Permit C ITY OF TIGARD PLUMBING PERMIT
DEVELOPMENT SERVICES PERMIT #: PLM2005 - 00154
DATE ISSUED: 4/22/2005
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171
PARCEL: 2S 112AD - 00700
SITE ADDRESS: 14830 SW 72ND AVE ZONING: I -
SUBDIVISION: LOT: JURISDICTION: TIG
Project Description: Installation of backflow device.
CLASS OF WORK: OTR GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS: 1
OCCUPANCY GRP: UNK 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
UNITED PIPE + SUPPLY CO INC
7600 SE JOHNSON CREEK BLVD Description Date Amount
PORTLAND, OR 97206 [PLUMB] Permit Fee 4/22/2005 $46.40
[TAX] 8% State Surcha 4/22/2005 $3.71
Phone : Total $50.11
Contractor:
LBD LANDSCAPING LLC
7220 SE ALDER ST
PORTLAND, OR 97215 REQUIRED ITEMS AND REPORTS
Phone : 503- 631 -8755
Reg #: PLM ALL PHASES & B
LIC 7385
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: fpi Permittee Signature: I2..'eL. p �p
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.
04'10/2005 13:37 FAX 5035981960 CITY OF TIGARD IJ001
ONLY
it Eg ED . .
• ..
Plumbing Permit App oSi FOR OFFICE USF. �F.
City of T igard APR 21 2005 r: t:Bcd. . #_3'1?- PermitNo j \ - 4.c00 / `/
Haters
13175 SW Hall Blvd., Tigard, OR 97223 • plea Review Other pm N
Phone: 503.639.4171 Pax: .503.598.1960 r ' '?:.:;; =II
24- Hour Inspection Line: 503.639.4175 � T -1.1-- `I � Date Ready/By: / / f Ez1 Sea Page 1 for
Internet: www.cingard.or.us s - : r A Notified/Method! ( Sapplcmctal!atormation
TYPE OF WORK PEE* SC133:3313LE
❑ New construction fl Demolition For specialio adon use checklisA
Dts=iption Qty. Ba 'Total
r Addition/alteration/roplacemeut 0 Other New 1 - 2 -family dwaings (includes 100 it for each utility eonnection) :
CATEGORY OF CONSTRUCTION SFR (1) bath 24920
❑ 1. and 2- family dwelling 'Commercial/industrial SFR (2) bath 350.00 .
ID
SFR (3) bath 399.00
Accessory building ❑ Multi- family Bach additional bath/kitchen 45.00
❑ Master builder 6.60 - El O Fire aprinkl= (� sq. ft) �. _ Page 2 -
JOB SITE INFORMATION AND LOCATION _ Site utilities
Job sit° a ��3r1 _S 4i 7.l �
ddres. Catch basin or area dlahl 16.60
City /State/ZIP: '7' . /.- , 4 . . 0 ...e. i Dryweell, leach line, or trench drain 1 1 e 0
Footing drain (no. linear ft.: �� B
Suite /bldg./apt. nn.: Project name: ,(/ ,....r6. 110.00
Manufactured home utilities •
Cross street/directions to job site: Manholes 16.60
Rain drain comiector 16.60
Sanitary sewer (no. linear ft.: - ) Page 2
Storm sewer (no. linear ft.: Page 2
Subdivision:
Lot no.: Water service (no. linear R: _J Page 2
- Fixture or item
Tax map/parcel no.: -
Absorption valve 16.60
DESCRIPTION OF WORK Backf1ow prevent= / PO 2 L ib lid
N- 7 , - - Backwater valve • 16.60
Clothes washer 16.60
Dishwasher 16.60
Drinking fotmtain 16.60
15 PROPERTY OWNER 0 TENANT Bjectors/sump 16.60
Name: ...r /J / - .. Expansion tank 16.60
Address: L, h'C Fixture/sewer cap 16.60
City/State/ZIP: 7 b - - - 2 y Floor drain/floor aink /hub 16.60
3 Garbage disposal 16.60
Phone:( �) ; L Fax:( i '.
Hose bib 16.60
11 APPLICANT CONTACT PERSON Ice tinker 16.60
8116ixress 32111:11C4 _ - ./ A i 1 . - / ` _ , Interceptor /grease trap 16.60
Contact name: // 1 /i . ' 6 , 5 Medical gas (value: $ ) Page 2
Address: 7)....).o St 4 -z.-17 0 57 Primer 16.60
,� Roof drain (commercial) 16.60
City/State/ZIP: p�7 /� S 16.60
Phone:
(1 4 /07' k 4. ' a Fax:: ( . . Tub/shower/shower pan 16.60
E -mall: 0 .. et , ' a . ..di. V. , Urinal , 16.60
a NTRAC FOR Water closet w 16.60
Business name:
Water heater 16.60
/ r/, ,, / , , '
Other. _
Address: , G ltd./ ' _ - Subtotal `f -
City /State/ZIP: 1,0 - i/a.0 - Mtnian:m permit fee: 572.50 )
Phone; (-s4,) , - / „' Fax: ( ,
/
Residential bacldlow minimum permit fee: $3625 /
Plumbing Lic. no.: Plan review (25% of permit f • ._
CCB Lie.: / State sutebarge (8 of permit fee).--r-g.". fee).--r-g.". Authorized signature: : i TOTAL POW= FEE -
• j
Print name: bate: - ; / This permit application expires if a permit is not obtained wi a
/ Zvi WI : 180 days after it has been accepted as complete. a / /
*'Fee methodology set by Tri- County Building Industry Service
i:SuitdineensitaLM- PermFUgp.dee 13/03 440.4616T(10102/COWWEB)
i
CITY OF TIGARD
BUILDING DIVISION PERMIT #: PLM200500154
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 4/22/2005
Phone: (503) 639 -4171 At, � i
Inspection Requests (24 Hrs.): (503) 639 -4175 , ' : _..
INSPECTION WORKSHEET FOR DATE: 9/16/2005 TIME: 7:01AM PAGE: 84
SITE ADDRESS: 14830 SW 72ND AVE CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: UNITED PIPE & SUPPLY CO INC
DESCRIPTION: Installation of bacldlow device.
OWNER: UNITED PIPE + SUPPLY CO INC, PHONE #:
CONTRACTOR: LBD LANDSCAPING LLC PHONE #: 503- 631 -8755
Inspection Request Scheduled For: Date: 9/16/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
325 RPlbacldlow preventer 015859-01 503 - 631 -8755 N
Corrections /Comments /Instructions:
C O 2 ' - ' 9
/
SS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
I
Inspector: L Date: - Ad Phone #: (503) 718-