Permit CITYOF TIGARD PLUMBING PERMIT
I DEVELOPMENT SERVICES PERMIT #: PLM2005 -00582
VIII 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 10/20/2005
PARCEL: 2S 112CD -12100
SITE ADDRESS: 15996 SW 77TH TERR ZONING: R -12
SUBDIVISION: HAMBACH GROVE LOT: 019 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 10/20/200E $36.25
PORTLAND, OR 97223 [TAX] 8% State Surcharl 10/20/200` $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: Permittee Signature: 4 2 2 4
CaII 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.
j3ct 19 05 11r Martin Sander 503 - 647 -9151 p.l
Plumbing Permit App ` / � i -ult ()Ft If I. t N 1 (/N 1.1 .. --
(� r+ Rcccii wr
City of Tigard It'4 o-.,trisr• id f q / 04 8 8 remit Ko.� 1,010.4.-012513 1,010.4.-012513 1,010.4.-012513 13125 SW Hall Blvd., Ti tom, O 7323 c9 2005 Plan Review
Phone: 503.639.4171 Fax: + $ 498,.1�960 r' ' .. dt�
Datc/By: r ketrmit No -
24- Hour Inspection Line: i .,¢ . 1 GH �- { D - „_L1 'f l Date Ready/By: Eil see Pace 2 for
!Memel: www.ci.ligard.or. 6 DING DIVISION Notificd/Meihod: Sappl ®evttit Information -
TYPE OF WORK FEE* SCHEDULE
Neweonatntetion ❑ Demolition
For apedolkfonnetiorsaceehe cast
Description 1 Qty; 1 Ea. 1 Total
❑ Addition /alteration/replacement ❑ Qlhtr New 1- 2-family dwellings (includes 100 R for each unlit). come-aim
CATEGORY OF CONSTRUCTION SFR (1) bath - 249.20J
❑ 1- and 2- family dwelling 0 Commercial/industrial SFR (2) bath 350.00
❑ Accessory building 0 Multi- family SFR (3) bath 399.00
Each additional bath/kitchen 45.00
❑ Master builder ❑ Other
Fire sprinkler (__ sq. fL) Page 2
308 SITE DEFORMATION AND LOCATION Site utilities
Job she address: (b 0 (,,S 64.) 1-7 i1- 'r e..ra-. Catch basin or area drawn 16.60
City/State/ZIP: T t'fio.ca, p I q'7 2_2_11 Drywell, leach line, or birch drain 16.60
Suite/bldg/apL no.: l Project palm! rI e -+71 t, -I" Footing drain (no. linear ft: ) Page 2
Manufactured home utilities 110.00
Cross street/directions to job site
Manholes 16.60
Rabe drain connector 16.60
Sanitary sewer (no. linear R.: Page 2
Storm sewer (no. linear ft.: ) Page 2
l kriN La �� r �l� Water service (no. linear ft.: ) Paec 2
Subdivision: t t IJ l �](j Lot no.: 1 Fixes or item
Tax map/parcel no.: Absorption valve 16.60
DESCRIPTION OF WORK Backf(owpm- ventar
mac'- • '_• .,f'
Backvrater valve 16.60
LO ncikCc z r_ _ J J) (� 4f 'a 4 Clothes washer 16.60
J Dishwasher 16.60
®. PROPERTY OWNER I ❑ TENS t?rinking fountain 16.60
Ejcetors/sump 16.60
'lame: L, mP De_- . C . _ Erpansian 16.60
lddress•• ( 2--i Ss s\,+tj ( m A� . Sure) Fixtureisewercap 16.60
:ay/State/ZIP: `='o- t 0 9. Z- Z-3 Floor draudfloorsink/hub 16.60
'hone 5D3) Co Za - $?D c{Z, Fax: ($tom S91? - get cC> G bib 16.60
NI APPLICANT ❑ CONTACT PERSON
me ce maker 16.60
tusincss ac
�'Mc Sc � v 6 3i / ricJ nds &At lnterceptor/greasetrap 16.60
'ontact name: i.,1 6,_.,...t--1\„--1 S' nao � Medical gas (value: 5 ) Page 2
