Permit CITY T PLUMBING PERMIT
I& DEVELOPMENT SERVICES PERMIT #: PLM2005 -00369
DATE ISSUED: 8/9/2005
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171
PARCEL: 2S108BA -00600
SITE ADDRESS: 15665 SW BULL MOUNTAIN RD ZONING: R -7
SUBDIVISION: LOT: JURISDICTION: URB
Project Description: Replacing tile shower and pan with fiberglass.
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: 1 SEWER LINE: ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Owner: FEES
JOHN KLUNE Description Date Amount
12370 SW DUCHILLY CT.
TIGARD, OR 97224 [UPLUMB] Permit Fee 8/9/2005 $72.50
[UTAX] 8% State Surchi 8/9/2005 $5.80
Phone : 503 639 - 4359 Total $78.30
Contractor:
CROWN PLUMBING
5429 SE FRANCIS REQUIRED ITEMS AND REPORTS
PORTLAND, OR 97206
Phone : 503- 771 -9449
Reg #: LIC 42671
PLM 34 -70PB
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 e set forth in OAR
952 - 0001 -0010 through OAR 952 - 0001 -0100. You may obtain copies of these; rules or! rect que lions to OUNC by
calling 503 -246 -6 99 or 1- 800 - 332 -2344.
Issued By: Permittee Signatur ,
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.
ON/09/2005 14:05 503 - 771 -9454 CROWN PLUMBING PAGE 01
Plumbing PermitApplicatioiil
I .., FOR <)FIFIC'E . list OI \L1"
(7 h' of Tigard
A R eceivedP '
�u rinll iSl, 'I u;1rJ. OR !)) 72) Dete/By1 Pe No ' — o ...eV 34/
I 'n' try: ■ i; n ,: -; t ' I Fa. 503.$98. 1960 Platt Revlc , V - I I J_ (O
.4. Ha ur Ini[ c •mc,n Lift:. x(13.619.4175 4 -ti�� I ±'' Dole/By: is I'cnnrr N., -
I7.I� 'nst v o.u. . iiprd,t r u.< _� Date Ready /By: lures) See a : for
NOtiPiotVMOdtod: I Pni al l.formariOn
'!', . �I� a. ar ;•<,:.�:... ' 1 Su Irrr.ent
.-, : ° ri� : !'.3'3i'FN: �� :r., . :' '.. •',r.g ; : ,
• construction
b 1..t a " `E�:i�r UIN..
- - - - -_` [Demolition For sperio!irrjormarion use cbrrktl�r,
liA ' dd ttxralrernounireplacement 0 Other:
Description Qty. Qty. Fa, T"
New 1
_ C.� r ..,,. :
C?OiL`4`j ;' r l ' U %.'.7, : ^x amity dwellings (includes 100 R - un .n connection
�W _ far each r nn
_ w i " o]? _I SFR(1)bath
and :•I,rntll� dwelling ❑ Commercial/industrial .� I ___ .
�• _ r trial SFR (2) bath __ ..._. .. --
CD . a building ❑ Multi- family (3) bath - -- ° -- - bu
SFR 3
0 . :►st,tr builder ❑ ()thee Each additional bath/kitchen 45 00
.. 3081 T e r .........4.;,,i! ; t a' I '9 ' ; ' l . ; I ; ; ; '. : Fire sprinkler ( _ sq. ft,) Page 2
; . - 1 .. ,_ . .. ._ f_ ._�::t f . _ , Site utilities
.lb ; :e . ddress. f ..,rG C. •S
-" '-- - - • • - - -- S B 0 1 ( it4. ZO Catch basin or area drain l I n he
• n : tut: /ih i ( C
' . cs G- ��� Q r ?Z.z.y Drywcll. leach line, ur trtnch drain -- -- -
.iie :11d.;._pl is _.._- 7 Project name; !
Footing — .� -- -
- tnbdrun(nu.Ina ;u'ti 1 I c :
• rt'S ;[r :<I. direct its fo �tti, site: Manufactured home utilities 1 16 ou ,
Manholes 16.60 -
-- Rain drain connector 6.60
-. --..... -- -_• _ Sanitary sewer (no, linear H.:
Page 2
' - -.... -. -.. • .__ ..._.- -._ -„ Storm sewer (no. linear ft.: ) Page . tdr a .r Water service (no. linear K
"_— ----
_ ._..._............ Lot no.: I 1 ?:,,r '
m ip ,:,r:ei Fixture or item . -... , _
— ° - . ^s ,� ' .• ,- -: ; ;, ,
,,.�, r Absorption valve T- -_ I r, r,
L_ . bES '
• ' ;1.: ' :':� '1:: � Back tlow prevcntcr � --
:•. 6 .Y.•e-Lfi1G' - / 'G _5- e2- 1--- ( i ,y �igF�GLi1 -ss
Backwater
I h� •
- - ._ . - . - - — . Clothes washer 16 60 i
_ Dishwasher 1 .-
I L I� PROPERTY,' O1lY r 16.60
- y , . rS¢ ! 7 : r , dr ;S t 'n Dunking fnunl;tin f In
::n'1e I j`r .. ii E)cCfOtS/SUtn
_, . Expansion lank M1
! sw7�4,l
Fixture/ ::ap - .2r.
