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Permit °� CITY OF TIGARD PLUMBING PERMIT COMMUNITY DEVELOPMENT PERMIT #: PLM2007 -00413 TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 9/10/2007 PARCEL: 2S110BB -00100 SITE ADDRESS: 14059 SW 119TH PL ZONING: R -4.5 SUBDIVISION: LOT: JURISDICTION: - FIG PROJECT: JUSTICE Project Description: Replace 40' of sanitary sewer line and 50' drain reversal. 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: 90 ft WATER CLOSETS: WATER LINE: ft DISHWASHERS: RAIN DRAIN: ft Owner: FEES JUSTICE, JANICE T 14059 SW 119TH PL Description Date Amount TIGARD, OR 97224 [PLUMB] Permit Fee 9/10/2007 $72.50 [TAX] 8% State Surcha 9/10/2007 $5.80 Phone : Total $78.30 Contractor: ARS LLC PO BOX 20698 PORTLAND, OR 97294 REQUIRED ITEMS AND REPORTS Contact # : PRI 503- 235 -8784 FAX 503 -491 -2932 Reg #: LIC 127325 PLM 34 -168PB 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. Issue• _ 1, /✓�/ d / Permittee Signature: 0 / / i_ CIA ..r 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. Plumbi>r9z Permit Appl , ` 4 t , FOR OFFICE I.JSE ONLY CI of Tigard �� ✓ E Pemit No.: A G M 77 - 4 SW Hall'Bd.. Trd, OR 97223 0 7 201 S E P ahaX Permit No.; Phone: 503.639,4171 Fax: 503 - 598.1960 A r . n r t,'l+l , , pale /B 24- Hour Inspection Line; 503.639.4175 CITY OF TIG - rd_I f Date Rcady /Ry: Aet{ ` El Ste Page z for Internet: www.ct.tignrd.or.Us i iL: :'c' 1 I /:,► Notified /Molhod: ye, Supplemental TYPE OF WORK _ FF.T.tR scIIE) tLE F ur speci in ormniian use checklist. ❑ New construction ❑ Demolition D©seri lion !a �'s� Total R (dddition /alteration /replacement ❑ Other: New 1- 2- family dwellings (includes 100 it tar each utility connection) CATEGORY OF CONSTRUCTION SFR (1) bath 249.20 j and 2- family dwelling ❑ Commercial /industrial SPR (2) bash 350.00 SFR (3) bath 399.00 ❑ Accessory building ❑ Multi- family 45.00 Each additional bath/kitchen • ❑ Master builder ❑ Other Fire sprinkler ( sq. . fl.) Page 2 ...-LH JOB SITE INFORMATION AND LOCATION Site utilities • Job site address: a l e Catch basin or area drain Mill 16.60 / �� Drywell, leach line, or trench drain 16.60 City /State/ZTP: Loyi / R, V ' Footing drain (no. linear it.: ) Page 2 min Suite/b1dg./apt, no.; Project name: t /� Manufactured home utilities = 110,00 Cross street /directions to -job site; manholes 16.60 E. I I ' I r 16, 60 l �A / *.. Rain drain connector / /rl<r S. , ,, , ( .1 ft.. nirAp Page 2 �ill • Storm sewr (no. linear it.:, ) IN Page 2 Subdivision: Lot no.: Water service (no. linear fl.: ) Page 2 Fixture or item Tax map /parcel no.: 16.60 Absorption valve /� DESC'RIP'TION OF WORK Ai ilackflow pre-venter Page 2 I �.e •ri: P E • . ff i ' i Backwater valve 14.h0 • Clothes washer 16.60 Dishwasher 16.60 - Drinking fountain 16.60 ■Il PROPERTI O1t'NP'R ❑ TENANT 16.60 Ejectors/sump Name: PiP I •r f 6>Y. Expansion tank 16.60 '9�• igrd... _ - • •.. . p-- �. ..Address:.. -_ • - � � "� FixturcJscwer cn 16.60 City/State /Z1P: /MF�i!M)l / Floor drain /floor sink /hub - 16.60 - I. q._ r Phone: ( 1 ,. / . j 1 ) Garbage disposal 16.60 16.60 APPLICANT ❑ CONTACT PERSON 16.60 Ice maker Business nrtmc; RS dba Jack Howk Flu t Ails Drain T bib interceptor /grease trop 16.60 Contact name; 6 i V Medical pas (value; $ ) Pagc 2 Address:. P.O. Box 20 , 9S Primer 16.60 City/State/ZIP; Roof drain (commercial) 16.60 Ptlrtland. OR 47294 Sink/basin /lavatory 16.60 Phone: (503) 235 -8784 - 1 Fax: ; (503) 491.2932 Tub/shnwer /shower pan 16,60 E -mail; Urinal 16.60 ('ON'I'I1 ('TOR. - Water closet 16.60 Business rtamc: ARS dba Jack Howk j'juim bin & Drain Water heater '��� ..._ Address: Box 20698 1 /,i) S ubt ota l "C►'��r , City /State/ZIP: Portland, OR 97294 L i 7/ .il �� /�► /, /- . - - _ Minimum permit fee: $72.50 Phone: (503) 2354784 Fax: (503) 491 -2932 Residential hackflow minimum permit Ibc: $36.25 CCB Lic.:. 127325 !f~ ' g lI .._ Plan review (25% of permit fee) e7 Phi gLic. no. � - State surcharge (8% of permit tee) t TOTAL PERMIT PEE ✓s!ri Authorized signature: ,! � ac.NA R.= Print name: 4 / / , - "7r7, i/ Date: 14 This permit application expires If a permit is not obtained ithin 180 days after it has been accepted As complete. lap PLEAS FAX BAC • 503-491-2932 .Fee mcl:hodoloev set by Tli- County Building Industry Service B .l'-+ CITY OF TIGARD - BUILDING DIVISION #: PL�i2007 01`l3 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 9/10/2007 Phone: (503) 639 -4171 - "NiVi "t Inspection Requests (24 Hrs.): (503) 639 -4175 J IL INSPECTION WORKSHEET FOR DATE: 9/14/2007 TIME: 7 :00AM PAGE: 36 SITE ADDRESS: 14059 SW 119TH PL CLASS OF WORK: SUBDIVISION: LOT #: TYPE OF USE: PROJECT NAME: JUSTICE DESCRIPTION: Replace 40' of sanitary sewer line and 50' drain reversal. OWNER: JUSTICE, JANICE T, PHONE #: CONTRACTOR: ARS LLC PHONE #: 503 Inspection Request Scheduled For: Date: 9/14/2007 Pour Time: Code # Inspection Description Confirm # Contact # Message 399 Plumbing final 065717-01 503- 235 -8784 Y Corrections /Comments/ Instructions: C arc. '-1 �� p isi PASS , PARTIAL APPROVAL ❑ CANCEL I I NO ACCESS ❑ FAIL I I CALL FOR INSPECTION I ADDITIONAL FEES ASSESSED Inspector: 0`4) ` ►3 a�--M �, Date: 1' 1 u1 l,r) Phone #: (503) 718-