Permit CITY TIGARD PLUMBING PERMIT
F . I DEVELOPMENT SERVICES PERMIT #: PLM2005 -00585
J1 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 10/20/2005
PARCEL: 2S112CD -12400
SITE ADDRESS: 16032 SW 77TH TERR ZONING: R -12
SUBDIVISION: HAMBACH GROVE LOT: 022 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 10/20/200` $36.25
PORTLAND, OR 97223 [TAX] 8% State Surchari 10/20/200f $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: 4 / Permittee Signature: �� C l
Call 503 - 639 -4175 by 7:00 a.m. for an inspection that business day.
This permit cant 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 11:41a Martin Sander 503- 647 -9151 p.
t jn bing Permit Application ... i• t 11: 01.1.1( I•: 1 .1 (1\ 1.1
�••�S E 1 \ E D Rcc U y:
City Of Tigard DateJ iv/ tt / v-7 13 Penult No 1 t /.206 -... 40 �! ��
13125 SW Hall Blvd., Tigard, OR Plan Review
Phone: 503.639.4171 Fax: 503.5911 y: 1960 ' Date/B Other Permit No.:
24- Hour lnspcctiott Line: 503.639.4 N 7 i.)�. •i _ I.,, /pate R.ady/By: MCI a See 1 Qty. 1 Pe pa 2 for
Internet: www.ciiigard orus 6 T 1 9 7f[05 Notifed/M ihod: 7 '✓ Supplemental inracmatioa
C
F )VORK FEE' SCHEDULE"
r For special inform un use cited:rex
New N corsbuction BUILDING ply l tem o Iiti on
Des cription E. 1 Total
'' `555
❑ Addition /alteraiion/replooement ❑ Other. New I- 2-family dwellings (includes 100 R for each utility connection)
CATEGORY OF CONSTRUCTION SFR (1) bath 249.20
❑ 1- and 2- family dwelling ❑ Commercial/industrial 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.) . P3e2
JOB SITE INFORMATION AND LOCATION Site utilities
Job site a d d r e s s : I `p 0 'Al- 6v1 -11 - - t . Tl -RA_ . Catch basin yr area drain 16.60
City /StateJZIP. T i Q fk q-12-z-1-1 Drys+ ll. leach line, ortrench dram 16.60
Suite/bldgJapt. no.: I Project "Inc' H}(L,),, )1)(1,_0 .1" Footing drain (no. Iuicar R: ) Page 2
Manufactured home utilities 110.00
Cross strcct/diredions to jab site: Manholes 16.60
Rain drain connector 16.60
Sanitary sewer (no. linear r ft.: Page 2
}� L ( '272..., Stonn sewer (no. linear ft: ) Page 2
t l�i'Yt U(FL� l siYl Lot no.: Walcrservitaa(no. linear ft: Paget
Subdivision:
�� `� Fixture or item
fax map /purest nom Absorption valve 16.60
DFSCRIP ZION OF WORK Backflow prevente r Page 2 I v¢-2
Backwater valve 16.60
L�( j nctscn r� Q LS s Clothes washer 16.60
J Dishwasher 16.60 1
®. PROPERTY OWNER I ❑ TENANT Drinking fountain 16.60
Ejectors/sump 16.60
Jame: Le5e..1\ Cl (1,t) vv O)•u f - c Expansion tank 16.60
1ddress: ( 2 : 1 SS 5 ) � g 1 - . fc�^i. suite -1 Cat) Fixturesawer cap 16.60
:ity /Statc/ZfP: rpy -k. tc,....r-LA 0 v={ ‘--'"7 LZ3 Floor drain/floor sinklhuh 16.60
'hones 603) to ,Zo - R t c, gD Fax ($Z?- S9 g - g99 at:), Garbage disposal 16.60
81 APPLICANT ❑ CONTACT PERSON Hose bib 16.60
Ice maker 16.60
tusiness niece; -(cc. C-)y) c n P SG (5wti01 - 1C1 S 1941 intexcepior/ trap 16.60
'ontact name: rte) el.. .r -t-1 - S nlJlO� Medical gas (value S ) Page 2
ddress: V) 0 . OS uX 3C>-/ Primer 16.60
ity/Stote/ZIP: A ' 1 0,,,4-1,1, e l: o q - 7 1 33.... Roofdrain (cormnereial) 16.60
/ t Sink/basin/lavatory 16.60
hone: (503) to Y s 5 4,"7. f Fax :: (e..53.-') 4:7 7 � 7 - / v f-S/
Tub/shower/shower pan 16.60
-mail: Urinal 16.60
CONTRACTOR Water closet 16.60
usincss name: 0 4. N 7 Slc H- 67 Y Water heater 16.60
Other:
n
ddress: T ._ a . I& O -, - C 7D - Subtotal
ity/StateIZIP: ( N-41,, 40 (,,._ ,• .S C )1 - 7 permit ' Minimum pnit e: 572.50
:one: (503) ( - f '7 - 5 5 177 -7 Fax: (5 (0 c / '7 C / .5 / Residential backflow minimum permit foe: 53635
213 Lic.: 5 L f Z Plumbing Lic. no.: Plan review (25% of pcmtit fee)
v . Q . O State surcharge (8% of permit fee) . 2_5 uthotiud signattetc t t TOTAL PERMIT FEE
;at name: -
G V# C r - ��s• Dale: .% - 0 This permit application expires if a permit is not obtained within
180 days after it has been accepted as complete
*Fee methodoloev set by Tri-Countv Buildine Industry Service Board
. ---• . ,
• CITY OF TIGARD
, BUILDING DIVISION
A617 PERMIT #: PLM2005-00585
i
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 10/20/2005
Phone: (503) 639-4171 ,,„fimoviiiilitlt\
Inspection Requests (24 Hrs.): (503) 639-4175
INSPECTION WORKSHEET FOR DATE: 11/15/2005 TIME: 7:02AM PAGE: 49
SITE ADDRESS: 16032 SW 77TH TERR CLASS OF WORK:
SUBDIVISION: HAMBACH GROVE LOT #: 022 TYPE OF USE:
PROJECT NAME: HAMBACH GROVE
DESCRIPTION: backflow preventer for irrigation.
OWNER: LEGEND HOMES, PHONE #: 503-620-8080
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. Plumbing final 021279-08 603-647-5667 N
Corrections/Comments/Instructions:
(___-/
PASS Ti PARTIAL APPROVAL 1] CANCEL Lill NO ACCESS
1 1 FAIL 1 1 CALL FOR INSPECTION fl ADDITIONAL FEES ASSESSED
Inspector: _/ i Date: \-' l ,/ '\* /0 (hone #: (503) 718-
•
CITY OF TIGARD
BUILDING DIVISION PERMIT #: PLM2005 -00565
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 10/20/2005
Phone: (503) 639 -4171 /iru Nypl�i�l
Inspection Requests (24 Hrs.): (503) 639 -4175 „_,W
INSPECTION WORKSHEET FOR DATE: 11/15/2005 TIME: 7:O2AM PAGE: 50
SITE ADDRESS: 16032 SW 77TH TERR CLASS OF WORK:
SUBDIVISION: HAMBACH GROVE LOT #: 022 TYPE OF USE:
PROJECT NAME: HAMBACH GROVE
DESCRIPTION: backflow preventer for irrigation.
OWNER: LEGEND HOMES, PHONE #: 503- 620-B080
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
325 RP /backflow preventer 021278.07 503 -647 -5567 N
Corrections /Comments/ Instructions:
I 1 PASS I I PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
U FAIL n CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Date: / ' d -1 Phone #: (503) 718 -