Permit - c
T� F T I PLUMBING PERMIT
DEVELOPMENT SERVICES PERMIT #: PLM2006 - 00382
4i DATE ISSUED: 8/14/2006
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171
PARCEL: 2S 104CA - 01400
SITE ADDRESS: 13165 SW ESSEX DR ZONING: R -
SUBDIVISION: HILLSHIRE LOT: 014 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
RALPH /LISA FARGO
13165 SW ESSEX DR Description Date Amount
TIGARD, OR 97223 [PLUMB] Permit Fee 8/14/2006 $36.25
[TAX] 8% State Surcha 8/14/2006 $2.90
Phone : 503 -579 -3399 Total $39.15
Contractor:
MATT SANDER LANDSCAPING INC
21350 NW FARM PARK DR
HILLSBORO, OR 97124 REQUIRED ITEMS AND REPORTS
Contact # : PRI 503- 647 -0800
FAX 503- 647 -0900
Reg #: LIC 5703
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: _` 0 .L y // 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.
2006 -08- 1101:15 MATT SANDER LANDSCAPING 5036470900» 5035981960 P 2/3
' Fixtures RECEIVED
� e1 1 ¢n lr , ( .''" , C?. ��,�'e. <v{ � ' �p'r j � 1
tryl 'W�,.^,„� d" �,"5- .v�
Plumbing. Permit Apalicatlon g , ' 1 [fl( Y lit "I,I( I, l u\C r��, `rye 4 j. $
AUG 1 2006 , y : _ / ... .
City of Tigard Removed , � ve ,,,, ; ,
13125 SW Hall Blvd., Tigard, OR 97223 CITY C BUILD . � IIG 1' ,,. FtoN Pla R 1>>stdAy: Review l�'D� i'+ Aa(� E.�3S7
Phone: 503,639.4171 Fax; 503.598.1960 1 O ther Permit No.:
24- Hour Inspccticm Line: 503.639,4175 : ;:e:41,''''', - :...1 , I . Date Ready/By ' S P U F
Internet: www.ci.tigard.or.us NutifiedIMNhud; / Supplemental Information
TYPE OF WORK FEE* SCHEDULE
❑ New construction ❑ Demolition For special information mu checkli..
Description 1 Qty. 1 Ea. 1 Total
❑ Addition /uhcrution/replacement ❑ Other: New 1. 2-family dwellings (includes 100 fl. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (1)balh 249.20
"At ' • and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 350,00
ID Accessory building El Multi-family Si k (31 bath 399.00
Each additional bath/kitchen 45.00
❑ Master builder ❑ Other:
Fire sprinkler ( sq. ft.) Pagc 2
JOB SITE INFORMATION AND LOCATION Site utilities
Job site address: /. / 6 5 5 Id ,ESS e)( ./)rive... ✓e- Catch basin or area drain 16.60
City /State /ZIP; r' / c3C4. rd G i C, )0Asrl 3 thywell. leach line. or bench drain 16.60
Suite/bldg. /apt. no.: I Project name: Footing drain (no. linear ft,; ) Page 2
r Manufactured home utilities 110.00
Cross street /directions to job site; �� i
1.6.sj CpLj�. - t - P-�
� � /c' Manholes 16,60
Rain drain connector 16.60
Sanitary sewer (no. linear ft,; ) Page 2
Stomt sewer (no, linear ft,; ) Pagc 2
Subdivision: 1 Lot no.: Water service (no. linear IL; ) Pagc 2
Fixture or item
Tax map /parcel no.: -
Absorption valve 16.60
DESCRIPTION OF WORK Hack flow prcvenicr / Pagc 2 1; ,
„c .4:L-Cr ems'
,/1'_ ,f -1-- i fitid_44,-.A..�s `` Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
PROPERTY OWNER 1 ❑ TENANT Drinking fountain 16.60
Ejectors/sump
- 16.60
-
Name: a ��� ` 7-. � - Expansion tank 16.60
Address; / a i t 2 �.i2• Fix turc /sewer ca
��G � -- . ) rG'L � � �x- c. ° . p 16.60
City/Stalc/Z1P; i 6_4(1
A
e( L - / / A j Floor drain/floor sink/hub 16.60
Phone: (�U,3) 2� -8,..3 .2 Fax: ( ) Garbage disposal 16,60
Hasc bib 16.60
0 APPLICANT ,CONTACT PERSON
Ice maker 16.60
Business name:
Interceptor /grease trap 16.60
Contact name: 1 1�. ` _G. , . 4.L - .> Medical gas (value: $ ) Page 2
Address; U ) ` _ / Primer 16.60
City/State/ZIP: �j �G «-� A- �"t'.'
-e r Roof drain (commercial) I 16.60 l
Phone: ( ) I Fax:: ( ) Sink/basin/lavatory 16.60
Tub /shower /shower pan 16.60
E -mail: Urinal 16,60
CONTRACTOR Water closet 16.60
Business name: Ligea ' 14,4,f,..44- l,,t . ;, ;,7 / t 41. Water heater 16.60
Address; c g /c+� 57? - 1) .1z) YI rY' , •` . - * �L- .- .41 -•4c_ Other;
City /State/ZIP: `r_ . / , /,, - -r , c(p A G / • ,x 4/ Subtotal
/ Minimum permit fee: $72.50 -
Phone: (5 )4,7-07,/)/) tf I ax: (523) 2,1/y /J 7? <J ly _ Residential baekflow minimum permit fcc; $36.25
CCB Lic.: 5 9Q /0 5/ 0fo Plumbing Lie. no.: / / (747 Plan review (253o nfpermit fee)
Slate surcharge (8% of permit fee) 5 , ,
Authorized signature: ; ji - . y,. - . . e.err_ - F C. TOTAL PERMIT FEE " , 37
r - .
Print name: - / 7 J -) j' d e r Date: g J// 64, This permit application expires if a permit is not obtained within
/ 180 days after it has been accepted as complete.
'Fee methodology sct by Tri- County Building Industry Scrv�
i.\Auildin \Permiu\PLMF.PmmitApp.doc 06/05 4404616
3 r
CITY OF TIGARD
BUILDING DIVISION PERMIT #: PLM2006-003B2
13125 SW Hall Blvd., Tigard, OR 97223 . DATE ISSUED: 8/14/2006
Phone: (503) 639-4171 iriP.
Inspection Requests (24 Hrs.): (503) 639-4175 L. ---...- .
INSPECTION WORKSHEET FOR DATE: 8/17/2006 TIME: 7:01AM PAGE: 62
SITE ADDRESS: 13165 SW ESSEX DR CLASS OF WORK:
SUBDIVISION: HILLSHIRE LOT #: 014 TYPE OF USE:
PROJECT NAME: FARGO
DESCRIPTION: Backflow proventer for irrigation.
OWNER: FARGO, RALPH/LISA PHONE #: 603-579-3399
CONTRACTOR: MATT SANDER LANDSCAPING INC PHONE #: 503
Inspection Request Scheduled For: Date: 8/17/2006 • Pour Time:
• ,
Code # Inspection Description Confirm # Contact # Message
399 Plumbing final 035111-01 603-M7-0800 N
Corrections/Comments/ Instructions:
—
/, , Y Y ' J P a _ A W #5.
,
/
Ai rr od oprip.- ow ---.
.--
_--
k ASS fl PARTIAL APPROVAL 1 CANCEL . EI NO ACCESS
n FAIL I I CALL FOR INSPECTION I I ADDITIONAL FEES ASSESSED
• Inspector: 111 t Date: / 0 Phone #: (503) 718-
, ____