Permit C ITY OF TIGARD PLUMBING PERMIT
DEVELOPMENT SERVICES
PE
DEVELOPMENT PLM2006 - 00301
��I DATE ISSUED: 6/9/2006
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171
PARCEL: 1S135DB-09500
SITE ADDRESS: 11175 SW 93RD AVE ZONING: R - 4.5
SUBDIVISION: REEL ACRES LOT: 001 JURISDICTION: TIG
Project Description: 1 hr. inspection for final inspection.
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: SEWER LINE: ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Owner: FEES
LACAN, MANUEL
11175 SW 93RD. Description Date Amount
[HRPLM] Hourly Plum 6/9/2006 $57.87
[HRTAX] Hourly 8% St 6/9/2006 $4.63
Phone : 503- 913 -6319 Total $62.50
Contractor:
OWNER
REQUIRED ITEMS AND REPORTS
Contact # :
Reg #:
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: Z Permittee Signature: eh')
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.
, /A
Plumbing Permit Ap 1 E RR' .tD
a • FOR OFFICE USE ONLY
City of Tigard n Datem �9 4 i $ • Permit NOY , � pb.. OU
13125 SW Hall Blvd., Tigard, OR 97223 JUN 2006 y r / 3O!
0
Phone: 503.639.4171 Fax: 503.598.1960 ` Pl an Revtew
� { Other Permit No.:
24- Hour Inspection Line: 503.639.4175 Lt 16 f -Jr' tiaA i4 / I I . Date Ready/By: Juris: El See Page 2 for
Internet: www.ci.tigard.or.us BUILDING DIVI • Notified/Method: Supplemental Information
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❑ New construction ❑Demolition i ' For special information use checklist.
Description Qty. Ea. l Total
I? Addition/alteration/replacement ❑ Other: New 1-2-family dwellings (includes 100 ft. for each utility connection)
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e s n• LATE : ;, «.; � °; a 't ,
�;;.,,`,. ��, � G ORY�sOF �C01 >ISTRIICTION ~�»•''''����,�,- : �� . �,5 SFR (1) bath 249.20
:.�• >.�•, ". � �.��" � � ' .. aR ikz;�a.....���'� °x +.,FR::.'vk ` a" �wearri s , ;.; ekaaey:�� +M�.:;�.;�..�:c�z:�� t=•.;c�•sw.�aw:..c .. ........... .: �:M >.�•.`�!
1- and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 350.00
0 Accessory building ❑ Multi- family SFR (3) bath 399.00
❑ Master builder Each additional bath/kitchen 45.00
❑ Ot her:
;.zar. r s Fire sprinkler ( , sq. ft.) Page 2
M :r ': * V ' JA ;..NFOR fio' ATION`, ` fi��'• 4 ,�,` rt r,..
,,a,, , _: kFk,•: t,x= -x,,-,; .. :.,. -6,t •,,, ,,-� . „ ; .,.,, ,.r „:f,.. L.,'„ ::M ,,. - . , , ;�,, :<tiw -3: " Site utilities
/7
Job site address: /1/ 5't l 3 . av " . Catch basin or area drain 16.60 -
City /State /ZIP: 7-7 / Wig-.,x 97 1-2-3 Drywell, leach line, or trench drain 16.60
Suite /bldg. /apt. no.: 1 Project name: Footing drain (no. linear ft.: ) Page 2
Manufactured home utilities 110.00
Cross street/directions to job site: Manholes 16.60
Rain drain connector 16.60
Sanitary sewer (no. linear ft.: ) Page 2
Storm sewer (no. linear ft.: ) Page 2
Subdivision: I Lot no.: Water service (no. linear ft.: ) Page 2
Fixture or item
Tax map /parcel no.:
•a . >:Mt z , x Absorption valve 16.60
