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Permit i X-(4,._ /6/3 C ITY OF TI CrAR® PLUMBING PERMIT PERMIT #: PLM2005 -00269 .�I� DEV w H BMENg r So R9 2C'ES -639 -4171 DATE ISSUED: 6/17/2005 PARCEL: 25111 DC -13100 SITE ADDRESS: 15925 SW OAK MEADOW LN ZONING: R -7 SUBDIVISION: SUMMERFIELD NO.11 LOT: 627 JURISDICTION: TIG Project Description: Installation of backflow device. 2/9/06 THIS PERMIT IS REINSTATED FOR PURPOSE OF FINAL INSPECTION FOR A PERIOD OF 30 DAYS. 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 CARLSON, EDWARD & LORA HAZEL Description Date Amount 15925 SW OAK MEADOW LN TIGARD, OR 97224 [PLUMB] Permit Fee 2/9/2006 $36.25 [TAX] 8% State Surchari 2/9/2006 $2.90 Phone : 503 - 684 - 5730 [PLUMB] Permit Fee 6/17/2005 $36.25 [TAX] 8% State Surchari 6/17/2005 $2.90 Contractor: Total $78.30 DOWN TO EARTH IRRIGATION 13075 SW PACIFIC HWY REQUIRED ITEMS AND REPORTS TIGARD, OR 97223 Contact # : PRI 503 684 - 3500 FAX 503- 968 -8297 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 -6699 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. DATE, TIME FAX NO. /NAME DURATION PAGE(S) RESULT MODE 02/10 15:15 5039688297 00:00:42 01 OK STANDARD -8lL (£0s) :#euolid 42. :area SS300V ON ❑ 03SSBSSV 5334 lVNOIiIGay 13ONVO p 00018Lit Ie !!Nn wd eft mum Ds maw Gpuw Luna uogoodsul ue Pas poQ boo act Itu11S JOdor 8M uo • mum' / Acl 21d /19 itor � �pJ S -' elS �, auonormsul /spawwoO/suopenoO 00%$1191:09 SO1T.99Z0 TRANSMISSION VERIFICATION REPORT TIME : 02/10/2006 15:16 NAME : TIGARD BUILDING DEPT FAX : 5036243681 TEL . SER.# : BROD4J479592 NCI103dSNI d 1VAOdddV 1V1.1.1 d rug & p.urild :JoIoadsul 1 IVA SSVd �?1 t (V2 C) iho ?Q CITY , C OF TIGARD BUILDING DIVISION ; - PERMIT #: Pl.M2 city - 002[;9 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 6/17/200F, Phone: (503) 639 -4171 .� ' ll i Inspection Requests (24 Hrs.): (503) 639 -4175 .-. ' I L INSPECTION WORKSHEET FOR DATE: 2/10/2006 TIME: / :04AM PAGE: 72 7tOreff-4r'1 , 4c esz. Moo SITE ADDRESS: 15926 SW OAK MEADOW LN CLASS OF WORK: SUBDIVISION: SUMMERFIELD NO.11 LOT #: 627 TYPE OF USE: PROJECT NAME: CARLSON DESCRIPTION: Installation of bacE low device. 2/9/06 THIS PERMIT IS REINSTATED FOR PURPOSE OF FINAL INSPECTION FOR A PERIOD OF 30 DAYS. OWNER: CARLSON, EDWARD & LORA HAZEL, PHONE #: 503-684 -5730 CONTRACTOR: DOWN TO EARTH IRRIGATION PHONE #: 503, 6843500 Inspection Request Scheduled For: Date: 2/10/2006 Pour Time: Code # Inspection Description Confirm # Contact # Message 399 Plumbing final 026621 -05 503 - 684.3500 N Corrections/Comments/Instructions: eovi C r Sv L75 For— t •14-r <Fcok/ /'2c l /L�T,L•v Z) 1 R- P; Q1) 12 be 2 G FLo Id t i - b vi L6 PZib?1 / - S) i'R o\1i t] (: X.c.,57z v 12L-, Gcrc A� S rer‹. Tx(-&c_ c_ 1 Z°la - S, "fhe deters noted ' on this plumbing report shall installation be co rrected det and _ .' . . / / ,/ i _ j / , . � . ' an Inspection request made within SO i ?