Permit 11111 a CITY OF TIGARD 0 PLUMBING PERMIT
` COMMUNITY DEVELOPMENT PERMIT #: PLM2007 -00013
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 1/19/2007
PARCEL: 1S134CB-17700
SITE ADDRESS: 12272 SW ANTON DR ZONING: R -7
SUBDIVISION: ANTON PARK NO. 2 LOT: 104 JURISDICTION: TIG
Project Description: (1) floor repipe, replace (2) shwoer valves.
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: 1 CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: URINALS: GREASE TRAPS:
LAVATORIES: 3 OTHER FIXTURES:
TUB /SHOWERS: 2 SEWER LINE: ft
WATER CLOSETS: 2 WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Owner: FEES
ANDREA MITCHELL
12272 SW ANTON DR Description Date Amount
TIGARD, OR 97223 [PLUMB] Permit Fee 1/19/2007 $132.80
[TAX] 8% State Surcha 1/19/2007 $10.62
Phone : 503 -810 -9544 Total $143.42
Contractor:
CROWN PLUMBING
5429 SE FRANCIS
PORTLAND, OR 97206 REQUIRED ITEMS AND REPORTS
Contact # : PRI 503- 771 -9449
FAX 503 -771 -9454
Reg #: LIC 42671
PLM 34 -70PB
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: d `� �` Permittee Signature: , -e
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.
t.
01/19/2007 12:37 5037719454 CROWN PLUMBING PAGE 02
. REC;EiV7r1f)
Plumbing Permit Application ruli 011 u'si: (.) \i.1
City of Tigard JAN 1 9 2007 Received IN ., g, DatcB ; "I° Permit N, U(%Q I3
13125 SW Ha11 Blvd Tigard, OR 97223 y �4. / /
N Phone: 503.639.4171 Fax: ,art : p}� i Plan Review
I t c ; .� i; i inspection Line: 503.639,41
'g'� ' _Liu DaIrIB Other Permit Nei.;
,
71st g nov � . r D R nd y / B
Internet: www.ti d -or. ov 1��� •�. ��rt� EZy See o
NatifiCd/Metho d: - /
I;'_f,� ii;, ;:: ' 5upplcme z etal ] nrarmntion
TYPE OF WORK lE 6 . 5 fvHED 1
,. C EE
❑ New construction ❑ Demolition For special i,lformatloa use checklist.
Eil 1)cscri . tion • . Ea. Total
Addition /alteration /replacement ❑Other: New 1- 2-family dwellings (includes 100 ft. for each utility connection)
j9liiii :;;,l;; „,. :.,:'., ,,., . . OF CONSTRUCTION SFR (I) bath
249.20
® l- and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 350.00
121 Accessory building El Multi-family SFR (3) bath 399.00
❑ Master builder ❑ Other: Each additional bath /kitchen 45.00
( i'tii;;i; I ? ; i; ; y . .,' : :`: : 'ifI3'SITE I1VF0 Fire sprinkler ( sq, ft.)
nkle Page 2
RMATION AND LOCATION Site utilities
Job site address: 12272 SW Anton Drive Catch basin or area drain 16.60
City / State/ZIP: Tigard, OR 97223 Drywell, leach lint, or trench drain 16,60
Suite/bldg. /apt- no.: Project name: Footing drain (nn. linear ft.: `) Page 2
- -
Cross street/directions to job site: Manufecn,rcd home utilities 110.00
Manholes 16 : 60
Rain drain conncctor _ 16.60
Sanitary sewer (no. linear it; �) Page 2
Storm sewer (no. iincar R,; _) Page 2
Subdivision: _ i -qt no.: Water service (no. linear tl.: ) Pape 2
Tax map /parcel no.: Fixture or item
Absorption valve
. gif , DESCRIPTION OF WORK 1 G,GO
Ili
sorpt a
Backflow prcventer ■ Page 2
ONE FLOOR R>JPTPE, REPLACE TWO SHOWER VALVES Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
';!! 'r ;N!! OWNER J . d ti , A r Drinking fountain Fijcctorsfsump 16.60
Name: ANDRA MITCHELL
16.60
Expansion tank ■ 16.60
Address: 12272 SW ANTON DRIVE
Fixture/sewer cap 16.60
City /State /ZIP: TIGARD, OR 97223 Floor drain /floor sinlc/hub 16.60
Phone: (503)810 -9544 Fax: ( ) Garbage disposal 16.60
iid+;::; !:...: ., ®APPf:7CANT ® CONTA.0 r PERSON. •`. Huse bib 1 6,60
Tee maker ■
Business name: CHRISTIAN PLL1M$ING..INC. DBA CROWN PLUMBING
Interceptor /grease trap 1 6.60
Contact name: DENNIS UNDERWOOD Medical gas (value: $ ) Page 2
. ■
Address: 5429 SE FRANCIS STREET Primer 16.60
City/ State/ZIP: PORTLAND, OR 97206 Rnof drain (commercial) 16.60
Phone: (503) 771 -9449 I Fax; : (503) 771 -9454 Sink/basin/lavatory 3 16.60 49.80
E -mail: Tub /shower /shower pan 2 16.60 33.20
Urinal 16,60
, 3 f it • �lHiE :Id " :;r;; ;., • •„,,,•,;.„ - .'• CONTRA CTOR
Water closet 2 16,60 33.20
Business name: CHRISTIAN PLUMBING, IN DBA CROWN PLMBiNG -
TI water heater 1 I6.60 16.60
Address: 5429 SE FRANCIS STREET Other.
