Permit '11 CITY OF TIGARD
PLUMBING PERMIT
COMMUNITY DEVELOPMENT PERMIT #: PLM2007 - 00232
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 6/4/2007
PARCEL: 1 S136CA -02700
SITE ADDRESS: 11095 SW 79TH AVE ZONING: R - 4.5
SUBDIVISION: FRIENDLY ACRES LOT: 022 JURISDICTION: TIG
PROJECT: DUONG
Project Description: Replace approx. 50' of sanitary sewer with new cleanout.
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: 50 ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Owner: FEES
LEON DUONG
11095 SW 79TH AVE Description Date Amount
TIGARD, OR 97223 [PLUMB] Permit Fee 6/4/2007 $72.50
[TAX] 8% State Surcha 6/4/2007 $5.80
Phone : 503- 860 -7440 Total $78.30
Contractor:
AMERICAN RESIDENTIAL SERVICES LLC
28655 SW BOONES FERRY RD
WILSONVILLE, OR 97070 REQUIRED ITEMS AND REPORTS
Contact # : PRI 503- 685 -9050
FAX 503- 685 -9185
Reg #: LIC 127325
PLM 34 -168 PB
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: J i Laioyi
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.
''' : JUN ;28P FROM: RESCUE ROOTER (503)685 -9381 TO: 5035981960 P.1'2
L., ..� ►g ' Fixtures '
• , ,sue �. � . ' i�olz OFFICE USE ONLY Plumbing Perm`t1 1 '�7�1 el t 0 I F Received i ,� Plumbing in
, ' s ` Daie/By: Lori 61- c-, 1 ) Permit No,: r LM `LOO 1 -a1232
City of Tigard Planning Approval Sewer
' Datc/B Permit No,'
; 1 � 0 20% y:
13125 SW Hall Blvd. JLil Plan Review Other
Tigard, Oregon 97223 Datc/By: Pcm,it No.:
b Oregon r-r r.r t ,, ,,-. < '- '�
" Post - Review Land Use
Phone: 503-639-4171 Fax: 50.3.-A1.84.19'60- � - t 1. ,ti. ', Date/By: Case No.: :
Internet: www.ci.tigard.or.usz, F- a j•C';� .n e .J it Contact ] n .: 114 Sec Page 2 for
24 -hour Inspection Request: 5032639 x"175 Narne/Method: 6- _ supplententat Information.
' :' TYPE'OF3WORK:. _ ' FEEL SCHEOULE'(fo.r'specliil lnforinateon`u'se'clieeklist) ;r '
New construction ❑ Demolition Description Qty. Fee(ca.) f Total
Addition/alteration/replacement ❑ Other: New 8c 2- family dwellings e
CATEGORY OF CONSTRUCTION •r(Incl'udes ft for each utility.connectioti)
A SFR (1) bath 249.20
1 & 2 - Family dwelling (l Commercial /Industrial SFR (2) bath 249
Accessory Building ❑ Multi- Family SFR (3) bath 399.00
❑ Master Builder ❑ Other: Each additional bath/kitchen -- 45.00
JOB SITE and LOCATION Firc sprinkler sq. ft.: Page 2
Ito t.S qqd , 41 a . , Site Utilities ` ` r ;, * ;P'
Job site address:
Suite #: 1 Bldg. /Apt. #: Catch basin/area drain 16.60
Drywell /leach line/trench drain 16.60
Project Name: L 4L0 V1 iaJa Otn A Footing drain (no. linear ft.) , Page 2
Cross street/Directions to job site: Ma nufactured home utilities 1 10.00
R,CA•ci 1, ow pc4.46t, Manholes 16.60
Rain drain connector 16.60
Sanitary sewer (no. linear ft.) SD r , Page 2 ,c'S
Subdivision:
Lot #: Storm sewer (no. linear ft.) _ Page 2
Water service (no. linear ft.) e
