Permit \'= `' CITY PLUMBING PERMIT
° C COMMUNITY DEVELOPMENT PERMIT #: PLM2008 - 00161
TICAR 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 4/18/2008
PARCEL: 2 S 109 D D - 0 8400
SITE ADDRESS: 12797 SW DA VINCI LN ZONING: R -
SUBDIVISION: BELLA VISTA LOT: 014 JURISDICTION: TIG
PROJECT: BELLA VISTA
Project Description: I nstalling backflow preventer.
CLASS OF WORK: ALT 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
RIVERSIDE HOMES, INC.
1925 NW AMBERGLEN PKWY Description Date Amount
#200 [PLUMB] Permit Fee 4/18/2008 $36.25
BEAVERTON, OR 97006 [TAX] 12% State Surch 4/18/2008 $4.35
Phone : 503- 645 -0986 Total $40.60
Contractor:
PRO LANDSCAPES OF OREGON INC.
PO BOX 261
ST. PAUL, OR 97137 REQUIRED ITEMS AND REPORTS
Contact # : PRI 1 -503- 633 -3400
FAX 1 -503- 633 -3401
Reg #: LIC 7326
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.
•
ermittee Signature: 500 �
Issued By. mss— c � -1 -.01 • /i'�
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.
`iO4/16/2008 12:58 15036333401 PRO LANDSCAPES PAGE 02/03
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® 13125 SW Hall Blvd„ Tigard, OR 97223 = Date/B : �/%/L 4 Aug Permit No.: /L!�) 3 ��i rL� // /
t Phone: 503,639.4171 Fax 503 R r ",- i Plan Review O V�/C1 !(O I
k "
63941 Other Permit Nn,;
","` rn �*�` Inspection Line; 503,.'75 �t ; , � �,
d t 11{4& I nternet www.tigard- or,gov - —' ; j' .. D Ready/By: /Wig 121 see Pn r 21Ur
Notificd/Mothod' Snppramcntal Information
TU E OF'WoRJ r
»E* stmt./ E
15 New construction 0 Demolition Fors ;of in orntation use checklist
-
Dcscri . tion
0
Addition /alteration /replacement ❑ Other: Total
New l- 2- 11bmily dwellings (includes 100 ft. tior each utility connection)
CATEGORY OF • CONSTRI/CfON SFR (1) bath 249.20
1- and 2- fa mily d welling ❑ CommerciaUttdustrial SFR (2) bath 350.00
0 Accessory building ❑ Multi - family SFR (3) bath EMI 399.00 Mill
❑ Master builder Other: Each additional bath/kitchen - 45.00 M.
Fire sprinkler ( sq. ft,) Page 2 —
,101. SITE INFORMATION AND Locie `ION Site utilities
Job site address: al 41 5W 00 y Catch basin or area drain MIIIIIMSIMIE
City/State/zrr: -T'a'i ant )r_ it 1 2... Drywell, leach line, or trench drain 16,60 —
SuitelbidgJap no.: Projec [/fit/
t na -� V� Footing drain (no. linear it.: _,_) Page 2 MN
Cross street/directions to job site: v Manufaen,red home utilities 110.00
-- Manholes 16.60
Rain drain connector 16.60
Sanitary sewer (no. linear R.: ) Page 2
Storm sewer (nn, linear ft.: ) Page 2
Subdivision: Lot nn . Water service (no. linear ft.; _ Page 2
Tax map/parcel no -: Fixture or item
_ . Absorption valve 16.60
DESCRIPTION N OF WORK Backllow
- prev enter Page 2
lel, l, # •i r'n u , 1 nt _ Backwater valve 16.60 EMU
Clothes washer =11 16,60
Dr rag fo 16.60
WA 1'IfOPERTY OWNER 0 TENANT Drinking fountain 16.60
Ejectors/sump _ 112311
Name: \\ir' Z 7 it ' *(1 ii - ._ 1 • Expansion tank 16,60 EMI
Address: 1 ld 1 LM y l Y . Ca lQ f }i,()11 Fixture /sewer cap all
City/State/ZIP: `"� D J r e Floor drain /floor sink /huh
16.60
Phone; (9y) jD_ — d l g IP Fax: (Z ' 0-- 0q1..1 -j, Garbage disposal 16,60 —
AfPPL)<i AlV f Hose bib 16.60
0 C ONTACT PERSON
Ice maker 16.60
r
Business name: . e5 O ` Y 1 MI�
r"'� ' � Intea..��,tcrr /grease trap
Contact name: ail . •,..) u 1 tJ Medical gas (value: $ 1 Pagc 2 III
Address: I U E5 ,. ( ) Primer 16.60
-
City /Statv/7IP: ' - . , b -- `y1 Roof drain (commercial) 16.60 —
Phone: �) I& Fa x:: 3( .,(�
Sink/hasin /lavatory 16.60
Tub /shower /shower pan 16.60 III
E-mail:
Urinal 16.60
CONTRACTOR Water closet 16.60
Business name: ,I / ji
A. • Water heater NM 16.60
Address: op ` r , ffi/' Other, _�
City /Slate/ZIP: Subtotal
Minimum permit fee: $72.50
Phone: ( ) Fax: ( ) Re backflow minimum permit fee: $36.25 , i s
t.CB Lie.: '.7-3 Plumbing Lic. no.: Plan review (25% of permit fee)
Authorized signature: State surcharge (12% of permit fee) `f j
t,4l v. 4 1! - TOTAL. PERMIT FEE [WPM
Print name: 3y. i 1 1 d . d Am in , . Date:11 11 d ° l This permit application expires if a permit is not obtain within
'` iSO days niter it has been accepted as complete.
*Frc mcthnrinlnav sal by Tri- enuniv I41Tilddinn lndnatry Srrvice Rnnnl
CITY OF TIGARD
BUILDING DIVISION PERMIT #: PLM OC,'8 -00161
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 4/18/2008
Phone: (503) 639-4171
Inspection Requests (24 Hrs.): (503) 639 -4175 _,:.
INSPECTION WORKSHEET FOR DATE: '1/29/2008 TIME: 7:00AM PAGE: 28
SITE ADDRESS: 12797 SW DA YINCI LN CLASS OF WORK:
SUBDIVISION: FJEI..LA VI TA LOT #: 01'l TYPE OF USE:
PROJECT NAME: 13L:LLA VI fA
DESCRIPTION: Installing b t :14144 preventer.
OWNER: RIVERSIDE HOMES, INC_, PHONE #: 503.1:50986
CONTRACTOR: PRO LANDSCAPES OF OREGON INC. PHONE #: 1
Inspection Request Scheduled For: Date: 4/29/20013 Pour Time:
Code # Inspection Description Confirm # Contact # Message
395 ivii; c ills per.:kion f 068982 -01 503- 633 -
//
Corrections /Comments/ Instructions:
ret c" 91,j
YL PASS ❑ PARTIAL APPROVAL CANCEL U NO ACCESS
1 1 FAIL n CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: c u i Date: (I 2,0 i'aT) Phone #: (503) 718-