Permit C ITY OF TIGARD PLUMBING PERMIT
AA DEVELOPMENT SERVICES PERMIT #: PLM2005 -00420
,LaAi?. 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 9/1/2005
PARCEL: 2S111DB-13800
SITE ADDRESS: 15085 SW DAWN CT ZONING: R -4.5
SUBDIVISION: LAUNALYNDA PARK LOT: 003 JURISDICTION: TIG
Project Description: Backflow preventer for irrigation.
CLASS OF WORK: OTR GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS: 1
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: ft
DISHWASHERS: RAIN DRAIN: ft
Owner: FEES
KRIBS, GORDAN J AND LINDA J Description Date Amount
15085 SW DAWN CT
TIGARD, OR 97224 [PLUMB] Permit Fee 9/1/2005 $36.25
[TAX] 8% State Surcharl 9/1/2005 $2.90
Phone : Total $39.15
Contractor:
DOWN TO EARTH IRRIGATION
13075 SW PACIFIC HWY REQUIRED ITEMS AND REPORTS
TIGARD, OR 97223
Phone : 503 684 - 3500
Reg #: LIC 8169
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 - 246-6 or 1- 800 - 332 -2344.
Issued By: 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.
}
FROM FAX NO. : Nov. 12 2002 01:27PM P2
Building Fixtures
Permit App // ,,, r O ,
Plumbing ,
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>USE, ON l , MI 5
City of Tigard u � nags ; / / Permit Na. "00
13125 SW Hall Blvd., Tigard, OR 97223 Plan Revie
Phone: 503.639.4171 Fax; 503.598.1960 AUG 3 0 ,y , :�i Date/By: Other Pertrdt
24- flour Inspection Line: 503,639.4175 1 L
.., , , pate ReadyBy: .i s• E! See Page 2 for
Internet: www.ci.tigard.ar.us c , e .2 NotifiediNlethod: Supplemental Information
cU' t i is MS's -�t w t II 'i;l �I�� jyU iy i � "r 41i I ' '�'. f (j ✓ . at'J > Sr h e r' • 41 : e Sl C:�4 177 ' ' TcOp t?.,7, . ::".; :VP - t c :; ' ,�: t.;,
y l .r w,'�l,y,r 1144 ;I� 9t �• t Fc .,, f r r„ o- 'a a j .• - ,= 0 , ..7C •.. ' I.� 6 r s:t:.
tl. JJ`+: Gr' r.. �i�i�r. �A u�:. �' dr�ci�Gf ,��'��- �''�LC:9':�>'fkJGh �YIY•';I . Pn:' L'.:' 2d,'`., t".' �1r: s:,..: 1L �. I��?�4s. vl .2i G'�✓��:'I�a�lf4'N`�'�" X1 1 �'�2 ? •T ��...�t7�•.[n,•...?'.,'i�ee: ..., .... ..a:,_..r ....- .:' .,
■-1 ew construction " ❑ Demolition For special information use checklist
Description Qty, Ea. Total
❑ Addition/altcration/rcplaccmcnt ❑ Other:
}� � � ��, New 1- 2- family dwellings (includes 100 ft. for each utility Connection)
711 � ` r � v � ,� f .K e a rl, .M fr i i 3 ` 2∎ . 75 ` i i - � S I i L tr 9 h am ' ..74 SFR (1) bath ■ 249,20 t.
170 and 2- family dwelling ❑ Commercial/tndustrial SFR (2) bath 350.00
■ Accessory building 0 Multi- family SFR (3) bath 399.00
❑ rp Master builder p Other
Each additional bath/kitchen ■ 45.00 MI
r t �' }'1113 P y � , ' J A „' �E�IL1 F ( I 43i a y 1 J Wji i f i t' r Ll�l�9 � � "� µ1l 1,34 gti
• f�� Fire sprinkler ( s€ ft) Page 2
� ''+ilJii i'di r�: .., _,uT :zt.x; S .3..�_'i: ;: 1. : •t' ^ ? !i at ivIi7 hat ',11t Site utilities
Job site address: i °
I d o f la C Catch basil, or arcs arain ■ 16.60
City/State/ZIP: l �� f , ' 2 'f 7 .. y Drywell, leach line, e, or wench drain 16.60
Suite/bldgJapt- no.: 1 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
Sanitary sewer (no. linear ft.: ) Page 2
Storm sewer (no. linear ft: ) Page 2
Subdivision: I Lot no.: Water service (no. linear ft.: ) Page 2
Tax map /parcel no_:
Fixture or item
(1k IrG��pir1? i IUd r I G i iw �G Ki r I n A p Absorption valve 16.60
N 7rr'tF '� 1 I �r�li . f4 i�C X f l ' 1 t" 1 i '-€� i iR , gd; t' W t t Y((t�h,V
3/i ?✓1 ,:h`, ,7 ;l4. L_ ;,5r; : - . ,�iLt_. r!�. r M" .- 1 c8 .mss@ '•�'n . 4' `s lsilENt Backflow preven ter Page 2
Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
M rnr,a 1 i r_ r ?, f ✓ ls�)9o.Ef , -n+ II ' p in ^� n^ if i
I drt( ri i � l ' � , �} 0 ) ea[[ �I i n � � ^ 1 �ff 1 �' '�`o ; � � 11 1 i p ' ^ ' �� �� r " i Ci � ?ir9k �i r + i��� Drinking 16.60
1 l fi ei.l l td i,F_ :,'� i 5 'op i:.1. a : - 1,1 ,,;it 9" •"'iw Il4b " 7! ��.
