Permit CITY TIGARD PLUMBING PERMIT
DEVELOPMENT SERVICES PERMIT #: PLM2005 -00590
�,f �l 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 10/21/2005
PARCEL: 2S 112CD -11900
SITE ADDRESS: 15976 SW 77TH TERR ZONING: R -12
SUBDIVISION: HAMBACH GROVE LOT: 017 •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
LEGEND HOMES Description Date Amount
12755 SW 69TH
SUITE 100 [PLUMB] Permit Fee 10/21/200E $36.25
PORTLAND, OR 97223 [TAX] 8% State Surchan 10/21/200E $2.90
Phone : 503 620 - 8080 Total $39.15
Contractor:
MARTIN SANDERS GROUNDS MAINTEN
PO BOX 307 REQUIRED ITEMS AND REPORTS
NORTH PLAINS, OR 97113
Phone : 503- 647 -5567
Reg #: LIC 5742
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 -66 9 or 1- 800 - 332 -2344.
Issued By: 4:e.a././ Permittee Signature: Ara �!�/ ��► i` _
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.
Oct 19 05 11:42a Martin Sander 503 - 647 -9151 p.
?lnmbin 3P - z I.O1: rrn1 1( 1-: t •t 0.1.i
City of Tigard B ier D .2 1 D n Permit No.: f ... .. _ i i - y D
13125 SW Hall Blvd., Ti kt 972233 Plan Review '
Phone: 503.639.4171 F S93.598. 005 ,.. Qtlree Permit No.;
Daic/13y:
24- Hour Inspection Line 503.639.4175 _- n • „I.:„ Dale Ready/By: ., Et Scc Page 2 for
Internet: www.ci.tigarddnicTY OF TIGARD .....0.4-.
NoiinmuMdhoI: 1 Supplemented Information
LiUJLDIN tt ii IRRu FEE' SCHEDULE
,New construction ❑ Demolition For speda[irefor » ra>YVnmecherkFar
Description I Qty. l Ea. 1 Total
0 Addition /alteration/replacement ❑ Other. New I- 2-Gmily dwellings (includes 100 fl. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (1) bath 249.20
❑ 1- and 2- family dwelling ❑ Cotnmereialrndustfiai SFR (2) bath 350.00
❑ Accessory building 0 Multi- family s (3) bath 399.00
Each additional bath/kitchen 45.00
❑ Master builder ❑ Other: Fire sprinkler ( sq. ft.) Page 2
15-9-76, i JOB SrrE INFORMATION AND 11:0C4TION Site utilities
Job site address: "3 .S J L Rte Catch basin or area drain 16.60
City /State/ZIP .� Dryweli, lcacb line, or trench drain 16.60
i r�� d p �R �- z�
Suite/bldg /apt no.: ,Project name: u Footing drain (no. linear ft. :. ) Page 2
I t �h�11n t , ' 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
. n ba I Lot no.: 1"t water Vice (no, linear f .: ) Page 2
Subdivision: R6,.
