Permit CITY TIGARD PLUMBING PERMIT
twit DEVELOPMENT SERVICES PERMIT #: PLM2005 -00583
' 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 10/20/2005
PARCEL: 2S 112C D -12600
SITE ADDRESS: 16068 SW 77TH TERR ZONING: R -12
SUBDIVISION: HAMBACH GROVE LOT: 024 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 Surcharp 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 -6699 or 1- 800 - 332 -2344.
Issued By : Permittee Signature: /mi /: // / _
•
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.
A '
19 05 12:03p Martin Sander 503 - 647 -9151 p.1
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:SW Hall Blvd., Tigard. OR 97223 19 Dar: . f p `j '
Permit No.. "' /, 5-92.-- ®� 1 9 �oo '4e Phut Review
.nc 503.639.4171 Fax: 503 598.1464 T 1>ate/By: Other Permit No.:
A- Hour Inspection Line: 503.639.4175 i' ,
.-�i ` .�. Date ltcadylBy &1 See Pape 2 for
Internet: wwweitigard,or,us 'i► Noh6ed/Mcr1md: Supplemental information
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Description Earn
Q Addition /alteralion/re.Placcmeni ❑ Other New 1- 2-family dwellings tags (mdudes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (1) bath 24920
❑ 1- and 2- family dwelling ❑ Commercial/industrial SFR (2) bath 350.00
❑ Accessory building ❑ Multi- family . SFR (3) bath 399.00
❑ Master builder ❑ Ot11ei- Each additional bath/kitchen 45.00
Fite sprinkler ( se., R) _ Page 2
. JOB SITE INFORIHATION AND LOCATION Site utilities
Job site address .'. � R 9 ( s kl 1 f r 4 ( 1 • Catch basin or area drain 16.60
City /State/ZIP: "T i lojtd Q is G Z z. Li Dry yell, leach line. or trench drain 16.60
Suite/bldg./apt. nog: Project Ilan 1-f am hit^ .� Footing drain (no. linear ft,: 1 Pagc 2
Manufactured home utilities 110.00
Cross street/directions to job site: Manholes 16.60
Rain drain connector 16.60
Sanitary sewer (no. linear ft_: ) Pagc 2
Storm sewer (no. linear B.: ) Page 2
� 1)G c Al LbDS,S'� 1 Watcrscrvice (no. linear R: ) Parr 2
subdivision: L no.. {
Fixture or item
fax map/parcel no.: Absorption valve 16.60
DESCRIPTION OF WORK Bast: flow prevrnlcr Pagc 2 P
c, 4-1
,�i ► Backwater valve 16.60
Le6tn .cCetr -e- Ll n 4 ri Clothes washer 16.60
Dishwasher 16.60
PROPERTY OWNER I ❑ TENANT Drinking fountain 16.60
Ejectors/sump 16.60
Jame: 1.--e5 s a 1, ev-ve Expansion tank 16.60
lddress: ( 1 SS S"- L n i Thi es . SSu1T ) bi) F'otttarlscwer cap 16.60
:sty/State/ZIP: P ". t �� A 0 R 'I 7 Z-Z3 Floor drain/floor sink/hub 16.60
'hone: bb3) to 2,c) - 2z) RD Fax: (S-� 59 g - g9 CO Garbage disposal 16.60
APPLICANT ❑ CONTACT PIER.SON Hose bib 16.60
Ice maker 16.60
tusincss name: Ct e-ttyl se& �� a .r- ( rt,LArld S 't- Interceptor /grease trap ( 6.60
:ontact name: r� f i--N.-1 S4 nfri Medical gas (velum $
Pace 2
sddress: ^ 0 10X ,7 Primer 16.60
:ity /Slata21P: A ) 6 „,...4.-k e l f ; 0 t 9 3_.. Roof drain (commercial) 16.60
Fax:: ( ) 61 f7 - 7/3-7/ Sink/basin/lavatory 16.60
hon(3) � Y 7 - SS �� 1
Tub /shower /shower pan 16.60
-mail:
Urinal 16.60
CONTRACTOR Wat closet 16.60
usincss name: /v/ 4L 1 Ilk , c s z---i-- Zi7 tiCk"./hcaA5 Water heater 16.60
ddress: P. 0 , te. x -r.),- -- 1 Other
ity /Statc/ZTP: N 0. ( " �,n r c Gc._ :' 5 6 J h ` --- 1 - 1.3 Subtotal
� Minimum permit fee: S72.50 SO
hone: (5Oy I Li? - 5$ 6 - 7 Fax: (5 Co e r 1 -- 9l 5 / Residential baeicflow minimum permit fee: S36_25
C13 Lie,: 5') 1. f Z Plumbing Lk. no.: Plant review (25 %ofpermit fix)
ulhorized signature: / State surcharge (S% of permit fee)
_mac... a /V -//..-0 TOTAL PERMIT FEE . 2_5
rint name: /A4 4 vfiih 5.4 a j,+- Date: d - g c)5 This permit application expires if permit is not obtai ed wflhin
180 days after it has been accepted as complete. j )
Fee methodotoev set by Tri- Countv Buildinr Industry Semi Bc rr
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