Permit l / - o ff
CITY OF TiGARD
PLUMBING PERMIT
° COMMUNITY DEVELOPMENT PERMIT #: PLM2006 - 00551
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 11/13/2006
PARCEL: 25111 DC - 06500
SITE ADDRESS: 09480 SW BRENTWOOD PL ZONING: R -7
SUBDIVISION: SUMMERFIELD NO.9 LOT: 499 JURISDICTION: TIG
Project Description: Drain relocation for tub to shower conversion.
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: CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES:
TUB /SHOWERS: 1 SEWER LINE: ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Owner: FEES
FOREST CLEMENCE
9480 SW BRENTWOOD PL Description Date Amount
TIGARD, OR 97224 [PLUMB] Permit Fee 11/13/200E $72.50
[TAX] 8% Statc Surcha 11/13/200E $5.80
Phone : 503- 652 -2626 Total $78.30
Contractor:
MRP SERVICES
PO BOX 33585
PORTLAND, OR 97292 REQUIRED ITEMS AND REPORTS
Contact # : PRI 503 -652 -2626
FAX 503- 241 -6565
Reg #: LIC 106824
PLM 3 -265PB
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: Permittee Signature: 77
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.
- A-
Plumbing Permit Application � RO12 url IcCI usE (01,Y
City of Tigard � CEI V E R De e/Bv: I ' t 1, 1....# iriiWi __ -Old ,�
13125 SW Hall Blvd., 'Tigard, OR 97 28 Plan Review
Phone; 503.639.4171 Fax: 503.596.1960 1 2V1 � 2 " "2" il ti. 11 Dat Other Permit No.:
`i
24- Hour Inspection Line: 503.639.4175 NOV �; Date Ready /By: Julys. la See Page 2 for
Internet: www.ci.tigard.or.us i 1 Notified/Method: Supplemental Information
Ak, �''Y .Pi +" ;i: a �� • L 1 '� i. L�K" .rapeaviT.,•Art", 3 is
❑ New construction BU
• 'I r iemalition ' For special information use checklist
,
Description I Oty. I Ea. I Total
1 1 Addition/alteration/replacement ❑ Other:
New 1 - 2 dwellings (includes 100 fl. for each utility connection)
4 7,1 i e l l 7 i ' 1'7 , k �a ® ' i n' ..' ,� e s • 't:;it : '� I
SFR (I) bath 24920
►.+ I. and 2- family dwelling ❑ Commercial/industrial SFR (2) bath 350,00
ID Accessory building ❑ Multi - family SFR (3) bath 399.00
ID Master builder ❑ Other
Each additional bath/kitchen 45.00
*a,174,, , �'qT, Fire sprinkler ( sq. tt.) Page 2
, 1 }r7 r ,'"' (?,le ' w o + Sm 1 F M - Y 6 to 4, ; ' AY y . i' :''+' x . , � site utilltic6
lob site address: ttff 1< I 1• _IV •li 1 Catch basin or area drain 16,60
City /State/ZIP; 1 11 :it' • � ,.RI� It Drywell, leach line, or trench drain 16.60
Suite/bldg./apt. no.; Project name: / t Footing drain (no. li ft.; Page 2
Manufactured home ut 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 ft.: ) Page 2
Subdivision: I Lot no.: Water service (no. I incur 1; ) Page 2
Tax map /parcel no.: Fixture or item
Absorption valve 16.60
r , . ,, ,n�' ' 4.,.1 Se 'I �1' <kfPL''...;: !Ns'. , '�l C +.
