Permit CITY TIGARD PLUMBING PERMIT
DEVELOPMENT SERVICES PERMIT #: PLM2005 -00591
II 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 10/21/2005
PARCEL: 2S112CD-12000
SITE ADDRESS: 15984 SW 77TH TERR ZONING: R -12
SUBDIVISION: HAMBACH GROVE LOT: 018 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 10/21/200` $36.25
PORTLAND, OR 97223 [TAX] 8% State Surcharl 10/21/200: $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 -669 or 1- 800 - 332 -2344.
Issued By: ,,7� 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.
fy lct 19 05 11:42a Martin Sander 503- 647 -9151 p.6
ECE /• tlllt M1'1( 1. t N1 t/\1.1
Plumbing Permit App ca' • t •
City of Tigard Tigard, 1x� �zz� 9 2005 nat a'1✓ D 1 �y(•v• L
/ / - • ."
13125 SW Hall Blvd„ Ti O Plan Review ether [omit No.:
Phone: 503.639.4171 Fax:( , DatDate/By: 24- Hour Inspection Line: �I GA R D _ - t : 'A_. Mac R y�y: od: tuns: See page 2 for
Interact: www.ci.tigard.o . 1 ING DIVISION wotifrod/Meh I ® Supplemental Information
TYPE OF WORK FEE* St" HEDULE
lition For . . al informatfon use checklist
1Vt w comstruction ❑ Demo - Description Qty. Ea. Total
❑ Addition/alteration/replacement ❑ Other: New 1- family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (1) bath 249.20
❑ 1- and 2- family dwelling ❑ Commercial/ ndustrial SFR (2) bath 350.00
SFR (3) bath 399.00
❑ Accessory building ❑ Multi-family
Each additional bath/kitchen 45.00
❑ Master builder ❑ Other. _ Fire sprinkler (_____ sq. ft.) Page 2
(,55\ JOB SI E INFORMATION AND LOCATION _ Site utilities
Job site address: S 1 1 VA '` G try- • Catch basin or a ea drain . 16.60
City /State/LIP: I I �^ Il, leach line, or trench drain 16.60
T d ci- Z Z 1- Footing drain (no. linear R: ) Page 2
Suite /bldg/apt. no.: 1 Projectnem= }tai, h0 c, Manutucturcd home utilities 1 10.00
Cross street/di`ections to job sit : _ Manholes 16.60
Rain drain connector , 16.60
Sanity y sewer (no. linear ft_: ,____) Pagc 2
-
Storm sewer (no. linear ft.: ) Page 2
L Water service (no. linear ft.: _ _) Page 2
(,�
Subdivision: t la_r n Ua cAA C SSi� 1 Lot no.: t e g
Fixture or item
Tax map /parcel no.: Absorption valve 16.60
DESCRIPTION OF WORK Backfiow prcventer Pagc 2 -
Backwater valve 16.60
"1 ' . n Clothes washer ■ 16.60
LeiSc�� V n�'! � ! Dishwasher _ 16.60
Drinking fountain 16.60
0. PROPERTY OWNER I ❑ TENANT
Ejcctors/sump 16.60
lame: 1 &g111a � t�I' 1 CA/ . Expansion tank 16.60
Address: v t 2-1 SS S W (,9 T[1 AVG; , S1J1TF. 11>') Fixttmesewer cap 16.60
:ity /State/ZIP• rDy teen Al 0l!Q `' -/ ZZ3 Floordrain/floorsink/hub 16.60
Garbage disposal 16.60
?hone: � ( 2-0 ' R a S?} Fax: (5-p� sc} - g9 o0 Nose bib ■ 16.60
tg APPLICANT ❑ CONTACT PERSON 16.60
lee maker
3usiness name: a 1v1 Sa ,,,,A ? i () yDUyl d S &4 t . interceptorgrease trap 16.60
:(nlaet mane: tvl l 4-ly1 S a c)�o�� Medical gas (value: $ ) ■ Page 2 -
Address: e D I 3CC-7 Primer 16.60
:i /Staie/ZIP: a 0 . q - 7 1 3:S Roof drain (commercial) 16.60
LY ice �` �'� / Sink/basin/lavatory 16.60
'hone: (50 [ p '- f 7 - S 5 6, -7 . I Fax:: (� 6' (17 - 7l.S/ Tub /shower /shower pan 16.60
? -mail: Urinal 16.60
CONTRACTOR Water closet 16.60
lusiness name: nt Y b L? c tv- 62 f (_ A Watenccater 16.60
Other
rddr ess:
f . a , 6 t»C 3c -? Subtotal
i _ /State/Z1P: n � �� � �/� e-i / 1 ty I .) UY - k 1/ [ !.c ;1i1 S ,
[ >C� ! 1 Minimum permit fcc: 572.50
t Residential backflow minimum permit fee $3625
hone: ( K 7 " 5 b F ax: � (o ` 7 9/ S
5 7 y Z P l m t bi ng Li no Plan review (25% of permit fey)
CB Lie.: State surcharge (8% of permit fee)
uthorized sigtaturc: / I ! ' v 5 TOTAL PERMIT FEE
rint name: Date Q �1 K Thi per mit application expires if a permit is not obtained within
1/1 IC I r l L , SL A �. � 180 days after it has been accepted as complete.
*Fee methodoloev set by Tri- County Buildinre Industry Service Board
CITY OF TIGARD
BUILDING DIVISION PERMIT #: PLM2005 -00591
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 10/21/2005
Phone: (503) 639 -4171 /Onaru �l�ui�p�i"I�I�
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 10/27/2005 TIME: 4:11PM PAGE: 75
SITE ADDRESS: 15984 SW 77TH TERR CLASS OF WORK:
SUBDIVISION: HAMBACH GROVE LOT #: 018 TYPE OF USE:
PROJECT NAME: HAMBACH GROVE
DESCRIPTION: Bad/Slow 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 -04 503 - 209- -6346 N
Corrections /Comments/ Instructions:
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•
PASS ❑ PARTIAL APPROVAL ❑ CANCEL n NO ACCESS,
FAIL ❑ CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED
Inspector: , Date: ) 2 3 Phone #: (503) 718-
.
CITY OF TIGARD
BUILDING DIVISION PERMIT #: PLM2005 -00591
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 10/2112008
Phone: (503) 639- 4171n °�N�ii� @Ij�l
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 10/27/2005 TIME: 4 :11PM PAGE: 76
SITE ADDRESS: 15984 SW 77TH TERR CLASS OF WORK:
SUBDIVISION: HAMBACH GROVE LOT #: 018 TYPE OF USE:
PROJECT NAME: HAME3ACH GROVE
DESCRIPTION: Back flow 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 -03 503 - 209-5346 N
Corrections /Comments/ Instructions:
•
;PASS n PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
FAIL 1 1 CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Date: L) /` Phone #: (503) 718 -