City/State/ZIP: PORTLAND, OR 97206 Subtotal 132,80
Phone: (503) 771 9 Minimum permit fee: $72.50
( ) 449 _ Fax: (503) 771 -9454 Residential backflow minimum permit fee: $36.25
CCB Lie.: 42671 Plumbing ,: 34 -7011 Plan review (25 %ofpermit fcc)
Authorized signature: State surcharge (8% of permit fee) 10.62
TOTAL PERMIT FEE 143.42
Print name: DENNIS UNDERWOOD Date: 01/19/2007 This permit application expires if a permit is not obtained within
180 days after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
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01/23/2007 12:35 5037719454 CROWN PLUMBING PAGE 01
01/23/2007 12:26 YAX 50 38981960 CITY OF TIGARD � 2)003.
siAN
uild ng Ihvislon y _ . 2007
Request for Permit Actin 1 ' � "
D
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fl
TO: CITY OF TIGARD
Permit System Administrator
13125 SW Hall Blvd, Tigard, OR 97223
Phone 503.718.2430 Fain 503.598.1960 www.tigard- orr..gov
FROM: ❑ Owner ❑ Applicant > Contractor ❑ City Staff
(cheer eaei
REFUND OR Name:
INVOICE TO: (13"ines:; ar Individual) C. Ira ty w . ? I -' o
v (.1 Mailing Address: 541 Z c r � f .� c. { f
�� / .7 City /State /Zip: l � e � O ►Z 2, o C-
Phone No.: (Se )) ? ?/
PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (1):
CANCEL PERMIT APPLICATION.
REFUND PERMIT FEES (attach receipt, if available).
❑ INVOICE FOR MPS DUE (attach case fee schedule and explain below).
❑ REMOVE CONTRACTOR FROM PERMIT (do not cancel permit).
Y c t u s i t #: aL FYI 2 o G 7, at) o 1 3
Site Address or Parcel #: t 2 Z. 7t, w �a..'lf o t ✓ : 0, I' • r -Ad
Project Name:
Subdivision Name: It #:
EXPLANATION: c.. _ .•-e . - C — CD ir 0
Signature: Date: / / - 0 7
Print Name: T ( ,Q u c C e s a s ., f
I. The Director or Blinding Official may a uhotize the refund of:
any fee which ,rye eneeeee try paid or collected.
b) not snore than 50 of the land uec applleadoe fee when an applimtfan is withdrawn or canceled before any =view effort has bccn expended.
c) n more than so% of the lend tree el,P rtdan Fes Fat issued pcemits.
e) not teem thin 9O% of the building plan review fee when an application M etneckd before any plan review effete hen been expended.
t r i nor Mete that SO% of the bteldina pe stir fee foe booed peanits pent to aey itttpeedan requettee,
2 Refonde will be retuned to the ogginal Pntiyet in the Parse method in '+hull payment was received, Phrase aqua 1 weeks foe roeaaseag rofands.
1 C ?111(:1: t ()NI '1
Rte to . Admia:. Date /m07 13W721 Rte tie Bid-, Admix,: Data /Q jf, .) 8 •_,���
Rtflsrtd Pteces3Cd Date Qr /s'we Invoice Processed: Date S •
Pemut Canceled Date Lf ritN21 B - Puce] T _ Added Data a _
• • • t a Date //rjaMi Method L Amount / _ _
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