Permit L m
n
C,I TY OF TIGARD PLUMBING PERMIT
'' COMMUNITY DEVELOPMENT PERMIT #: PLM2007 -00363
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 8/1312007
PARCEL: 2S114BD - 01600
SITE ADDRESS: 09790 SW RIVERWOOD LN ZONING: R -4.5
SUBDIVISION: COPPER CREEK STAGE 2 LOT: 043 JURISDICTION: TIG
PROJECT: NELSON
Project Description: Install on - demand gas water heater.
CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: R3 FLOOR DRAINS; TRAPS:
STORIES: WATER HEATERS: 1 CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES:
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Owner: FEES
GORDON NELSON
9790 SW RIVERWOOD LN Description Date Amount
TIGARD, OR 97223 [PLUMB] Permit Fee 8/13/2007 $72.50
[TAX] 8% State Surcha 8/13/2007 $5.80
Phone : 971- 221 -8223 Total $78.30
Contractor:
3 MOUNTAINS PLUMBING
PO BOX 386
SHERWOOD, OR 97140 REQUIRED ITEMS AND REPORTS
Contact # : PRI 503- 925 -1342
FAX 503- 925 -9104
Reg #: LIC 169499
PLM PB99
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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 cal 'ng 503.246.6699 or 1.800.332.2344.
Issued By: ,J/ /Ill j A Permittee Signature: fC Q . / iR/ 2, I `( t
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.
08 -10 -2007 11:16 3 MTNS PLUMBING 5039259104 PAGE2
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Plumbing Per p RECEIVE®
Permit A plicatio
IN City of Tigard U G 1 0 2 007 nat�i�>e 8 f l3 1 O r SL Permit No.: put1 2007 _0032
�� • 13125 SW Ilan Blvd., Tigard, OR 9722_ Ilan Rev
P Phone: 503.639.4171 Fax: 503.5084yety O TIMID Dyta&gy: Other Pennit No.:
I' I t A It I
Inspection Line: 503.639.4175 Bath Divisii� � Ready,sy: r • 121 See Page 2 for
Internet: www.tigar4-or.gov / - Se. , lemeatal lnfOrmatiun
TYPE OF WORK FEE* SCHEDULE
❑ New construction ❑Demolition For special i tfornt1ian use checklist -
Description I Qty, I Ea. I Total
' Addition/alteration /replacement ❑ Other New 1.2-family dwellings (includes 100 f. for each utility connection)
CATEGORY OF COINSTISUCI ION SFR (I) bath 249 -20
V 1- and 2- family dwelling ❑ Commercial /industrial SFR (2) bath -- 350.00 �'
❑ Accessory building 0 Multi - family SFR (3) bath 399.00
.- °--- -- Each additional bath/kitchen 45.00 •
❑ Master builder ❑ Other
Fire sprinkler ( sq. ft.) Pagc 2 .
JOB SITE INFORMATION AND LOCATION Site utilities -
Job site address: 7 9a 2 I r (ntoyamod Lit Catch basin or area drain r
q 16.60
City /State /ZIP: ' Drywen, leach line, or trench drain 16.60
Suite/bldg, /apt, no.; Project name: Footing drain (no. linear ft.: _) Pagc 2
Manufactured home utilities 110.00
Cross street/directions to job site: Manholes 16.60
• Rain drain connector 16.60
• Sanitary sewer (no. linear ft.: ) Page 2
Storm sewer (no. linear it: _____) Page 2
Subdivision: Lot no.: Water service (no. linear ft.: _) Page 2
- Fixture or item
Tax map/pm-eel no.: Absorption valve 16.60
DESCRIPTION OF WORK Backtlov prcventer Pagc 2
.f' 7./). jy,e.',& 4v7 - . ' Backwater valve 16.60
e_i_01 6k5'
`w Clothes washer 16.60
Dishwasher 16,60
PROPERTY OWNER 0 TENANT
Drinking fountain 16.60 .
/ o, -.y Ejectors/s 16.60
Name: � r 4 62 Q ire / /J 4J Expansion tank 16.60
J
Address; Q , ) �ueru 10 L.1 /n • Fixture /sewer cap 16.60
City/State/ %1P: ' arr� • Floor drain/floor sink/hub 16,60
Phone (g1/ )) a o� f ' .9
Fax; ( )
c2Q....,9,2Q.3 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: Primer 16.60
City /SIate /ZIP' - __._��,__ - - -� Roof drain (commercial) 16.60
Phone; Sink/basin/lavatory 16.60
{ ) Fax ( )
Tub/shower /shower pan 16,60
- - - -- - - -- -- - - - - --
E -mail:
Urinal t. _ 16.60 ._
CONTRACTOR Water closet 16,60 •
Business name: 3 Row? ¢lk1 ".s P ' .I Water heater 7� .
a t 16.60 /4. 4 0
Address: c / S co , -/Ae c eC.1L ' <,Ce .ter /0 Other.
/; Subtotal
City /Statc/ZIP; S Or 9 7/Va
M inimum permit fee: $72.50
Phon yea Fax: ( 3) 9d�_ 2 f2 y . Rcsiden bnekflow minim permit fee: 536.25 `- : O
GCB Lic.: jA Plumbing Lie. nu.: p8 F9 Plan review (25% of permit fee)
Authorized signature:, / '` State surcharge (8% of permit fee) c,SD
7 ✓.e.np. ... _ D_
TOTAL PERMIT FEE 2d/,
Print name: M . ijj O1 Date: � 09 7 This permit application expires if a permit is not obtained within
/' v 150 days after it has been accepted as complete.
*Fee methevtnlnov cet by Tri- !'minty Rnildinp lnfiwtry Srrv+rr Armed
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CITY OF TIGAR®
BUILDING DIVISION PERMIT #: PLM2007 -00363
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 8/13/2007
Phone: (503) 639- 4171p°diJl� j
Inspection Requests (24 Hrs.): (503) 639 -4175 ...:.� `_- ` /d/C2/
INSPECTION WORKSHEET FOR DATE: 8/15/2007 TIME: 7:00AM PAGE: 54
SITE ADDRESS: 09790 SW RI VERWOOD L.N CLASS OF WORK:
SUBDIVISION: COPPER CREEK STAGE 2 LOT #: 043 TYPE OF USE:
PROJECT NAME: NELSON
DESCRIPTION: Install on= demand gas waterheater.
• OWNER: NELSON, GORDON PHONE #: 971- 22t8223
CONTRACTOR: 3 MOUNTAINS PLUMBING PHONE #: 503.9251342
Inspection Request Scheduled For: Date: 8/15/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
395 Mi c, inspe *on 053983 -01 503 - 925 -1342 N •
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C orrectPons /Comments /In ructions:
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.- n PARTIAL APPROVAL CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED •
Inspector: ✓
Date: J l 7 / Phone #: (503) 718 -
p Da / ( ) •