Permit CITY OF TIGARD PLUMBING PERMIT
• :F1' COMMUNITY DEVELOPMENT PERMIT #: PLM2008 - 00225
TIGARD . 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 5/21/2008
PARCEL: 2S 112C D -00701
SITE ADDRESS: 15950 SW 76TH AVE ZONING: R -12
SUBDIVISION: DURHAM ACRES LOT: 001 JURISDICTION: TIG
PROJECT: BLACKWELL
Project Description: Installation of residential 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 •
JAY & TRACI BLACKWELL
15950 SW 76TH Description Date Amount
TIGARD, OR 97224 [PLUMB] Permit Fee 5/21/2008 $36.25
[TAX] 12% State Surcha 5/21/2008 $4.35
Phone : 503-620-6711 Total $40.60
Contractor:
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ALL NATURAL LANDSCAPE INC •
PO BOX 2815
CLACKAMAS, OR 97015 REQUIRED ITEMS AND REPORTS
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Contact # : PRI 503- 740 -7733
' FAX 503 -536 -6535
Reg #: LIC 8431
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This pennit 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
y: l �1i • Permittee Signa re: �
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.
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INSPECTOR'S SIGNATURES ARE NOT ._ •
Inspections Required for: I19.nog -ecaa5 - REQUIRED ON GREEN INSPECTION CARD.
✓ Code I Inspection Description I PASS Date I By if Code Inspection Description I PASS Date I By
BUP - Building Permit ELC - Electrical Permit
405 Excavation 105 Underground /slab cover
410 Fill 110 Temporary electrical service
415 Grading 115 Electrical service
205 Footing 120 Electrical rough -in
805 MFG- Structure grading /footing 125 Wall cover
210 Foundation walls 130 Ceiling cover
215 Footing drain . 135 Low voltage
220 Slab 140 Sign installation
310 Crawl drain 145 A/C or heating unit circuit
225 Post /beam structural 150 Hot tub /spa /pool
230 Underfloor insulation 195 Misc. inspection:
235 Shear walls /anchors 199 Electrical final
240 Exterior sheathing
245 Firewall
250 Roof nailing ELR - Restricted Energy Permit
255 Wtr proofing basement walls 135 Low voltage
260 Tilt -up panel 195 Misc. inspection:
265 Masonry 199 Electrical final
• 270 Reinforcing steel (rebar)
275 Framing •
810 MFG - Structure set -up • MEC - Mechanical Permit
280 Insulation 605 Post /beam mechanical
285 Drywall nailing 610 Gas line
287 Suspended ceiling 615 Mechanical rough -in
295 Misc. inspection: 620 Hydronic piping
899 MFG - Structure final 625 Duct work
498 Grading final 630 Fire damper
299 Final inspection 635 Smoke detector shutdown
640 Exhaust hood
• 695 Misc. inspection:
699 Mechanical final
BUP - Fire Protection System Permit
905 Sprinkler underfloor /slab PLM - Plumbing Permit
910 Sprinkler rough -in
915 Fire alarm rough -in 305 Plumbing underslab
920 Suppression trip test 310 Crawl drain
995 Misc. inspection: 315 Post /beam plumbing
998 Alarm final 320 Plumbing rough -in
, 999 Sprinkler final 322 Shower pan
_ . 330 Water service •
335 Rain drain
340 Storm drain •
SIT - Site Work Permit 505 Sanitary sewer
405 Excavation 345 Culvert /catch basin
410 Fill 350 Septic tank
415 Grading 395 Misc. inspection:
205 Footing 399 Plumbing final
210 Foundation walls
215 Footing drain
420 Sprinkler supply lines SWR - Sewer Permit
495 Misc. inspection: 505 Sanitary sewer
498 Grading final • 595 Misc. inspection:
499 Final inspection 599 Final inspection
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Plumbing Permit Applications \ '
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Received City of Tigard �� i \N 1 t Date /By: 5 /9 OS v", Permit No.: P aODg ' 00. 2 . 2
• 13125 SW Hall Blvd., Tigard, OR 972 "� �
t" C: Plan Review
Ili a C )•„ Phone: 503.639.4171 Fax: 503.598.196QJ 1 1/4 \ N` Date /By: Other Permit No.:
t rr+E inspection Line: 503.639.4175 `'`� `
•TI (� ,1 h D cj` ` f�� Date Ready/By: l BI See Page 2 for
; ;I ;y , ; •,p. 2)}f ' Internet: www.tigard- or.gov ` 'p \ Notified/Method: i!� Supplemental information
)ef T IPE OF WORK FEE* SCHEDULE
New construction ❑ Demolition For special information use checklist.
Description 1 Qty. 1 F.a. 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
1- and 2 -family dwelling ❑Commercial /industrial SFR (2) bath 350.00
❑ 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: I5C15t) ' 1 1.cP p Catch basin or area drain 16.60
City /State /ZIP: 1 SO\Gxtl V� q , a 1 Drywell, leach line, or trench dram 16.60
Suite/bldg. /apt. no.: Project name: Footing Footing drain (no. linear ft.: ) Page 2
Manufactured home utilities 110.00
Cross street /directions to job site:
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
Fixture or item
fax map /parcel no.:
Absorption valve 16.60
DESCRIPTION OF WORK. Backflow preventcr ! Page 2 f
I .' 1 1 Ii _^ Backwater valve 16.60
1 Q ` 1 - 1 Clothes washer 16.60
N Dishwasher 16.60
Drinking fountain 16.60
PROPERTY OWNER 1 ❑ TENANT
Ejectors /sump I 16.60
Name: rQG �1�p Expansion tank 16.60
Address: 1 Q f r _ 1 - 1 k k tJ Fixture /sewer cap 16.60
City /State / /ZiPTI 0--(Z afl 0. Floor drain/floor sink /hub 16.60
I Garbage disposal 16.60
Phone: 61 Le - (011 I Fax: ( )
�E' Hose bib 16.60
J�
i�' APPLICANT ❑ CONTACT PERSON
ice maker 16.60
Business name. N l Nova i Ltu � i �.1 - �, • Interceptor /grease trap 16.60
Contact name:? T X .k. Lo MG. t Medical gas (value: S ) Page 2
Address:? p 1" i- g is ' Primer 16.60
. City /State /ZIP: - 1/4 ~ �no , Roof drain (commercial) 16.60
" 1 Sink /basin/lavatory 16.60
Phone: ( ' L 0 -11 3. Fax: : (S 3b(o - ( a
Tub /shower /shower pan 16.60
t
E -mail: 6 S- �'��V1C.Q i 1 1lo Urinal 16.60
CONTRACTOR Water closet 16.60
Business name: 11 vo a A t'1 1DQ _ - Eft, _ Water heater 16.60
Address: - PC) l� `-" Other:
City /State /ZIP: Oe_ t�clblb Subtotal
i N4inimum permit fee: $72.50
Phone: �J '-/ 46"-ri 3 Fax: (51) Sap (DS3' Residential backtlow minimum permit fee: $36,25 0 �
CCB Lic.: �(� � ' at Plumbing Lic. no.: Plan review (25% of permit fee) 4-
1 r State surcharge (12% of permit fee) 4
Authorized signature: Z *. TOTAL PERMIT FEE 1 WI- -4U-
Print name: N, l jj 1 et _ Date: €/1C This permit application expires if a permit is not obtained wi in /_A
180 days after it has been accepted as complete. 4 -Ki
*Fee methodology set by Tri- County Building Industry Service ard.
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