�� f iW DESCR IPTION OF��'1'ORK � M ° S -,.,
"s A r ig,f, „ *, ��. ,z.. < ;e, �, ri.o.4,) :viA __,,. r iii .. , _ :W# Rv a� ,.. Backflow preventer Page 2
i f ek) j) �',- 1, vt y 1 p -: Backwater valve 16.60
J
I Clothes washer 16.60
Dishwasher 16.60
:. . . , - .. <. w'x; . n. ,_.., w. _ ' :P n t �:. -.ri< . • Drinking fountain 16.60
r ' ,4 I I AOFERTI' O4YNER ' ' TE NAN< ,
'r -<< -= ?. - n . „,s ",;. " :,::t� °" Ejectors /sump 16.60
Name: � 4 / 74,..4,4z, Z Wit- 4 LA c Ai Expansion tank 16.60
Address: / / /7'!' i i i�,3' .� ,'Y' Fixture /sewer cap 16.60
City /State /ZIP: � Floor drain /floor sink/hub 16.60
Phone: J 2 ,3) _ _ , / , 3 . - 6 5 ( t 1 Fax: ( ) Garbage disposal 16.60
.2 ; ;; rs .h °r f ,, ,:� "v. - ,, x' :' N:M ,itli :<. :;Y �:. HIr r - Hose bib 16.60
_ ar t,'; . , AE,P.,ICANT' `,, ;G• 'Z', ; =�;: CQI�'T AC 4 0, t : ' 'RSON
='�a'� "i .,'. �.., usas�;';<' �.`- ..,;ru.�^o-,.Fry.. . ..�.4?���� �� :.�,.�r�` >,.�'s:.�,:��'�•: . ��:. . , .;..a�i'a.�m.•w"erd �.�.aa:,�
Iee maker 16.60
Business name: ef�u/ g-D ,�4Lu 1 ._ 1 Al a?. '
fir' � Interceptor /grease trap 16.60
Contact name: ,li ' -yy efe (..• Medical gas (value: $ ) Page 2
Address: ( - r ,&J i',1) ' 7 14/c ; / ) l , ,,, c.: Primer 16.60
City /State /ZIP: I i..3 � 01-„ Roof drain (commercial) 16.60
Phone: (37 6,, / v-- ' z- j7 Fax: : U �) f�/ _. ,� ` J / Sink /basin/lavatory 16.60
_ Tub /shower /shower pan 16.60
E -mail: ' a.�C € A..1 *=G frl'�' %v `L*` a
,:� . A, °h;° �,_ �t(ei c/
, <�., ..��;;� ,:.. ��„»�:,::,,,: y y?,;F" a ��:,��W+:. :ti Urinal 16.60
':,a � ���.: �':.r� ^'_ � °t` �:' '.�� t��"�;`" =;mow"
s ": �„ ". iz< .,,,; .,_ .< ' : > ',� CON'Tii iii12 ��; ,>.' _f "< a "'"U4W > "
., F - -. 3 4= A�� ,, . � ..:�., -s, - v - -. F � Water closet 16.60
Business name: Water heater 16.60
Address: Other:
City /State /ZIP: Subtotal
Minimum permit fee: $72.50 a
Phone: ( ) Fax: ( ) Residential backflow minimum permit fee: $36.25 - • TV 1
CCB Lie.: Plumbing Lic. no.: Plan review (25% of permit fee)
State surcharge (8% of permit fee)
Authorized signature: ��
TOTAL PERMIT FEE ! - '
. Print name: Date: This permit application expires if a permit is not obtained within
180 days after it has been accepted as complete.
*Fee methodology set by Tri- County Building Industry Service Board.
i.\ Building \Permits\PLM- PermitApp.doc 06/05 440- 4616T(10/02 /COM/WEB) / / 01, $6A
Plumbing Permit Application FOR OFFICE USE ONLY
City of Tigard Received Permit No.:
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 p Date/By: Other Permit No.:
24- Hour Inspection Line: 503.639.4175 !�, j. c!f I 1 Date Ready /By: ruris. ® See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method: Supplemental Information
1'1PE OF i1 Q ,; ti WWI . - : FEE SCHEllU1:E . ' `
w s "� . ":gym " s4 .<F... avy,' �4i,C ":. ". ,;, o ..,.,,{.. "fig, >.. ..: -�� _ ._ ia'�°.:?�;,�,.,.. ., .:<:�.�.. ,, . 4`,4 , 44.4 ,4 ,1:
.- - ... -�, u *.s.. < �,. . ,.