: E '1 :' .IA '' 4 . ,�'.+':i� iii 1ST. �t :"•.4 s � ;,...E .1:4 '4i, Y' s r
_nwa5, �. x. 4�� +� - 3_.}��i*nr�- ?T`Xth.�`' .a`L� 4;ki,...,':9'��'�,: Backtlow preven[er Page 2 I�
0.( *e C g j ,(tea TL ' � *) Backwater valve 16.60
''friA o' A� Clothes washer 16.60
•
Dishwasher 16.60
qq 55
t { n y , m , _ r : 0 ' t d3lu Z Tl�' r i` ,r J� +• ,f k Z'• . . Drinking fountain 16.60
t Il . ''� � I.. . ,� "_ y . y K:..P. �4a.� , .. - • p.. , .+..:.
e ,1 t . � , 9 � ' S f►W.. U(, s •.;• ti ° x
r" ' '" "'' " �-:i Ejectors/sump 16.60
Name: I] 0 i 4 l _ / J ' l.. / Expansion tank _ 16.60
Address: 4. ( q lrallMllrMierjrlIll1 . Fixture/sewer cap 16.60 I
City/State /ZIP: I aii f ' g ` , L 1 , ,� Floor drain/tloor sink/hub 16.60
Phone: 03) j F Fax: ( ) _Garbage disposal 16.60
,, rte � '
" 1`+; cur ;` _ �'al r _a . "k ll re 4
lm ' rS � fi . 1 "'Tv .. ,, Hosc 16.60
��/( � ,. a ' ` . 5s ° " t ``` Ice maker 16.60
Business name: 1' 1 F. P _ , "Let,c Interceptor /grease trap 16.60
Contact name: ii ; • 14- r t .1N
Medical gas (value: $ ) PkIge 2
Address: P O : r 2L5EG Primer 16.60
City/State/ZIP: ' 11 a /.�...o. lit! ? t_u Roof drain (commercial) 16.60
- Phone: ( j 3) r _ •L r , Fax :: (, Q' • Rawl
_ Sink/basin/lavatory 16.60
Tub/shower/shower pan 16.60
E trail / _ 1(� � 6 I■ I i U e Urinal n 6i:i5 tot{it il4r �c t'iyul �i weir f ey > 4 ��
iu j` ^ ,,. 16
T
•
h, za e ' � n,J�is•Ll. +a. ; 01 . '1 rxrf-x .. .�'s`�? �I i � !a° � . ....:.r:. _• Water closet _ 16.60
Business name: ,l1 1 :& ` or, ` : I L i Water heater 16.60
Address: i1 Q . X 3 3 I Other
. City /State/ZIP: ° p] .a . - 'V, del a Subtotal to ! i (p . (p D
Minimum permit tee: 572.50
Phone: 3) I • a i , „� . = ' Residential backflow minimum permit fee: $36.25 is • - l�
!�
CCB Lie.: , Plu Lic.no.: 3 , � (p S Q 0� rm
Plan review (25% of permit fee)
1
Authorized signature: -% di ` State suroharge (8% of permit fee) �
_ TOTAL PERMIT FEE /g', 30
Print name: rI-Jfl' c ' OW N SO'L) Date : it.--/Olik /Olik This permit application expires if a permit is not obtained within
• [ 180 clays after it has been accepted as complete.
*Fee methodology set by Tri- County Building Indusny Service Board.
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CITY OF TIGARD
BUILDING DIVISION PERMIT #: PLM2006-00551
• I 13125 SW Hall Blvd., Tigard, OR 97223 0/ DATE ISSUED: 11/13/2006
Phone: (503) 639 -4171 f 11 //31 nspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 11/20/2006 TIME: 7:01AM PAGE: 60
SITE ADDRESS: 09 480 SW BRENTWOOD PL CLASS OF WORK:
SUBDIVISION: SUMMERFIELD NO.9 LOT #: 499 TYPE OF USE:
PROJECT NAME: CLEMENCE
DESCRIPTION: Drain relocation for tub to shovver conversion.
OWNER: CLEMENCE, FOREST PHONE #: 503 - 652.2626
CONTRACTOR: MRP SERVICES PHONE #: 503
Inspection Request Scheduled For: Date: 11/ ?0/ ?006 Pour Tim •
V —I
Code # Inspection Description Confirm # Contact # Mess ge "'
320 Plumbing rough -in 040001 -01 503.652 -2626 r `Y
Corrections /Comments /Instructions:
i
-1 0 ham 0 _..
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: \m ( Date: �,l /�� Phone #: (503) 718- 2.>f Z/