�DS Fixture or item
Tax map/parcel no.: Absorption valve 16.60
DESCRIPTION OF WORK Backflow preventer Page 2
• Backwater valve 16.60
lArldl.c01 re._ Clothes washer 16.60
J Dishwasher i 6.60
B(. PROPERTY OWNER 1 ❑ TENArsrr Drinking fountain 16.60
Ejectors/sump 16.60
`lame: Le5enC1 yvrlf D. _ Expansion tank 16.60
A d d r e s s : 1 7- S S S i L - ) 9 m i k J . SLAW ) j ) Fixture/sewer cap - 16.60
2ity /State Z1P: rDy k 0 v 9 Z-Z3 Floor drain/floorsink/hub 16.60
'hone: 603) ( Za - ?0 D Fax: (s- S9 g -gel Garbage disposal 16.60
APPLICANT ❑ CONTACT PERSON Floss bib 16.60
ess name � ` ice maker 16.60
3usin
I Alit c� c n..-4 .p_s (5)YCic1Y? Gl -s 19-'tt- lnterncptodgrease trap 16.60
2ontact name: [ a ,, -h0,-I S 4 06 Medical gas (value S ) Page 2
lddrets: P 0 . 16.v� ? Primer 16.60
:ity/Smte21P: A '� 0Y 44 4 t o / l; :" 0 9 - / 3_S Roof drain (commercial) 16.60
Lk 16.60
'hone: (SO$) (1j LI -,- S 5 U - 7 • I Fax :: (e 6: y7 - WS/ Tub/shower /shower pan 16.60
:-mail: Urinal 16.60
CONTRACTOR Water closet 16.60
:usiness name: M.44 ilk) �ri j Watcr heater 16.60
,ddress: .19 . p . o k -Z7 -7 Other:
pity/State/ZFP: (0 i' 4 - ( .Ne , 5: � .7 r.3 3
Subtotal S72_5
Minimum permit fee: 572.50
hone: (soy (p Lf 1 - 5 5 6 7 Fax: (5 ( `r -1 S! 5 / Residential backfow minimum permit fee: 536.25
CB Lic.: 5 -) L J Z Plumbing Lie. no.: Plan review (25% of permit fee)
.uthorized signature: State surcharge (8% of permit fee)
IO ' ° J - V S TOTAL PERMIT FEE 3.
rint name: l,1/7 G I/ - 1 1 / ' c _S - ` A. - ,.< ( Date: driRT ce I This permit application expires if a permit is not obtained within
180 days after it has been accepted as complete.
*Fee methodology set by Tri Building Industry Service Board
•
CITY OF TIGARD
BUILDING DIVISION PERMIT #: PLM2005 -00590
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 10/21 /2005
Phone: (503) 639 -4171 .4,0 a tt.
Inspection Requests (24 Hrs.): (503) 639- 4175��'� 1i
..
INSPECTION WORKSHEET FOR DATE: 10127/2005 TIME: 4:11PM PAGE: 78
SITE ADDRESS: 15976 SW 77T11 TERR CLASS OF WORK:
SUBDIVISION: HAMBACH GROVE LOT #: 017 TYPE OF USE:
PROJECT NAME: HAMBACH GROVE
DESCRIPTION: Bacl4low preventer for irrigation.
OWNER: LEGEND HOMES, PHONE #: 503- 620 -8080
CONTRACTOR: MARTIN SANDERS GROUNDS MAINTEN PHONE #: 503- 647 -5567
Inspection Request Scheduled For: Date: 10/28/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
325 RP /backflow preventer 019529 -01 503.209 -5346 N
Corrections /Comments /Instructions:
I - SS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
FAIL n CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: r Date: (O/0 /) )7 jPhone #: (503) 718 -
CITY OF TIGARD '
BUILDING DIVISION PERMIT #: PLM2005.00590
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 10/21/2005
Phone: (503) 639 -4171 u� d 4 im���6� i i
Inspection Requests (24 Hrs.): (503) 639 -4175 = . � ` 1
INSPECTION WORKSHEET FOR DATE: 10/27/2005 TIME: 4:11PM PAGE: 77 .
SITE ADDRESS: 15976 SW 77TH TERR CLASS OF WORK:
SUBDIVISION: HAMBACH GROVE LOT #: 017 TYPE OF USE:
PROJECT NAME: HAMBACH GROVE
DESCRIPTION: Baclflow preventer for irrigation.
OWNER: LEGEND HOMES, PHONE #: 503 - 620.8080
CONTRACTOR: MARTIN SANDERS GROUNDS MAINTEN PHONE #: 503 -647 -5567
Inspection Request Scheduled For: Date: 10/28/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
399 Plumbing final 019529 -02 503-209 -5346 N
Corrections /Comments /Instructions:
PASS ❑ PARTIAL APPROVAL n CANCEL ❑ NO ACCESS
FAIL n CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED
Inspector: Y 1 '. Date: ' `b 1 Y` ) 1\f Phone #: (503) 718-