Tax map /parcel #: . C . '�tt/WW or to :,: 2 ",.t:
bES;CRLMLON OF WORK Absorption valve _ 16.60
O f iP, $ VUfh J u AIM. 14,VV CO h' ;11194 , Backflow preventer Page 2
"G J G�„ :pork Backwater valve 16.60
i
��l��.� �' � Clothes washer 16.60
Q 1 v " / t e�`� R � � e," 16.60
Dishwasher 16.60
�rtnn�l� - 3 S�ln1tl� r`tf�a � Drinking fountain 16.60
:TENANTO € ' ,. '
;�PROPERT+Y;O�., It %:-IIE���� � � Ejectors/sump 16.60
Name: LtoA D LA , gyl Expansion tank 16.60
Address: // nc- I 1-9$L 404, Fixture /sewer cap 16.60
Floor drain /floor sink/hub 16.60
City /State /Zip: d ma, Gt �'2' Garbage disposal 16.60
Phone: 03 -p( D -1H Li b Fax: Hose bib 16.60
V] APPLICANT t in 'CONTACT 'PERSON ice maker 16.60
Name: ARS R,ts cvil_. R- 0144A. '- ( -o. bah'. terceptor / grease trap 16.60
1 \ V- Medical gas - value: $ Page 2
Address: - Primer 16.60
City/State/Zip: . drain (commercial) 16.60
Phone: 5- p3 -2.O I/�6 I Fax: Sink/basin/lavatory 16.60
E -mail:
Tub /shower /shower pan 16.60
CONTRACTOR ' ' ' Urinal . 16.60
Water closet 16.60
Business Name: /� ftv► jZ,.t jdtt�,�toll� 1 !►� (�. 1 �� Water heater 16.60
2
Address: '(oSS cut) toanit Rd . VSA '�swwM Other:
City /State /Zip: Wi Iswlv at og, Other:
�
Phone: ,�'0- =gaSD Fax: 3 --(o,� Jtl /fir i:Plumbing,PerrrtltFees+ Yn.`.. Subtotal $ q.Z • sl)
CCB Lie. #: I 2,q- 2.S Plu ' - yg } � 1, ,, Minimum Permit Fee $72.50 $
Authorized -
Residential Backflow Minimum Fee $36.25
. EXe • Signature: C, GSM Date: 4 Plan Review (25%0 of Permit Fee) $ f0
12/141(0? n „ i State Surcharge (8% of Permit Fee) $ s
TOTAL PERMIT FEE $
( lease print name)
Notice: This permit appllca on expires if a permit Is not obtained within All new n diagram ercia require 2 sets of plans with isometric or
180 days after it has been accepted as complete.
•Fer diagram
set by review. Duilding Industry Service Board.
is \DstsTermit Forms\PImPermitApp.doc 01/03
r . `
CITY OF TIGARD •:.
BUILDING DIVISION PERMIT #: PLM2007 010232
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 6/4/2007
Phone: (503) 639- 4171Niilt
Inspection Requests (24 Hrs.): (503) 639 -4175 4 __..
INSPECTION WORKSHEET FOR DATE: 6/13/2007 TIME: 7:01AM PAGE: 7
SITE ADDRESS: 11095 SW 79TH AVE CLASS OF WORK:
SUBDIVISION: FRIENDLY ACRES LOT #: 022 TYPE OF USE:
PROJECT NAME: DUONG
DESCRIPTION: Replace approx. 50' of sanitary sewer with new cleanout.
OWNER: DUONG, LEON PHONE #: 503850 -7440
' CONTRACTOR: AMERICAN PHONE #: 503 - 685.9050
Inspection Request Scheduled For: Date: 6/13/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
395 Misc. inspection 050154 -02 503.209.7160 N
Corrections /Comments /Instructions:
10. P i 1/
e az-/-e---- t
6 PASS 1 PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
FAIL CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: ii). Date: A Phone #: (503) 718-