Permit ` A CITY OF TIGARD
PLUMBING PERMIT
COMMUNITY DEVELOPMENT PERMIT #: PLM2007 - 00376
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 8/20/2007
PARCEL: 2S102DD - 00801
SITE ADDRESS: 13855 SW HALL BLVD ZONING: R -4.5
SUBDIVISION: EDGEWOOD LOT: 006 JURISDICTION: TIG
PROJECT: BOGAN
Project Description: Line work for sewer connection. Septic system to be pumped and filled or removed.
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
BOGAN, BUTCH AND SUSAN HANSON
13855 SW HALL BLVD Description Date Amount
TIGARD, OR 97223 [PLUMB] Permit Fee 8/20/2007 $72.50
[TAX] 8% State Surcha 8/20/2007 $5.80
Phone : Total $78.30
Contractor:
JACK HOWK PLUMBING
PO BOX 20698
PORTLAND, OR 97294 REQUIRED ITEMS AND REPORTS
Contact # : PRI 503- 235 -8784
FAX 503 -491 -2932
Reg #: LIC 23847
PLM 26 -208PB
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: � Permittee Signature: 0eyt rl
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 USE'
City f Tigard • ' CE1VEDA Recto/edgy � P e r m i t N �.�1 )4907,0z• 370 .
131 SW Hall 131vd_, Tigard, OR 9 Datc /Hy: 4 0"1
Plan P
Phone: 503.639,41:71 Fax: 503.598.1960 Rcvic
Plan R Other Pcrant N� kAg.). , 7427 ,.. ck
24- Hour Inspection Line: 503.6394175 p�,� 1 . ( 2 00 . ,a � I�
w ontc p /0 I"Ii ,.- Et Sc e Page 2 for
Internet: ww.ci.tigard.or,us tw Notified/Method; 'f Supplemental inthrmatinn
TyrlGiV 91 •• FEE* SCHEDULE
�U't..til - 4-' • em ion
Far special information use checklist [] New ettnstrnction L! Demolition
Description l Qty. I 13a, I Total
ddition /alteration /replacement ID Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
/' CATEGORY OF CONSTRUCTION SFR (1) bath 249.20
12 ` and 2- family dwelling 0 Commercial /industrial SFR (2) hath 350.00
❑ Accessory huiiding El Multi-family SFR (3) bath 399.00
-- -- Each additional bath/kitchen 45.00
❑ Master builder ❑ Other:
Fire sprinkler ( - sq, ft.) Page 2
JOB `1ITF INFOR11,iATION 1NI) LOCATION Site utilities •
Job site address: \3 f .. Q ( Catch basin or area drain 16.60 T
City /State /7,.1'._ (\ Drywell, leach line, or trench drain 16.60
Footing drain (no. linear ft,: ) Page 2
Suite/bldg. /apt. no.: I Pry ! ° n q
V ) Manufactured home utilities 1 10.00
CMS Street/directions to. job site: Manholes 10.60
Y.r+r - - Rain drain connector 16.60
•
Sanitary acw (no. li near f1.: Page 2_.
Storm sewer(no. linear t,:. ) Page2
Subdivision: loot no.. Water service (no, linear ft.: ) Page 2 -
Fixture or item
Tax map /parcel no.: Absorption valve - - - 16,60
DESCRiYTi3ON OF WORK ,K l3ackflow pteventer Page 2
\ � � 7 '--;. -C '''';-"--• - ?-- ��.6.4 _- 0 ��0 Backwater valve 16,60
ra /" --~ " S`�[ij': Clothes washer 16.60
• 0 Dishwasher 16,60
Drinking Fountain 16.60
C . RO1'ERTi' OWNER ❑ TLN_■NT
Ejectors/sump 16 -60
Name: c N.. �k C-- G,V� Expansion tank 16.60 ..
Address: ... r , . .j. -
\ � j`��Q Fixture /sewer cap 16,60
City /State /Z ' • d . `�? Z Floor drain/noor sink/hub 16.60
w
Pho .� 3 L ` ^ LL t 2 Fax: ( ) Garbage disposal 16.60
` � l 1 bib 10,60
�7 APPLICANT ❑ (r)NT A(T PERSON
Ice maker 16.60
Business name: ARS dba Jack Howk Plumbing & Drain -
Tntcrecptnr /g«aAC imp 16.60
Contact. nil • : (NYC , Medical gas (valve: $ ) Page 2
Address; . P.O. Box 20698 Amer 16.60 _
City/State/ZIP; Portland, OR 97294 Roof drain (commercial) 16.60
Phone: (503) 235 -87S4 Fax: ; (503) 491-2932 Sinklbasin /lavatory - 16.60
E-mail: Tub/shower/shower pan 16.60
Urinal 16,60
C'ONTRAt •1'OR Water closet 16.60
Business name: ARS dba Jack Howk Plumbing & Drain Water heater 16.60
Address: P.O. Box 2069_8 Other:
City /Statc/ZIP: Portland, OR 97294
Subtotal
Minimum permit fee: $72.50 ^ L.
Phone: (503) 235 -4784 Fax: (503) 491-2932 Residential backflow minimum permit fee: $30.25 d'•
• CC13 Lie.: 12-- ' ' "_`~ - �,., Plumbing Lie. no.....- j ( ( / Plan review (25% of permit fcc)
State surcharge (8% of permit fee) 1 5 i g
Authorized signature;' -
- .. ,.�.w. TOTAL PERMIT FEE � �
Print nattfc: 0";-%.0 - S/J-j Date: ( ccli) This permit application expires if a permit is not obtained within
PLEASE FAX BACK: 5®3 -491 -2932 180 days After it has been Au as complete.
"Fee methodoloev col by Tri• C.rnmty Building Industry Service bSnard.
'CITY OF TIGARD
_
BUILDING DIVISION PERMIT #: PLIv12007-00376
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 8/20/2007
k li tk `
Phone: (503) 639-4171 el
LL
INSPECTION Zl li i
Inspection Requests (24 Hrs.): (503) 639-4175
INSPECTION WORKSHEET FOR DATE: 9/13/2007 TIME: 7:01AM PAGE: 42
. _
SITE ADDRESS: 13855 SW HALL BLVD - - CLASS OF WORK:
SUBDIVISION: EDGEWOOD LOT #: 006 TYPE OF USE:
PROJECT NAME: BOGAN
' DESCRIPTION: Line work for sewer connection. Septic system to be pumped and filled or reToved.
<----■. .-------.... D c4 ... c, A............."
OWNER: BOGAN, BUTCH AND SUSAN HANSON; PHONE #:
CONTRACTOR: JACK HOW}( PLUMBING ' - ' PHONE #: 503-236-8784
Inspection Request Scheduled For: Date: 9/1/2007 Pour Time:
. _
Code # Inspection Description Confirm # Contact # —.sage
399 Plumbing final 066643-01 • 603-235-8784 V
Corrections /Comments/ Instructions:
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Nli PASS fl PARTIAL APPROVAL fl CANCEL n NO ACCESS
I I FAIL. CALL FOR INSPECTION El ADDITIONAL FEES ASSESSED
A ; ti('-'- Date: )/\ 1 b.--
Inspector: Phone #: (503) 718-