Permit MII! CITY bITIGARD PLUMBING PERMIT
Il COMMUNITY DEVELOPMENT PERMIT #: PLM2007 -00032
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 2/1/2007
PARCEL: 2S 103CB - 04300
SITE ADDRESS: 12250 SW MARION ST ZONING: R -4.5
SUBDIVISION: WILLAMETTE NO.2 LOT: 022 JURISDICTION: TIG
Project Description: Replace 65' 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: 65 ft
DISHWASHERS: RAIN DRAIN: ft
Owner: FEES
WILLIAMS, MICHAEL R Description Date Amount
12250 SW MARION STREET
TIGARD, OR 97223 [PLUMB] Permit Fee 2/1/2007 $72.50
[TAX] 8% State Surcha 2/1/2007 $5.80
Phone : 503 -590 -5340 Total $78.30
Contractor:
PIPELINE PLUMBING
PO BOX V -108
333 S STATE ST REQUIRED ITEMS AND REPORTS
LAKE OSWEGO, OR 97034
Contact # : PRI 503- 624 -1906
FAX 503- 624 -1926
Reg #: LIC 158260
PLM 3 -510PB
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: AdA,014,4 /ajh Permittee Signature: 4 (4 JJ"
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.
Jan 31 07 03:48p PIPELINE PLUMBING (503) 624-1926 p.1
Plumbing Permit Appl> $CElVED FOR OFFICE 1 SF ()NIA
114 City of Tigard pp �A�' B �� a PetmlitN. Ill ,,, .-v003'--
• 13125 SW Hall Blvd., Tigard, ORJJ233 1 2007 Plan Revie
Phone: 503.639.4171 Fax: 5935981910 t�910TIGAHD Da1e'R
I G A R D Other Permit No.:
Inspection Line: 503.639 Date Ready/By:
)4---1 ®
r See Page 2 for
Internet: www.tlgard- or.ga,BUILDING DIVISION Notified/Method: / supplemental Information
TYPE OF WORK FEE* SCHEDULE
❑ New construction ❑ Demolition For spedoi Information use checklist
Description I Qty. I Ea. I Total
�Addirion/alteration/ replacement ❑ Ohm
New 1- 2- family dwellings (includes 100 ft for each utility connection)
CATEGORY OF CONSTRUCTION SFR(1)bath 24920
i- and 2- family dwelling ❑ Commercialfmdustrial SFR (2) bath 350.00
❑ Accessory building El Multi-family SFR (3) bath 399.00
El Master builder Each additional bath/kitchen 45.00
El O ther: Fire sprinkler ( sq. ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities
Job site address: I . D-T E t..,--.1 1..t ( du < A" Catch basin or area drain 16.60
City/State/ZIP: \ i. c\ Zrc.1 t CA.- t c"1---A-Q1.3 Deywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: I Project name: Footing drain (no. linear ft.: ) Page 2
Cross street/directions to job site:
Manufactured home utilities 110.00
Manholes 16.60
Rain drain connector 16.60
u l e c .SL,...) l a \ 'A.Le . Sanitary sewer (no. linear ft.: _ J Page 2
Storm sewer (no. linear ft.: _) Page 2
Subdivision I Lot no : Water service (no. linear ft.: 105) t Page 2
Fixture or item
Tax map /parcel no.: Absorption valve 16.60
DESCRIPTION OF WORK
1 , 1 T 16.60
Backflow prevents Page 2
)1 (LL.(r _ t� ek_ (D j 0)6 e - Backwater valve _
a t
e o O t AI C�� -.# [ � r v i Le .. Clothes washer 16.60
l` K Dishwasher 16.60
C1 PROPERTY OWNER I ❑ TENANT Drinking fountain 16.60
W Ejectors/sump 16.60
Name: j(,t(,� `� Expansion tank 16.60
Address: � f.� o..../1 Fixture /sewer cap 16.60
City/State/ZIP: Floor drain/floor sink/hub 16.60
Phone: O 5 63 (/0 I Fax: ( ) Garbage disposal 16.60
❑ 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: i Primer 16.60
City/State/ZIP: Roof drain (commercial) 16.60
Phone ( ) I Fax :: ( ) Sink/basin/lavatory 16.60
Tub/shower /shower pan 16.60
E-mail:
Urinal 16.60
CONTRACTOR Water closet 16.60
Business name: a n Water heater 16.60
-
Address: .333 St, 1�i.1 hull fi - cLi e. Si , -10 Other:
Subtotal
City/StaterZrP: L CL.lit 1r L 1 0 - c.2 C °11-1-31-4 0 Phone: ( - F ( Minimum permit fee: $72.50 -+ t
�p�.r -} I �t�lR ,`,3) L/0,4 - l 4 . t..p . Residential backflow minimum permit fee: $36.25
CCB Lic.: I5 7.5 a1LD Plumbing Lic. no.: S .. 10 P8 - Plan review (25% of permit fee) 0 State surcharge (8% of permit fee)
Authorized signature:
�/' lil.� (fYIQt TOTAL PERMIT FEE
Print name: 6- ILv l Lin c1 I Date: 13 t 0 I-- This permit application expires if a permit is not obtai e d within
180 days after it has been accepted as complete.
*Fee methodology set by Tri -County Building Industry Service Board.
1: 18mldvu\Pennits1PLM- PermitApp.doe 05/26'06 440- 4616T(I042/COM/WEB)
CITY OF TIGARD _ .. (k /
BUILDING DIVISION PERMIT #: PLM2007 -00032
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 2/1/2007
Phone: (503) 639 -4171 A 0 ,JE 1 1,
Inspection Requests (24 Hrs.): (503) 639 -4175 J " I .
1 ( e '
INSPECTION WORKSHEET FOR DATE: 2/2/2007 TIME: 7:03AM PAGE: 69
SITE ADDRESS: 12250 SW MARION ST CLASS OF WORK:
SUBDIVISION: WILLAMETTE NO.2 LOT #: 022 TYPE OF USE:
PROJECT NAME: WILLIAMS
DESCRIPTION: Replace 65' water service.
OWNER: WILLIAMS, MICHAEL R, PHONE #: 503-590.5310
CONTRACTOR: PIPELINE PLUMBING PHONE #: 503 - 6241906
Inspection Request Scheduled For: Date: 2/2/2007 Pour Time: (4
Code # Inspection Description Confirm # Contact # Me: ag- O ' d d
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330 W. er sere ce 042890 -01 503 -624 -1906 N
Correcti ns /Com ents /Ins ructio
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-PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: VZ,,_C Date: 2/276 7 Phone #: (503) 718 - 2 " 6( Z' 1