❑ New construction ❑ Demolition For special information use checklist
Description I Qty. I Ea. Total
Addition/alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
`" >'. wCAItECORY, _OF CONSTRUCTI ON 7 SFR (1) bath 249.20
' i • I- and 2- family dwelling El Commercial /industrial SFR (2) bath 350.00
❑ Accessory building El Multi-family SFR (3) bath 399.00
Each additional bath/kitchen 45.00
❑ Master builder ❑ Other:
Fire sprinkler ( sq. ft.) Page 2
wJOB, SITE ='I FORMATION -A A°NDY;;LOCATION :
��,,... -- �"....u.�: � ,., - te r.,,....,::,. -�:w ; . . :�. Site utilities
Job site address: " /// 7' 5'4J f3 . f a Catch basin or area drain I 16.60
y
City /State /ZIP: T-1 ./.,?Yl, 97 Z.7'3 Drywell, leach line, or trench drain 16.60
Suite /bldg. /apt. no.: / Project name: Footing drain (no. linear ft.: ) Page 2
Manufactured home utilities 110.00
Cross street/directions to job site:
Manholes 16.60
Rain drain connector 16.60
Sanitary sewer (no. linear ft.: ) Page 2
Storm sewer (no. linear ft.: ) Page 2
Subdivision: I Lot no.: Water service (no. linear ft.: ) Page 2
Fixture or item
Tax map /parcel no.: valve
,; ; z•;Y'a, ; :, . :ey > -' , , : >::°" ° %- Absorption 16.60
4 4V DES OF ,WORI{ >'' - -Ak V ' '° �: m
.: -_ . „e.,- _, � ., e ..,,d , . ,. .. :: �. -it ,, ... Backflow preventer Page 2
e6i/I we4) 1) j, h t - Backwater valve 16.60
( ( Clothes washer 16.60
Dishwasher 16.60
- v ., ; '<, Aft °3 : :: ; , ,',, Drinking fountain 16.60
EROPERTY 'OWNER'i ''F , - ;, *' +;TENANT - ' 3:;'''a ;
A f Ejectors /sump 16.60
' t.
Name: /J4' EL_ A- LA c.A,V Expansion tank 16.60
Address: /7/7 ' Ati 3. Av Fixture /sewer cap 16.60
City /State /ZIP: �� Floor drain /floor sink /hub 16.60
Phone: (4223) v'/,j 6 3 / f Fax: ( ) Garbage disposal 16.60
16.60
„ . N Hose bib 16.60
��'< ° 4 -` " ^gi"' ®;APPLICANT''_' '� "'" 7 "" ® .0
.ONTACTE"PERS�O;:' -
a�.. . > _ . avn
� ' n' = , - ° Ice maker
Business name: U ,a,/'t-b-D /1(,)4 ,447 C Interceptor /grease trap 16.60
Contact name: TI i2. � +
✓ € Medical gas (value: $ ) Page 2
Address: J d(9 t) N j,J _c vcf,Cj pi, 7f-42 Primer 16.60
City /State /ZIP: Ali 9 r3 .t,t7 01- Roof drain (commercial) 16.60
Phone: (.1 6./ V.--F2-2-S (.�' 3) 6/$ ,Y,,� T u b/ s asin/l /shows X 16.60
Fax:
`, � ` 7 /V el- pan �( 16.60
E -mail: ��/���� r/JL r Urinal 16.60
F CONTRACTOR a 1v Water closet 16.60
Business name: Water heater 16.60
Address: Other:
City /State /ZIP: Subtotal
Minimum permit fee: $72.50 �7
Phone: ( ) Fax: ( ) Residential backflow minimum permit fee: $36.25 7l . J "
CCB Lie.: Plumbing Lic. no.: Plan review (25% of permit fee)
State surcharge (8% of permit fee)
Authorized signature: TOTAL PERMIT FEE 72 =4r0
Print name: Date: This permit application expires if a permit is not obtained within
180 days after it has been accepted as complete.
*Fee methodology set by Tri- County Building Industry Service Board.
i:\Building\Permits\PLM- PermitApp.doc 06/05 440- 4616T(I0 /02/COM/WEB)