Permit MI CITY OF TIGARD
PLUMBING PERMIT
COMMUNITY DEVELOPMENT PERMIT #: PLM2006 -00594
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 12/18/2006
PARCEL: 1 S133DC -08900
SITE ADDRESS: 13225 SW SHORE DR ZONING: R -7
SUBDIVISION: WINTER LAKE LOT: 019 JURISDICTION: TIG
Project Description: 70' water service replacement.
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: 70 ft
DISHWASHERS: RAIN DRAIN: ft
Owner: FEES
BRANDENBURGER, KAREN J
13225 SW SHORE DR Description Date Amount
TIGARD, OR 97223 [PLUMB] Permit Fee 121181200E $72.50
[TAX] 8% State Surcha 121181200E $5.80
Phone : 503 -509 -8562 Total $78.30
Contractor:
LOVETT EXCAVATING INC
2925 SW HARTLEY DR
GRESHAM, OR 97080 REQUIRED ITEMS AND REPORTS
Contact # : PRI 503 -504 -2847
FAX 503- 288 -1630
Reg #: LIC 125507
PLM 26 -773PB
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 &L 4 , U,,ae Permittee Signature:
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.
x 12/.18/2006 14:44 5032881630 PAGE 01/02 •
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PlumbimQ PErmit ,A lication FoR � � � ,, • 1 S �o Received / ao b- a
City of Tigard 8 Irle l- 1% o '
13125 SW Hall Blvd.. Tigard. OR 97223 Plan Review Other Permit No.: _
X4 1 Y j j:.�,. ,:. ; ,.• •, ili
Phone: 503.639.4171 Fax: 503.598,19 � ,� a'� Date/B Ivne: Fa See PnRC 2 for
24- Hour Inspection Line: 503.639.41 e E O t Rcad
Y . ! I R / • a i4 " Supplemental Information
Internet; www.Ci.tiFard.or.us ,1 :'91'U[ • NntifiedlMethnd: •
TYPE or WORK _
_ , . For s if' rael inform n n u se check►itl.
❑ Now construction ❑Demolition Descrip I a. TatRl
0, Addition/alteration /replacement ❑ Other: New I- 2- family dwelling.' (includes 100 ft. For each utility connection)
• S L249.20
CATEGORY OF CONt5T1ii1t TIUN 350.00
[] C ommercial /industrial SFR (2) bath
1 - and 2 family dwelling
- SFR (3) bath 399,00
[] Accessory building ❑ Multi family Each additional bath/kitchen 45.00
❑ Master builder ❑ Other: Fire sprinkler ( , sq. ft.) Pngc 2
Job site address: v �1.
i00 SITE INFORMATION AND LOCATiON site utilities _
d � I Q W (, _ Y Catch basin or area drain 1 6.60
Drywell, leach line. or trench drain 16.60
City/State/ZIP: T� r Footing drain (no. linear ft.: ) Page 2
Suitc/bldg./apt. no.: Project name: Manufactured home utilities 1 10.00
Cross strcet/dircctions to job site: Manholes 16.60
3 ) 1-4`/ Ram drain connector 16.60
v Sanitary sewer (no. linear ft: ) Page 2
Storm sewer (no. linear ft,: ) / . Page 2
Water service (no. linear ft : q J Page 2
Subdivision: Lot no.:
_ Fixture or item
Tax map /parcel no.: Absorption valve 16.60
I3T9CRIP I`tON • OF WORK Backflnw preventer Page 2
1 -1 . „ 1 T" t r, 0 I I 1 - 13ackwatervalve _ 1(t•60 _ •
t/ C �� v Clothes washer 16.60
Dishwasher 1 6.(i0
• • Drinking fountain 16
0 PROPERTY OWNER I ❑ TENANT ejectors/sump 16.60
Name: 7�IJt/ Expansion Pink 16 -
Address: ` 1 Fixture/sewer cap 16.60
City /Stott /7..1P:
Floor drain /floor sink/hub 16.60
- •
p, O Garbage disposal 16.60
Phonc �) l O S Fax: ( )
Hose bib
16.60 0 APPLICANT ❑CONTACT lYrtLSON Ice maker 16.60
Business name: Interceptor /grease trap 16.60
Contact name: Medical gas (value: $ ) Page 2
-•
Address: Primer 16.60
Roof drain (commercial) 1(1.60
City /Statc/7iP:
511)1c/basin/lavatory 16.60
Phone: ( ) l Fax:: ( ) Tub /shower /shower pan 16.60
F.. -mail: Urinal 16,60
CONTRACTOR ' Water closet 16.60
Business n V Water heater . 16.60
_ l/�`4- t i�1
�r�l.Lld�_ -- v
Addre + (� 1 other Snbmtnl
City /State /ZIP: G'� �c�R 0,o lJ Minimum pemt fee: $72.50 /� . 4.1 Phone: (503) 5 0(-f - _ • Fax: (5' - 88- « • Residential backflow minimum permit fee: $36.25 . 70-( i/
yp Plan review (25% of permit fee)
CCl3 Lic.: . 3 Plumbing 1.ic. no.: 0 -- 3U
Stare surcharge (R% of permitfec) 5,
Autholired signature: _l j �� TOTAL. P1rRMI1' FEf; �
Print mime: &rn - �b W4 Date; 12.118 This permit application expires if* permit iii not obtained within
( 180 days otter it 1ms been accepted as complete.
