Permit CITY OF TIGARD PLUMBING PERMIT
° COMMUNITY DEVELOPMENT PERMIT #: PLM2008 - 00151
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 4/9/2008
PARCEL: 2S 112CC - 20200
SITE ADDRESS: 15680 SW 81ST AVE ZONING: R -12
SUBDIVISION: GAGE FOREST LOT: 009 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
J T ROTH CONSTRUCTION, INC.
12600 SW 72ND AVE Description Date Amount
SUITE 200 [PLUMB] Permit Fee 4/9/2008 $36.25
PORTLAND, OR 97223
[TAX] 12% State Surch 4/9/2008 $4.35
Phone : 503- 639 -2639 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: 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.
lutr_jg in s Per mit Auplication �O
Building Fixtures G I (;1: �_,l 1 ,1. 1': , - , U.1,1
I o City of Tigard s t � 5° Dam/By: (J V (3 "411 t No. ? > �-`_ e
13125 SW Hall Blvd., Tigard, (11t X 7223 ti 1-S7
' I Phon 503.639.4171 Fax 503.598.1. c a W Date/ay: T
Plan Review - I Permit No.: h j r f ca
on Lute. 503.639.4175 ��±±
r ,c, . , , ; G Date Ready/By: runs: 0 Sec Page 2 for
Internet www.tigard or.gov O`` ' ��� \ �_ O
Notifced/Method Supplemental emenfa! Information
.' `_
1� .. Ety. g ye -
® New construction it I . olition For - • is ' . ', a us : eC t.
0 Addition/alteration/raplacemant Other: Des . tinny► Total
_, New 1- 2- family dwellings (includes 100 $. for each utility connection)
C,.A140:01 Y' : '' CONS`140, 017 1 bath . .. _ .. ''�. , � . . SFR O 24920
® 1- and 2 -family dwelling Q Commcrcialrmdustrial SFR. (2) bath III 350.00 Mil
Accessory building ❑ Multi - family SFR (3) bat; 399.00
[] Master builder O - Each additional bath/kitchen 45.00
Fire sprinlder („_ __ sq. ft) Page 2
,i r, :: 1'(lt 1 W -' �Ilt giti&- i • ,AIV,,,... - .1i'1 .. Site utilities
Job site address: 15680 SW 51 Ave. Catch basin or area drain 16.60
City /State/ZIP: Tigard, OR 97224 Drywall, leach line, or trench drain 16.60
Suite/bldgJapt, no.: [Project name: Gage Forest Footing drain (no. linear B.: ,,,,,,_) Page 2
Manufactured home utilities 110.00
Cross street/directions to job site:
Manholes 16.60
]fain drain Connector 16.60
Sanitary sewer (no. linear ft.: ) Page 2 MIMI
Storm sewer (no. linear it: _J MN Page 2 Mil
Subdivision: l Lot no.: 9 Water service (no. linear ft.: _,) Page 2
Flixare or Item
Tax rnaplparcel no.:
f ; , _ Absorption valve 16.60
»1 :Oi; WORK =
...... ,.. , , Bac3Ctlow enter Page 2
Pte' aG
Irrigation System Installation Backwater valve 16.60 1111
Clothes washer 1 16 6 :6- II 60
16.60
1 Drinking fountain 16.60 iii...
:. L 1660
Name: .1T Roth Construction Expansion tank 16.60
Address: 12600 sw 72" Ave. Fixture/sewer cap IIIII 16.60
City/State/ZIP: Tigard, OR 97223 Ploor drain/Poor sink/hub 16.60 -
Phone: (503 )639 -2637 Fax: (503)624-0239 Garbage � � 16.60
Hose bib 16.60
g3►i'I,t Ar1� : ] " !f f ;� EI S ;` 16.60
Business name: 1 crest Landscape, Inc. Iutcrcepror /grease trap 16.60
Contact name: Vanessa Medical gas (value: $ )
Addresa: 40437 NW Verboort ltd. Winer
Roof drain (commercial) 16.60
City /State/Z1P: Forest Grove, OR 97116
Sink/basinnevey: yr 16.60
Phone: (503) 357-3808 Fax:: (503) 359 -1908 Tub/shower /shower pan 16.60
E -mail: Urinal 16.60
=+COR Water closet 16.60
Business name: Forest Landscape, Inc. Water heater 16.60
AddnesS: 40437 NW Verboort Rd. Other.
Subtotal 27.55
City/State/ZIP: Forest Grove Minimum permit fee: $72.50
36.25
Phone: ( 503) 357 -3808 Fax: (503) 359 -1908 Residential backflow minimum permit fee: $3625
Plrmnbin Plan review (25% of permit fee)
CC)3Lie.: LCB 8253 u 1l (�4 3r � X11 , $ Lie. tier.: State surcharge (12% of permit fee) MEI
Authorized signature: it i TOTAL PERMIT FEE 40.60
Print name: Vanessa Castslneda 1 Date: 4/8/08 This permit application expires If a permit is not obtained within
180 days after it has been accepted as complete.
*Fee methodology set by Tri- County Building Industry Service Board.
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CITY OF TIGARD -
1 BUILDING DIVISION PERMIT #: PI.M 00 (3C! la 1
13125 SW Hall Blvd., Tigard, OR 97223 D ATE ISSUED: 4/9."2.008
Phone: (503) 639 -4171 - - cij a. f l '
Inspection Requests (24 Hrs.): (503) 639 -4175 1.L I
INSPECTION WORKSHEET FOR DATE: 4/15/2008 TIME: 7:02AM PAGE: 5
SITE ADDRESS: 15680 SW 81ST AVE CLASS OF WORK:
SUBDIVISION: GAGE FOREST LOT #: 009 TYPE OF USE:
PROJECT NAME: GAGE FORES1
DESCRIPTION: Installing backflow preventer.
OWNER: J T ROTH CONSTRUCTION, INC., PHONE #: 503 -639 -2639
CONTRACTOR: FORES1 I. ANDSCAPE, INC PHONE #: 503- 357 -3808
Inspection Request Scheduled For: Date: 4/15/2008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
395 Mirc. inspection 068403-07 503. 806.0602 Y
Co r /Comments /Instructions:
Vim/ 1,' [� . '\
Ca.,r€.fli- &Taki-dt--
A PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: al , v\`" -- Date: (4 1 /Ai 0 e Phone #: (503) 718-