.ddress: r - 0 . t,.-).-›e 3+C>•-7 Primer 16.60
ity /Slntr Z1P: A 43 e' eA___;y1 0 i. '9 t 3_ Roof drain (commercial) 16.60 J
hone: (503) (p `YJ- 5 5 6_, [ Fax:: ( ( c/7 - yj s-/ Sirek/htesin/lavtrtoty 16.60
Tub/shower /shower pan 16.60
-mail: Urinal 16.60
CONTRACTOR Water closet 16.60
tsincss name ,i-44..( i--)1,7 �
p c� ` t?fy .� roe Water heater 16.60 • idress: f -0 . tg. O >C �a -7 Other. -
ubtotal
ty /State/ZEP: IV) 0.,,,--1--0.,,,--1--(,, - 44. ( ..-v, S r--AR "7 13'3 Mvlmimum permit fee: 572-50
cone (..5 *y ( `f - 7 - 5$ 6 Fax_ (5C9) C r -7 -- C r f 5 / Residential backflow minimum permit fee: 536]5
:B Lic.: 5 y Z Plumbing Lic. no.: Plan review (25 %ofpermit fm)
rJ State surcharge (8% of permit fee)
tthorized signature: //� TOTAL PERMIT FEE .
int name: uri a v - h/ ,_' i�
.. Gr • l Date (5›..- f< [)S J This permit application expires if a permit is not obtained +eithin
180 days after it has been accepted as complete -
*Fee methodoloev set by Tri- Countv Buildine Industry Service Board
CITY OF TIGARD •
BUILDING DIVISION PERMIT #: PLM2005-00582
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 10/2012005
Phone: (503) 639-4171
:
Inspection Requests (24 Hrs.): (503) 639-4175
INSPECTION WORKSHEET FOR DATE: 11/15/2005 TIME: 7:02AM PAGE: 76
•
SITE ADDRESS: 15996 SW 77TH TERR CLASS OF WORK:
SUBDIVISION: HAMBACH GROVE LOT #: 019 TYPE OF USE:
PROJECT NAME: HAMBACH GROVE
DESCRIPTION: Backflow preventer for irrigation.
OWNER: LEGEND HOMES, PHONE #: 503-6209080
CONTRACTOR: MARTIN SANDERS GROUNDS MAINTEN PHONE #: 503-647-5567
Inspection Request Scheduled For: Date: 11/15/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
3.99 Plumbing final 021279-02 503-647-5567
Corrections/Comments/Instructions: •
kl t,' ;via k- MI6
`■1
\-k
osql74)...4.‘ v °
1:53 PASS E PARTIAL APPROVAL fl CANCEL E] NO ACCESS
FAIL fl CALL FOR INSPECTION fl ADDITIONAL FEES ASSESSED
\ AS — Al
Inspector: Date: Phone #: (503) 718-
CITY OF TIGARD
BUILDING DIVISION PERMIT #: PLM2005 -00582
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 10/20/2005
Phone: (503) 639 -4171
Inspection Requests (24 Hrs.): (503) 639 -4175 __...
INSPECTION WORKSHEET FOR DATE: 11/15/2005 TIME: 7:02AM PAGE: 77
SITE ADDRESS: 15996 SW 77TH TERR CLASS OF WORK:
SUBDIVISION: HAMBACH GROVE LOT #: 019 TYPE OF USE:
PROJECT NAME: HAMBACH GROVE
DESCRIPTION: Backflow preventer for irrigation.
OWNER: LEGEND HOMES, PHONE #: 503 - 620.0080
CONTRACTOR: MARTIN SANDERS GROUNDS MAINTEN PHONE #: 503- 647 -6567
Inspection Request Scheduled For: Date: 11/15/20055 Pour Time:
Code # Inspection Description Confirm # Contact # Message
32\ RP /backflow preventer 021279 -01 503 -647 -5567 Y
Corrections /Comments /Instructions:
PASS U PARTIAL APPROVAL n CANCEL ❑ NO ACCESS
❑ FAIL 1 1 CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED
r Inspecto , D ate: / AL-- P #: (503) 718 -