"Fee methodology set by Tri- County Building Industry Service Bonrd
It\ Building \Permit* \PL.M.PamitApp.dnc nn/ns a Cr( InM1JCOM/WKal
01/04/2007 14:15 5032881630 PAGE 01/01
01/03/2007 11:45 PAI..5035981960 CITY or TIGARD w. "• "'
kii■tdilf .a."I
i ' :1 Building Division
. R equest for Permit Action 4
:. .y 6 +� /� Q��® SP '1'�li r\ � 1 ...1St- Ii3D 1 t'
♦ i
TO CITY OF TIGARD � . , �. o �
Permit System Administrator O p p1,
• 13125 SW Hall Blvd., Tgard, OR 97223 \' <"!
Phone: 503.718.2430 , Fa= 503.598.1960 w w- ^ox$� _ �
FROM: ❑ Owner ❑ Applicant 'Cout:actot Will . Staff
(check onej
REFUND OR Name: `
INVOICE TO: (&tsimestorTndivlth ii) Iry 111 _ 7 tat AC
V 0 1 mailin A dtiress: 2.-17.- J 5 Pr) . , = � V
cit /State /Zip: _ el v CI X F-- Sf
• 0y07 / Phone No.: •??` t .. 4 -- 7
PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (1):
CANCEL PERMIT APPLICATION.
E : REFUND PERMIT FEES (attach receipt if available).
INVOICE FOR FEES DUE (attich case fee schedule and explain below).
REMOVE CONTRACTOR FROM PERMIT (do not cancel permit).
Peunit #: t'I-A'1 - 0D10 —OOH17
Site Address or Parcel #: I 3 ,2ay 5 v? 6 k "bte-
Project Name:
Subdivision Name: Lot #: --
EXPLANATION:
AD l C XCJd
Si itibTai , ■r�..t ' rf • ! ' Date. 1
n ■
Print Name; 111 / 1 A
1. The Di rotor or Building Official may nethodre the refund of
n) any fee which was etrooeoutly paid or co11ec ad. -
b) not more then 80% of the land urn application fee when an oppllwdon it wield:end or canceled befets eery review ef6ort has been =vended.
e) not move then 80°h of the land ux applioldso Re for Issued permits.
e) not more then 80% of the building plan review Fee when an application is canceled before any plan review efm bee been expended.
d) not more than 80% of the building permit fen for leaned permits prior to any itspeeaon requests.
2 Rea man will be marred to the original Payer i.. the nacre method in which payment um received. Please allow 1 -2 wccka foe mewling refands.
t.i)1: ( LSE
Rte to S • s Adzuia: Date Er1111.1 Rte ea Adam: Date / Pin' B
-
Refund Proeee•0ed: Date elf B % Invoice Processed: Date B •
Pa m& Canceled: Date 17Mjili ,E'W Paceeil T. _ ..ed: Date
, � Date/ ,A� M Vf
la It 06 n doe cvtti51 1 06