Permit ' !� a CITY OF TIGARD PLUMBING PERMIT
° COMMUNITY DEVELOPMENT PERMIT #: PLM2008 - 00146
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 4/9/2008
PARCEL: 2S 112CC -20300
SITE ADDRESS: 15672 SW 81ST AVE ZONING: R -12
SUBDIVISION: GAGE FOREST LOT: 010 JURISDICTION: TIG
PROJECT: GAGE FOREST
Project Description: Installing backflow preventer.
CLASS OF WORK: ALT 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
JT ROTH CONSTRUCTION
12600 SW 72ND AVE Description Date Amount
TIGARD, OR 97223 [PLUMB] Permit Fee 4/9/2008 $36.25
[TAX] 12% State Surch 4/9/2008 $4.35
Phone : Total $40.60
Contractor:
FOREST LANDSCAPE, INC
40437 NW VERBOORT RD
FOREST GROVE, OR 97116 REQUIRED ITEMS AND REPORTS
Contact # : PRI 503- 357 -3808
FAX 503- 359 -1908
Reg #: PLM 8253
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: �� , .",��1111P Permittee Signature: GA,/}Ck(/
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.
• llutg Permit A 1 ,
Building Fixtures
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SW Hall B - rj Phone: 503.639.4171 Fax:' Tigard OR 972 smoc t Ivir‘ N.-pc-mit wo.;
, „ , Inspection Line: S03.639.4175%0 ",„. DWISO% DatedBF
Date ReetlytBy: Judi: in See Pep 2 for
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M New construction 0 Demolition For special infinsnation use checklist
Description J Qty. I Ea. 1 Total
[3 Addition/alteration/replacement 0 Other: New 1- 2-famlly dwellings (includes 100 It for each utility cormeetion)
';''';'!"i' ';:'-';' ' ;':::. A . 64614:tii.of4sTitierioN ::: ,.::•• .:......::',, ::: . sett (1) bath 24920
. .
0 1- and Mamily dwelling 0 C,ommereial/industrial SFR (2) bath 350.00
0 Accessory building 0 Multi-family SFR (3) bath 309.00 - --
Each additional bath/kitchen 45.00
0 Master Wilda 0 Othei:
Fire sprinkler ( sq. ft) Page 2
' '' ::.-.,';,: : • :i :Y,:..::: site utilities
Job site address: 15672 SW 81 Ave. Catch basin or area drain 16.60
City/State/Z1P: Tigard, OR 97224 Drywell, leach line, or trench drain 16.60
_ - Footing drain (no. linear 0 -: --) Page 2
Suite/bldg./apt. no.: I Project name: Gage Forest
Manufactured home utilities 110.00
Cross street/directions. to job site: 16 60
Manholes
Rain drain connector 16.60
- - - —
Sanitary sewer (no. linear ft: ) Page 2
• Storm sewer (no. linear ft.: _____) Page 2
Water service (no. linear ft.: Page 2
Lot no.: 10 - _
Subdivision; Fissure or item
Tax map/parcel no.; Absorption valve 16.60
_
0.0*ii*04 ; ,...:-. ••••••. : - '7• :' ' '-',: . ':: ' Baelc:flow Preveitter I Page 2
... , PA • , 1 ‘ , A ., ., l• AAA
• • A •
Irrigation System Installation 16.60
- Backwater valve 16.60
Clothes washer —
Dishwasher - 16.60
16.60
16.60
Name: Tr Roth Construction Expansion tank 16,60
Address: 12600 sw 72 Ave. Fixture/sewer cap 16.60
Floor drain/floor sink/hub 16
City/State/ZIP: Tigard, OR 977.23 _ - —
Garbage disposal 7
Phone: (503)639-2637 Fax: (503)624-0239 16.60
° 16
-.7 16.60
- Hose bib _
i ----- . _
16.60
Business =MC: Forest Landscape, Inc. . Intereconegreasemm 16.60
Contact name: Vanessa Medical gas (value: $ __ ) , Page 2
Primer
16.60
Address: 40437 NW Verboort Rd. - ---
Roof drain (commercial) 16,60
City/Si.ste/ZIP: Forest Grove, OR 97116 16.60
Sink/basin/lavatory
Phone: (503) 357-3808 Fax : (503) 359-1908
Tub/shower/shower pan 16.60
- _
E-mail: Urinal 16.60
16.60
Water closet -
Water heater 16.60
Business name: Forest Landscape, Inc. .
Other: 1 ..
Address: 40437 NW Verboort Rd. Subtotal 27.55
City/State/ZIP: Forest Grove - Minimum permit fee: $72.50 3625
Phone; ( 503) 357-3808 Fax: (503) 3594908 _Residential backflow minimum permit fee: $3625
Plan review (25% of Permit fee)
CCB Lie.: LCB 8253 0 t 1 V-v)tl i (. J Plumbing tic. no.:
State surcharge (12% of permit foe) 4.35
- 0 -- 40.60
• TOTAL PERMIT FEE
Authorized signature:. ' ji, , 44„ i 1 permit is not obtained within
Print name! Vanessa Castaneda
I Date! - 418/08 1 This Pe 1:: a da l l i s ca af i t i ; n it ha if a accepted as co
_
*Pee methodology set by Tri-County Building Industry Service Board.
440-46161110/02COMIWO
1:113uiktingThivAnza-PermitAmdoc 12/27/06
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CITY OF TIGARD .
BUILDING DIVISION PERMIT #: P1 .M .003 -0O 1 16
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 4/9,x2018
Phone: (503) 639 -4171 ay,'�Iln
Inspection Requests (24 Hrs.): (503) 639 -4175 t F__..
INSPECTION WORKSHEET FOR DATE: 4/15/2008 TIME: 7:02AM PAGE: 8
SITE ADDRESS: 1%72 SW 131ST AVE. CLASS OF WORK:
SUBDIVISION: GAGE FOREST LOT #: 010 TYPE OF USE:
PROJECT NAME: GAGE FOREST
DESCRIPTION: Installing backflow preventer.
OWNER: PHONE #:
CONTRACTOR: FOREST LANDSCAPE, ING PHONE #: 503 - 3808
Inspection Request Scheduled For: Date: 4/15/2008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
395 Mi;--c. inspection 068403-04 503. 805-0607 N
.uk, e-i �Jv�•I.
Corrections/Comments/Instructions:
COQdt. �1 "-ri yt--)
XI PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: (.51 Date: L I CCIaS Phone #: (503) 718-