/. 1 f b 5 � calendar days per OAR 918-786.0230 SeYn.. ryt7c. � U•a • PASS / PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS p FAIL CAL - •R INSPECTION ❑ ADDITIONAL FEES ASSESSED V • Inspector: Date: Z '/0 0 � #: (503) 718 - T • CITY TIGARD PLUMBING PERMIT DEVELOPMENT SERVICES PERMIT #: PLM2005 - 00269 , DATE ISSUED: 6/17/2005 °. 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 PARCEL: 2S 111 DC - 13100 SITE ADDRESS: 15925 SW OAK MEADOW LN ZONING: R - 7 SUBDIVISION: SUMMERFIELD NO.11 LOT: 627 JURISDICTION: TIG Project Description: Installation of backflow device. 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 CARLSON, EDWARD & LORA HAZEL 15925 SW OAK MEADOW LN Description Date Amount TIGARD, OR 97224 [PLUMB] Permit Fee 6/17/2005 $36.25 [TAX] 8% State Surcha 6/17/2005 $2.90 Phone : 503- 684 -5730 Total $39.15 Contractor: DOWN TO EARTH IRRIGATION 13075 SW PACIFIC HWY TIGARD, OR 97223 REQUIRED ITEMS AND REPORTS 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 -6699 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. : Aug. 29 2002 01:21PM P1 -- ! ' Building Fixtures V , .,, T 7. _ .z , '- t �' .:-:.r d L. �4�n 4 '�F� . Plumbing Permit�i I : = FOR OF r[C E U5E OI�1< l � 7„::.:.7-4'' i ; 1 ; s City of Tigard ,. 5 Reed ' i Q� Permit No 1�� Q �� `c 6 13125 SW Hall Blvd., Tigard, OR 97223 qt 1 ) Pao Revie Y tea' Phone: 503.639.4171 Fax 503 = 598.1960. f n i . , , 1 r S , . na b Other Permit No.: 24- Hour Inspection Line: 503.639.4175 i\( O T � ' re. Noti !� , • Date Ready/Sy: Internet: www.ci.ti r" , 0 See Page 2 for d,or.us -4 t� � L Ca pIV fied/Metbod: ! i Supplemental Information pl ' ?"' ' , 7 e `Zv INA p • '" 7' .p: c. • �'S.S:.+• '+�a.. rs r- �,,. ^L': �F'. - r •. i ,�` 4.T'° t I r fi'f.9f 9 ' � �uu-G {, ,� 4+ '4 Ml y� ,. ' , . � I �: ,4 • ,e"^"`ZG �: '.-.. • . ` . T 11 3 , Ftl r� �I , a�t.-'i'xi` , �r,AM RA �' ,.E �� 1 i I' •a 1• ,w 4 Nh"F! ,darn. kY :th1; `.:w'.c yl. xi.•, .. ..'. ..•._�.•.:• ... . .1 • 1 9��t.�8i i J:wd "L.N. . . -`'P' tit wa :� .1.. t "� r�. ew construction ❑Demolition For special in ormation use checklist= Description Qty. Ea- Total 0 Addition /alteration/replacement ❑ Other: ��r ���� M _ New i - 2- family dwellings (includes 100 ft. for each utility connection) , Il !iK.ra�fw4ahr ,?1�N�u t ra ` u} xsi'� s �w � l` 1: ``r *'- SFR (1) bath 249.20 - and 2- family dwelling ❑ Commercia[Ttndustrial SFR (2) bath 350.00 Accessory building Et Mu1ti- fatuity SFR (3) bath 399.00 [] Master builder Other: Each additional bath/kitchen 45.00 ' i f >•'�i - �F�I wtl', •,,�.� d n. �r-t - . r'•�" - �.+.� J� 1 rGf'C{ iraa I� a i y c; r ,.. Fire Sprier sq. ft) Pa e 2 > >C,.