Permit CITY TIGARD PLUMBING PERMIT
• �� �� i DEVELOPMENT SERVICES PERMIT #: PLM2O%6 10029
'�'I� 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 3/15/2006
PARCEL: 25111 BA -07100
SITE ADDRESS: 09465 SW INEZ ST ZONING: R -4.5
SUBDIVISION: BUTLER TERRACE LOT: 005 JURISDICTION: TIG
Project Description: Replace 50' of water service.
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: ft
WATER CLOSETS: WATER LINE: 50 ft
DISHWASHERS: RAIN DRAIN: ft
Owner: FEES
CARRIE HANAUSKI Description Date Amount
9465 SW INEZ ST
TIGARD, OR 97224 [PLUMB] Permit Fee 4/4/2006 $72.50
[TAX] 8% State Surchar3 4/4/2006 $5.80
Phone : 503 - 816 - 2018 Total $78.30
Contractor:
CASEY'S PLUMBING INC
PO BOX 30075 REQUIRED ITEMS AND REPORTS
PORTLAND, OR 97294
Contact # : PRI 503- 253 -0030
FAX 503- 262 -8251
Reg #: LIC 147298
PLM 26 -725PB
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes
and all other applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is
not started within 180 days of issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law
requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 -00: • -.I ; • rough OAR 952 - 0001 -0100. You may obtain copies of these rul-. • r direct questions to OUNC by
ca • ng 503-246-66e! .; S 0- 332 -2344.
Is. ued By: k. 0 � � i 4. a „ Permittee Signat4g0I „d/jaa_F, _ -
Call 503 - 639 -4175 by 7:00 a.m. for an inspection that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
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Plumbing Permit AnDlicaAtIv ED FOR OFFICE USE ONLY
City of Tigard 1.' Date/By: 5 / D G - ' 4 Pemu1N,' i 2004 '/l'10 13125 SW Hall Blvd., Tigard, OR 97223 J� y
: e
�R 200 Plan kct'�rtc
Phone: 503.639.4171 Fax: 503.598.1960 @ " PAS t 1 4 th m rr Pc t fir..
1 +' Date/By: Date Read /F3
24- our Inspection Line: 503.639.4175 ,� -14 ;. 1 Ready /By: lu E t see Page 2 rat
'
Internee: www.ci.iigardor.ttti R hotifal/Methed:
�T� Gh Surypkrncntal tnforrnatton
' TYPE T.1 LlIVI$ FEE* SCHEDULE
CI New construction BOIt.0 i Demolition For special information use checklist
Description 1 Qty. .1 En. I Total _
® Addition /alteration replacement Q Other: New 1- 2- family dwellings (includes 100 ft for each utility connection)
CATEGORY OF CONSTRUiCTION SFR(1)bath 249.20
I ® 1- and 2 -family dwelling ❑ Commercial /industrial SFR (2) bath 350.00
[]Accessory building 0 Multi - family SFR (3)bath 399.00
❑ Master builder Each additional bath/kitchen 45.00
❑ O ther: .
Fire sprinkler ( sq. ft.) Page 2
,IOB SITE INFORMATION AND LOCATION Site utilities
Job site address: 9465 SW INEZ ST Catch basin or area drain I 16.60
City/State/ZIP: TIGARD, OR 97224 Drywell, leach line, or trench drain . 16.60
Suite/bldg. apt. no.: I Project name: N 4 N 1(1'U 5k1 Footing drain (no. linear ft: _) Page 2
Manufactured home utilities 110.00
Cross street/directions to job site: SON SW 93 AVE FROM SW MCDONALD
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. Iinear ft : 50) Page 2 'n�
Tax mapiparcel no.:
Fixture or item
DESCRIPTION OF WORK Absorption valve 16.60
Backilow preventer Page 2
REPLACE WATER SERVICE Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
Drinking fountain 16.60
® PROPERTY OWNER ❑ TENANT
Ejectors /sump 16.60
Name: CARRIE IHANAUSKI .
Expansion tank 16.60
Address: 9465 SW INEZ ST
Fixture/sewer cap 16.60
City /Slate/ZIP: TIGARD, OR 97224 Floor drain/floor sink/hub 16.60
Phone: (503)816 - 2018 I Fax: ( ) Garbage disposal 16.60
® A1'PLIt'a<NT Bose bib 16.60
0 CONTACT PERSON
lee maker 16.60
Business name: Casey's Plumbing
Interceptor /grease trap 16.60
Contact name: JULIE CAMPBELL Medical gas (value: $ ) Pagc 2
Address: PO BOX 30075 Primer 16.60
City /State/ZIP: PORTLAND, OR 97294 Roof drain (commercial) 16.60
Phone: (503) 253 -0030 Sinkfbasin /lavatory 16.60
( ) I Fax: (503) 262 -8251
Tub/shower /shower pan , 16.60
E -mail: caseysplumhingacomcast-net
Urinal 16.60
CONTRACTOR Water closet 16.60
Business name: Casey's Plumbing Water heater 16.60
Address: PO BOX 30075 Other:
City /Stale/ZIP: PORTLAND, OR 97294 Subtotal
Minimum permit fee: $72.50
Phone: (503) 253 -0030 Fax: (503) 262 - 8251 Residential backflow minimum permit fee: S36.25
2 ,s-t)
CCB Lie.: 147298 Plumbing Lie. no.: 26 -725PB Plan review (25% of permit fee)
Authorized signature- "a 11 ' /y �` State surcharge (8% of permit fee) S
A Jf TOTAL PERMIT rr� ,g.
Print name: JULIE r! MPBELL Date: 03 -14-06 This permit application expires if a permit i9 not obtained within
180 days after it has been accepted as complete.
*Fee methodology set by Tri- County Building Industry Service Board.
1% Building \P Pemut4pp.do 06/05 440 -46i 6T(10 /02/CODt/WEB)
E 69Z8 6uigwnid s,est:o d91:ZO 90 17l, J21A1
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CITY OF TIGARD -- P L 7 v a
BUILDING DIVISION ? PERMIT #: O 9
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: H
Phone: (503) 639 -4171 � glihilp
Inspection Requests (24 Hrs.): (503) 639 -4175 ° ='I _
INSPECTION WORKSHEET FOR DATE: TIME: PAGE:
SITE ADDRESS: 9 ! 6 CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME:
DESCRIPTION:
OWNER: PHONE #:
CONTRACTOR: PHONE #:
Inspection Request Scheduled For: Date: a -- /62-0P Pour Time:
Code # Inspection Description Confirm # Contact # Message
, 3 0 °
Corrections /Comments / Instructions:
Ca.it.. T�- f t.4,1 ( "- )1 Ac- T i s /0 1.,,L L
K PASS I J PARTIAL APPROVAL n CANCEL I NO ACCESS
FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
• Inspector: _GI i'vt-A- A` Date: 3//6/6 6 Phone #: (503) 718-