- I •.r. -._
5 1 !Ip - ei - -
r �_ —'—_
^� Floor draiNtloorsink/hub In ;(I
: ;`tree.�j7 ti3 . 4, 3 Fax:, )
Garbage d isposal � --- ---
I n. nU
0
—
AP.PL ICA IQT • : tiy <, : --• " r: `t ;; '. i,a=...: 4,i � � ■ : ,,,.:G•4 Hose
• t t .. a�::1.. ; { , +....y.' ly1i''?b 1� n l
I .lr ;
lius mes Ili (IIe' /� /- ice make I ^?- - - --"'-
ontuc! 141, tr �[ Interceptor /grease •
trap - T - 1 n --'. _..- .,..__-
. _ _._ '- - -._. . . �r.� / u r� _
.....1,7 ress
Medical gas (v :slue: ) ; Poet- '
/ 2.3 70 �("/� -9t r Gill GL �'_'. • Primer i --
' r% tita1.•.c IP • I bAU I i
.- _ - d (9 72 2;y Root' drain (commercial) 1000 i
ana t s _2 i 3 5i .v3j�r I Fax:: s ) Sink/basin/lavatory nt911 to ptl
! • ; .,,+ ti ,,,,,.., r : � „ Urinal 1- �- --
nuln 'l CROWN rCO'.� "`''� "wry i . 2 a.`"4. ;Z' ;01: Water closet - _-
PLUMBING 1 in NI :
- - Water heater `�
' 5.29 SE FRANCIS STREET - i NJ - --
_ Other. - ._..
n•Stztr 'Z P' PORTLAND. OR 97206 - 1
Subtotal' -
:r (F. i1 ?71
"'�
Minimum permit lee S t(l I 1
,7/ ? Fax: (5'13) 771 -9454 Residential back
now minimum permit tee i io ; . '
1 1.1: 3:4171 .. _..... - `
_ _ . _ -- _ -- Plumbll 1g LiC. n • 34 -70PB Plan review (25 %%, 411 rentt1t 1' - -- --
— - ._._... Ittt• surcharge (X %01 per 1 • :r/
m n =tell I; rn11i. Underwood / TOTAL f•PR I F F
1 Date; �f� f j � I This permit application expires if a permit is no. obtain• eo � ;thi.
/ ! 180 days after it has bean accepted as complete,
a1n: r;, .. •, ., r: , •tai „ 4 , r a 03 "Fee methodology Set by Tri- County Building Industry San lcc Board
44114616TI10102/CO )WEal
08/15/2005 11:20 503 - 771 -9454 C PLUMBING PAGE 01
08/15/2(06; 10 :16 FAX 5035981960 CITY OF TI Ri OOi
P141
•
Building Division
'' 4pplicant Request for Permit Action
• Ci o '• ard
TO: CITY OF T:GARD, BUILDING OFFICIAL
13125 SW PI all Blvd., Tigard, OR 97223
Phone: 503.i39.4171 Fax: 503.598.1960
. )4,,,i...)
FROM: Applieant N; :me:
Mailing Adel fess: i Q...3 Ouc.
}
ECEIVED City /State /Zip: sr - I(74. iii _ -
4IJG 2005 s 200 P h on e No.: CO ` — 4 5
CITY OF .FIGARO Fax No.:
B ' —
UILDING Dt1'!StO f
LTASE TAKE ACTION CHECKED ( FOR TILE FOLLOWING PERMIT;
CANCEL PERMIT APPI !CATION,
REFUND PERMIT FEES
7 ; ��-� - Permit No.: 1L [n 'D.CaOS ..•10®
Type of Pen, nit: ? ti L Zip
II : f�
V
Si te ,A,ddres�; � i S(a (vS s ue., Lc) - ew__L.11/1-1" P
9 h/,7c)5 ' z- - -- Subdivisioxn
Lot No.:
EXPL NATION: ,_ _� 1 _ 1 - _ _ ! [o `? '
( /d i /vl <\ 7 4. A.4�l/ kn. G°,.,,. l am )
0 igiature: Date: d' / � o f
Print Name: . D e L , y 1��... e. o. (' co ,,D w„, ,L_uM�%/,/
/ • ,t4,.L/ /�3-.- & - � -► t (.ce c‘ O 0 90
/(0 0 s pmt. onA, for, r/ � �� -e-. 0i.6 4 f ,
,..) ,2, -soAy "' f , ri' , ,' FOR USE,ONLX ' ' : ^` _ :' �7'r, ""` 0s .
Route to Admin.: Date: By:
-
Permit Canceled: Date: 6 PA 4 /0S By: 4 ...
Refund Processed: Date: By :d -
Cashier Recei.t: Date: 19/a5" #:.200...C-3,// Amnt: $ 7f, –1c) :I./7A,,
f— —, e
Payment T • e: : , Per:
i:V3uitdineFormsawyermitAction 09 .27. ' l.dor 7 ! - 9`14 9 2/P