�..�T� Site A11lI1tIe3 Job site address: 2 5 (o ( •:t. vC , .:� _Y Catch basin or area dram 16.60 Ci tY /State/ZIP; 7:- �� 0 � - 71.2 Drywell, leach fine, of trench drain 16.60 Suite/bldg./apt no.: Project name: Footing drain (no. linear ft: ) Page 2 Cross strcot/dtrections to job site: Manufactured horn utilities _ 1 10.00 Manholes 16 -60 Ram drain corrector 16.60 Sanitary sewer (no. linear ft.: , ) Page 2 - Storm sewer (no. linear ft.: _ ) Page 2 Subdivision I Lot _ Water service (no. linear ft.: , ) Page 2 Tax map /parcel no.: Fixture or item ��'�I 1 t:. �1 r Y rvL /� r� li•1E7 , .'�;� zir� ?Zr ,� �� 1 _ 1 r {; �, ,�, r Absorption valve 16.60 . . . ,. rS:..... . ' ..1...K,(_ a n ` ' , .r�k. i s I ?l ' ✓ +. ,r : %.. .'d B ackflow prcventer Page t Backwater valve 16.60 Clothes washer 16.60 Dishwasher 16.60 till /f' t <vN� r "�'t 1 'C' ' 1� 'i A ? b.• LIB t i�l f1 '� �" -"' f°" - Tef. y1' -7Atl ,� N;( Drinking fountain 16.60 4�1 �4(l z2 x�Arf tt ,sl , r fl w- , ��i 1§.,�� '"�! t9' 'K s ��U�L 51_.'.a i„" Y'';'.1.11f O F , ad �iE ]� 1 .%„,. e ,mr� er..�:,r;� SLL -,� :1y�� r „ � �raex�.a..-�:ws Ejectors /sum 16.60 Name: ( 44 ` ne, 0 i -e,/Jlt,, (h 4- -3--iT c-S't Expansion rank 16.60 Address: • . /144.-A ' o f r 4 , Fixture/sewer cap 16.60 City /StatcIZ1P: • . ' O i s - ', Floor drain/floor sink/hub 16.60 Phone:. ■ - 7 C Fax: ( ) Garbage disposal 11111 16.60 ;1¢tl l y l3ii "lipl� xcnv.ti'l' G i3r r �, , r w N.. e'9F �� li { ; rci'r e trr,f� Vk " 6, `v r^r`s�j" 1,4 1 I r r Hose bib 16.60 u u1.�f� n fife .ul.r { ' i1�13E..,a.2f .M4. Si t dit V 41 ,.,:1^ r,« n,�t -0 r "1 � 1..r 1- l• � E lll t r i„maker 16.60 Business nnme: I�,,, O�/( +0 4 I4 Interceptor /grease trap 16.60 Contact name: , �4 I1i OI `e _ Medical gas (value: $ ) Page 2 Address:. 13 0 50 i c 4 L . tfkO y Primer 16.60 City/State/ZIP: - - • r 01 o f - 7 Z.Z.- % Roof drain (commercial) L. 16.60 Phone: ' g . . Sink/basin/lavatory 16,60 O (�� -.. Z�l E -mail: TLb /shower /shower pan 16.60 f` ,i Urinal :rVE � r, 4 ; 07 43 .y " •v� � 4 � �∎-- r 16,60 i z4,4i7S._r. es ` 7�h1 -:pa ' ,,p rP0 �} .' a .il . 4 1 /4 4, "t . r�; w? " -' ,. r, � • � =�k.��,;k Water closet � 16.60 _ Business came: je 4 Water heater 16.60 IIII Address: ,, iA 5a., o; c ,m Other: City /State/ZIP: , •- 4 •1 Q i?_ • 2Z Subtotal Phone: 5)3 )(,,, c Fax: ( ) Minimum permit fee: $72.50 Residential back -flow minimum permit fee: $3625 CCB Lic.: E5(Girt _ Plumbing Lic. no.: Plan review (2S% ofpermit fee) Authorize signalize: . State surcharge (8% of permit fee) • TOTAL PERMIT FE E �� Print nam � � 4 (►5 .. This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. 1 t ��n a dIM1 Mn *Fce methodology set by Tri Building Industry Service Board. :l iluadloglPUaLtBIP... FhrmitAvo.dec 11/03 A,C,/fnrnnrnnuin.. -. 1 / 1 ))