Permit C ITY OF TIGARD PLUMBING PERMIT
e � DEVELOPMENT SERVICES PERMIT #: PLM2005 -00254
I
13125 SW Hall Blvd , Tigard, OR 97223 503 - 639 - 4171 DATE ISSUED 6/10/2005
PARCEL: 2S 103RD - 00507
SITE ADDRESS. 11180 SW ERROL ST ZONING: R -4 5
SUBDIVISION• ECHO HEIGHTS LOT: 010 JURISDICTION: TIG
Project Description: New sewer connection
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: 100 ft
WATER CLOSETS. WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Owner. FEES
MEEKER, TIM JANE A Description Date Amount
11180 SW ERROL ST
TIGARD, OR 97223 [PLUMB] Permit Fee 6/10/2005 $72 50
[TAX] 8% State Surcha 6/10/2005 $5 80
Phone . Total $78.30
Contractor:
HOLLENBACH + HURD INC
3000 SW 174TH AVE
ALOHA, OR 97006 REQUIRED ITEMS AND REPORTS
Phone : 591 -5987
Reg #: LIC 121807
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. — 4 2/41 ; p��� Permittee Signature
T A41
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.
Plumbing Permit Application FOR OFFICE .usE ONLY
City Received e 'y,�/ �- q
25 of Tigard
SW Hall Blvd, Tigard, OR 97223 Rec ( / Q �� " ,1 -- Penmt Nod 1 �z�l i �Q,�,J e �
Phone 503 639 4171 Fax 503 598 1960 Plan Review
131
24- Hour Inspection Line 503 639 4175 . r l ' H i Date/By Other Permit No �� ge 2 f
Internet: i^, /?;0 t www ci Tigard or us . - Date Ready/BY la See Page 2 f
8 Noutied/Method 1 I (r Supplemental Information
TYPE OF WORK FEE* SCHEDULE
❑ New construction ❑ Demolition For special information use checklist
Description 1 Qty 1 Ea 1 Total
N Addition/alteration /replacement ❑ Other New 1- 2- family dwellings (includes 100 ft for each utility connection)
CATEGORY OF CONSTRUCTION SFR (I) bath 24920
® t- and 2- family dwelling ❑ Commercial/industnal SFR (2) bath 35000
❑ Accessory building ❑ Multi -family SFR (3) bath 399 00
Each additional bath/kitchen 45 00
❑Master Mulder 0 Other Fire sprinkler ( _ sq ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities
lob site address: 11180 SW Errol St. Catch basin or area dram 16 60
City/State/ZIP Tigard, Or. 97223 Drywell, leach line, or trench drain 16 60
Suite/bldgJapt. no : I Project name sewer connection Footing drain (no linear ft ) Page 2
Manufactured home utilities 110 00
Cross street/directions to job site: walnut to former, right on Errol near end of street.
Manholes 16 60
Rain dram connector 16 60
Sanitary sewer (no linear ft 1 ) 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. 2S103AD00507 Absorption valve 16 60
DESCRIPTION OF WORK Backflow preventer Page 2
abandon septic tank, sewer line to main laterial Backwater valve 16 60
Clothes washer 16 60
Dishwasher 16 60
® PROPERTY OWNER ❑ TENANT Drinking fountain 1660
Ejectors /sump 16 60
Name Tim Meeker Expansion tank 16 60
Address: 11180 SW Errol St. Fixture/sewer cap 16 60
City/State/ZIP: Tigard, Or. 97223 Floor drain/floor sink/hub 16 60
Phone (503)348-6455 Fax (503)968 -8227 Garbage disposal 1660
❑ APPLICANT ❑ CONTACT PERSON Hose bib 16 60
Ice maker 16 60
Business name
Interceptor /grease trap 16 60
Contact name Medical gas (value $ ) Page 2
Address Primer 16 60
City/Slate/ZIP Roof drain (commercial) 16 60
Phone.( )
Fax • ( ) Sink/basin/lavatory 16 60
Tub /shower /shower pan 16 60
E-mail. Urinal 16 60
CONTRACTOR Water closet 16 60
Business name: 1a01\,27r�f, r1 \r--_k \ .- Water heater 1660
Address: Other.
Subtotal
City/State/ZIP- permit fee $72 50 9 _2 . , 5r
Phone ( ) Fax ( ) Residential backflow minimum permit fee $36 25
CCB Lie dd Plumbing Lic no
� / p J Plan review (25% of permit fee)
//l
State surcharge (8 %ofpennnfee) s.(1
Authorized signature:
. / TOTAL PERMIT FEE 78' „? D
Print name. I fm M P p Date 6//0 /� This permit application expires if a permit is not obtained within
/// 180 days after it has been accepted as complete.
*Fee methodology set by Tn-County Building Industry Service Board
•' 7
CITY OF TIGARD
BUILDING DIVISION
PERMIT* PLM2005.00254
13125 SW Hall Blvd , Tigard, OR 97223 DATE ISSUED: 6/10/2005
Phone. (503) 639 -4171 ,""riuVi lA
Inspection Requests (24 Hrs )• (503) 639 -4175 &-
INSPECTION WORKSHEET FOR DATE 6/13/2005 TIME. 7:08AM PAGE 67
SITE ADDRESS 11180 SW ERROL ST CLASS OF WORK
SUBDIVISION. ECHO HEIGHTS LOT #: 010 TYPE OF USE
PROJECT NAME MEEKER
DESCRIPTION. New sewer connection
OWNER' MEEKER, TIM JANE A, PHONE #.
CONTRACTOR HOLLENE3ACII + HURD INC PHONE #. 591 -5987
Inspection Request Scheduled For: Date' 6/13/2005 Pour Time
Code # Inspection Description Confirm # Contact # Message
505 Sanitary sewer 009067 -01 503. 936.5733 N
Corrections/Comments/Instructions:
f/i /
!'�
�Q PASS ❑ PARTIAL APPROVAL El CANCEL ❑ NO ACCESS
✓ ❑ - AIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
l
Inspector: " 77'7 Date: / Phone #: (503) 718-
.