +
Inspection Requests (24 Hrs.): (503) 639 -4175 .:\„: -� A_L.
INSPECTION WORKSHEET FOR DATE: 6/29/2007 TIME: 7:OOAM PAGE: 39
SITE ADDRESS: 15510 SW OAKTREE LN CLASS OF WORK:
SUBDIVISION: SUMMERFIELD NO.10 LOT #: 552 TYPE OF USE:
PROJECT NAME: UPRIGHT
DESCRIPTION: Replace 60' of water service.
OWNER: UPRIGHT, COLLEEN M, PHONE #:
CONTRACTOR: CASEY'S PLUMBING INC PHONE #: 503 -273 -003(1
Inspection Request Scheduled For: Date: 6/29/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
399 Plumbing final 051196.01 503. 253-0030 Y
Corrections /Comments/ Instructions:
.4■ _ , _ _
If / _ . -/42i....e.e I
w i , „. _., Airiw." .,,„ir _.,. ,v .... , _ r
Al
•
/ /
i f/i
a
iI 41 _
' , ,/ .0 /---- Ap,
FIN 'ASS f APPROVAL ❑ CANCEL (l NO ACCESS
•
I I FAIL CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: / I 'S.J. Date: Phone #: (503) 718 -e 3)
; CITY OF T' PLUMBING PERMIT
/ e
„� COMMUNITY DEVELOPMENT' PERMIT #: PLM2007 -00255
TiGARD` 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4 DATE ISSUED: 6/19/2007
"' '` 4,` g ��� - PARCEL: 2S111DB
SITE ADDRESS: 15510 SW 0
_ .. SUBDIVISION: SUMMERFIE
PROJECT: UPRIGHT Backflow cafl8(583)289.1745 789856
Project Description: Replace 60' ( Assembly > KO T *T A�
Test Report ®W- s oa „ NEW
r�rnvc 0 =mats EXISTING
j ' _ INSrALATI N rvices
I" ❑ ❑
REMOVED
CLASS OF WORK: OTR , ❑ REPLACEMENT
TYPE OF USE: SF Owner: Upwright Residence Phone: (503) 620 - 4809
OCCUPANCY GRP: R3 Mailing 15510 SW Oak Tree Ln
STORIES: Address:
FIXTURES
SINKS: City: Tigard State: OR Zip: 97224
LAVATORIES: 9 Assembly 15 SW Oak T ree L n
Address: Tigard OR 97224
TUB /SHOWERS:
WATER CLOSETS: ❑R.P.B.A 4 D.C.V.A ❑R.P.D.A ❑D.C.D.A ❑P.V.B.A ❑S.V.B.A ❑A,V,B ❑ AIR GAP
DISHWASHERS: Size: , S Make: 1/ :7 Model: () U f
Water Serial
Owner: Purveyor: Number: AV ‘ 6 3 %)
Assembly
UPRIGHT, COLLEEN M Location: i t4 a ✓1,-2. /4 .' ,' .
15510 SW OAKTREE LN REDUCED PRESSURE ASSEMBLY P.V.B.A S.V.B.A INITIAL TEST
97224
TIGARD, OR 97224 !
#1 CHECK ; `: DpUBL .:; AIR INLET CHECK PASSED
PRFCS DROP CHECK #1
INITIAL RELIEF VALVE OPENED AT: PRESS DROP FAILED
Phone : TEST OPENED AT (B) TIGHT 3, / ❑
MIN 2 PSID
RESULTS BUFFER A - LEAKED ❑ PSID DATE:
B = CHECK #2 PSID PSID _k i 2.4..,,/ �; O 7
Contractor: RELIEF VALVE 3 PSID TIGHT ®-7, S DID NOT FAILED
CASEY'S PLUMBING INC PASS ❑ FAIL ❑ LEAKED ❑ PSID OPEN ❑ ❑ �STEM
PO BOX 30075 -
PORTLAND, OR 97294 -
COMMENTS
REPAIRS �f(]
AND /OR PARTS C UO OME` DZ CCOF
Contact # : PRI 503 - 253 -00: �❑
FAX 503-262-82.f # 1 CHECK REDUCED PRESSURE ASSEMBLY P.V.B.A / S.V.B.A AFTER REPAIRS
TEST # 1 CHECK
DROP ) ' DOUBLE CHEIX J D ATE:
Reg #: LIC 147298 AFTER { A) ICHECK #1 0
PLNI 26-7251 REPAIRS RELIEF TIGHT El OPENED AT: PRESS DROP
OPENED MI PSID l / Uri
BUFFER M°" 7 °A (CHECK #2 �
A
Ul
- B = TIGHT El PSID PSID PSID PASSED ❑
MIN 3 PSIn
IN COMPLETING AND SUBMITTING THIS TEST REPORT, THE TESTER CERTIFIES THAT THE
ASSEMBLY HAS BEEN TESTED AND MAINTAINED IN ACCORDANCE WITH ALL APPUCABLE
RULES AND REGULATIONS OF THE WATER SYSTEM, AND STATE REGULATIONS.
WATER METER # . 1 v 7 / ETECTOR METER READING
Washington CERT#
TESTERS SIGNATURE / 4610
Ryan H t l $S Oregon CERT#
This permit is issued subject to the re TESTERS PRINTED NAME 020372
applicable laws. All work will be done American ow GAUGE #
(503
issuance, or if work is suspended ford COMPANY NAME (503) 2 0 8 9#1745 5/13/07
GAUGE CALIBRATION DATE
Utility Notification Center. Those rule ADDRESS 905 N Interstate Ave, Portland OR 97217 SERVICE RESTORED
these rules or direct questions to OU
Issued By: • % �/ �, Permittee sI nature: , . /i,,
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.