Permit C ITY OF TIGARD PLUMBING PERMIT
COMMUNITY' DEVELOPMENT PERMIT #: PLM2008 - 00152
T,1 ARP 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 4/10/2008
PARCEL: 2S103DC -05800
SITE ADDRESS: 13700 SW 115TH AVE ZONING: R -4.5
SUBDIVISION: VIEWMOUNT LOT: 046 JURISDICTION: TIG
PROJECT: GALVIN
Project Description: Installing 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
ROY & LIND GALVIN
13700 SW 115TH AVE Description Date Amount
TIGARD, OR 97223 [PLUMB] Permit Fee 4/10/2008 $36.25
[TAX] 12% State Surch 4/10/2008 $4.35
Phone : 503- 670 -7632 Total $40.60
Contractor:
INNOVATIVE LANDSCAPING
9630 SW OMARA ST
TIGARD, OR 97223 REQUIRED ITEMS AND REPORTS
Contact # : PRI 503- 670 -7632
FAX 503- 670 -7532
Reg #: LIC 173432
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:4Z_ � -� - �� 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.
Plumbing Permit Application
Building Fixtures ' ,4'1 FOR OFFICE USE ONLY
' �/
City of Tigard � ' d Received
Date/ By: 0 0 V G Permit No. Pi") X.0 Cvo/ 5
a 13125 SW Hall Blvd., Tigard, OR 97223 Ca plan Review v
C ` •. Phone: 503.639.4171 Fax: 503.598.1960 r 1 '!! - )a y Other Permit No.:
T I G A R D Inspection Line: 503.639.4175 <- . L exReady /By: Juris: ® See Page 2 for
Internet: www.tigard - or.gov �� ^"� bttified/Method: Supplemental Information
TYPE OF WORK t O . ? V x FEE* SCHEDULE
❑ New construction ❑ Demolitioe s,ir For special information use checklist
�gL
Description Qty. 1 Ea. 1 Total
%Addition /alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (1) bath 249.20
I- and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 350.00
ID Accessory building ❑ Multi - family SFR (3) bath 399.00
Each additional bath/kitchen 45.00
❑ Master builder ❑ Other:
Fire sprinkler ( sq. ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities
Job site address: 13700 t W 115 j A Catch basin or area drain 16.60
City /State /ZIP: �' a rd 0 C2 9 7 3 -,2 g6 / Drywell, leach line, or trench drain 16.60
5 1 Project name: G 1 i1; N 1Q Footing drain (no. linear 11.: _) Page 2
Suite/bldg. /apt. no.:
4 �s t d e�te Manufactured home utilities 110.00
Cross street/directions to job site: SO Fa r U t e „J kak ie .a-
-
Manholes 16.60
S / ,. A U e. 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
Fixture or item
Tax map /parcel no.:
Absorption valve 16.60
DESCRIPTION OF WORK Backflow preventer I Page 2
i t r l i4,1 j � t � y Stei4" 1 et c I 1 a/ / Backwater valve t 16.60
/J Clothes washer 16.60
Dishwasher 16.60
g PROPERTY OWNER I ❑ TENANT Drinking fountain 16.60 -
Ejectors /sump 16.60
Name: Q ny , 1.1,A` i C, vl A. Expansion tank 16.60
Address: ` j - 3 7 oo Sit) (I s tKV 'a - Fixture /sewer cap 16.60
City /State /ZIP: e.ici recd t (0 9 7,0 3 - .g ld / Floor drain /floor sink /hub 16.60
Phone: (S j ) 6, -( Fax: ( ) _Garbage disposal 16.60
APPLICANT (CONTACT PERSON Hose bib 16.60
- /
Ice maker 16.60
Business name: - ,1..N nooa - llU e /ev c / Die Interceptor /grease trap 16.60
Contact name: cst el) e, e ni j J Medical gas (value: $ ) Page 2
Address: 9b3D 6 t) c ` l tt rz � , Primer 16.60
City /State /ZIP: t a /„ j I o e C f 7c,„_3 Roof drain (commercial) 16.60
` �1 Sink/basin/lavatory 16.60
Phone: (S0� 4 0 763 Fax: (� Y 6071) - - ' o�
Tub /shower /shower pan 16.60
E-mail: Urinal 16.60
/ CONTRACTOR -7- Water closet 16.60
Business name: j.I n G ii« T I!/ _ `,fl Ser✓ -W ily I L lil c.... Water heater 16.60
Address: I J Othe
j r2 �n s +„, s,� Subtotal
City /State /ZIP: T i�f✓ Minimum permit fee: $72.50
Phone: ( ) Fax: ( ) Residential hackflow minimum permit fee: $36.25 %
CCB Lic.: / 73L/3. VI 7 ' Plumbing Lic. no.: Plan review (25 %ofpermit fee)
State surcharge (12% of permit fee)
Authorized signature: - TOTAL PERMIT FEE
`t()r(v
Print name: n 7 e✓ /, 5 5 1� s Date: L(_ ((2 - p ( This permit application expires if a permit is not obtained within
r 180 days after it has been accepted as complete.
*Fee methodology set by Tri- County Building Industry Service Board.