.� Ejeetars/surnp _ 16.60
isf Name: G
• Expansion tank 16.60 IN
Address: f 5o AS 5 LA.) Oot` e.6 . C . Fixture/sewer cap 16.60
City/State/ZIP: (t '� O Floor drain /floor sink/hub 16.60
Phone: ( ) t Fax 803 ) Z3 , l3 A Garbage disposal 16.60
,�C }''StGl TTI � tOrr7Y• ?Y ' F- Kfi M {1,7,7, 1 ilr' ] ' `t1z ` 117R 3?'i'"34, yT xPl. ./
,'+ a pA n .� :v .t & rLr ,21 TI �1 9 IJg r�i PrAiit ii ! 4I 1 ai r I t
1�). l.'i.•Z...>": .:1.�: 7 . C. ��6' 4v�� i.._' 1 �. .:,._ .:.. i� .. LlL_: C,, .� �G I N'� 16.60
�.,����D.t. .. 16.60
Business name: (�,.,t� vl ...0 ' - (tb
�� ^^�� Interceptor/grease trap 16.60
Contact naxtte: o c i 0 cso Li v Medical gas (value: S ) Page 2
Address: t t, !Q - . ■ Primer 16.60
ity/ tat AI': ■ ■ . . a 0 • Roof drain (commercial) 16.60
p
Phone: (503) ( s2. 2 / � 2 , 5 . F ax:: 1 os 3 97 Sink/basin/lavatory 16.60
E -mail Tub /shower /shower pan 16.60 III
mt 7• "�J 1 I I� Pj 'v�IH +y , a 7r"t" �(tF0 9 iR;ilwi'v7l1 V n w. n _ urinal
rfi Cl !� t n ] 6.60
, ' ,,,, hvI ^^',.71}}Ks'" 4.,.. ., L�oa jf!l ^c c aa* Lt . , ,:., �y 4...i l 7 .,�df K '� 1
S ,ul ��.'n: � 1 � , �� >�? "� 3r • c.. � .:lu.l r.•t`k.. ar I s- .,,,5 �•y1,�-� Writer Closet 16.60
Business name: (11100 t A . , v • Water heater 16 -60 la:g
Address: , Other:
City /State/ZIP: t . _ ■ Q C 7.2 Subtotal
Minimum permit fee: $72.50
Phone: (5o3) (.(2 i SO O Pax; ( ) Residential backflow minimum permit fee: $36.25 Mill
CCB Lic.: -Plumbing Lic. no.: do. 6 9 Plan review (25% of permit fee)
State surcharge c 8% of i'
Authorized 6i ature: 8 (8% permit fee) P.
f �� J "� +� TOTAL PERMIT PEE firevAy
Print name: 5\.vver Date: 8 { ran This permit application expires if a permit is not obtained wt hin
180 days after it has been accepted as complete. a1. / 0
"fee methodology set by Tti -County Building Industry Service Board.
i.\ Building \ Petmita1PI.MP-PemtttApp.doe 17/03 440-4616T(OU/07/COM/WBB)
CITY OF TIGARD
BUILDING DIVISION PERMIT #: PLiVi2006-00420
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 9,11/2,006
Phone: (503) 639-4171 14111110tiliT\
Inspection Requests (24 Hrs.): (503) 639-4175
INSPECTION WORKSHEET FOR DATE: 213/2006 TIME: 7:02AM PAGE:
SITE ADDRESS: 16cik5 W i)AVYN CLASS OF WORK:
SUBDIVISION: LAUNALYNDA PARK LOT #: 093 TYPE OF USE:
PROJECT NAME: MSS
DESCRIPTION: Dackftow preventer for iingation.
OWNER: KMBS, GORDAN J AND LINDA J, PHONE #:
CONTRACTOR: DOWN TO EARTH IRRIGATION PHONE #: 5m-684-360g
Inspection Request Scheduled For: Date: 2,./3/2006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
396 Misc. inspection 02(201-01 fi()3-684-3500
Corrections/Comments/Instructions: , e;
d
)1.
ip -Ass PARTIAL APPROVAL fl CANCEL NO ACCESS
I FAIL 31 CALL FOR INSPECTION 7 ADDITIONAL FEES ASSESSED
•
Inspector: Date: Phone #: (503) 718-