Permit CITY OF TIGARD PLUMBING PERMIT
° COMMUNITY DEVELOPMENT PERMIT #: PLM2008 - 00147
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 4/9/2008
PARCEL: 2S112CC -20100
SITE ADDRESS: 15706 SW 81ST AVE ZONING: R -
SUBDIVISION: GAGE FOREST LOT: 008 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, 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: « ,,X„ 4 . Permittee Signature: — .A• GzlI
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.
. - 'iurnbin Permit A lice ' EAVED
Building Fixtures 1.(m 01,1 I t- : t : t s t: cr. I .)
c„It2Y5 of Tigard h? R 9 9 " i/ / r No
IN . hone S Bal Bl vd., Tigard, OR 9 73 Plan Review
Phone: 503.639.4171 Fax: 503.5 L9 4 liG N Otter Permit No,:
`' lam+ DsterBy..
I' I v 2 a interrtcC Inspection
www tigard or .417 �� TY
I % V %9%O Liam Ready/By: : See Tags s for
$ NG Notified/Method: Supplemental Information .
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New construction ❑ Demolition For special information rise chocklr'sk
Description I Qts•-J Ea. j Total
❑ Additian/alteration/replacement ❑ Other New 1- 2 -family dwellings (includes 100 It for each utility connection)
f.: .YF:.1;, � . . r ,. �,' "' n;. ' ' `u';Y I 24920
, ∎,;'; ::,'',..'‘,.'":.:.',:94,' Jl` C,#i1i'�� " ,>` Q1�7 011)19. i° SFR baW
10 1- and 2- family dwelling ❑ Cummcrtial/mdustrial SFR (2) bath 350.00
❑ Accessory building 0 Multi - family SFR (3) bath • • 399.00
❑ Master builder ❑Other Each additional bath/kitchen 45.00
.,, :: .:, c�art.."
Fire sprinkler ( sq. it) Page 2
. .. , .: :.. �� _, .,.., .r *.,�*,.. : � • : .... , �:.• :.,... • . :, ;:. Site atilltic9
Job site address: 15106 SW S1" Ave. Catch basin or area drain 16.60
City/State/HP: Tigard, OR 97224 Diywell, leach line, or trench drain 16.60
Suite/bldg./apt. no.: I Project name: Gage Forest Footing drain (no. linear ft.: ) Page 2
- Manufactured home utilities 110.00
Cross street/directions to job site:
Manholes 16.60
Ram drain connector _ . 16.60
Sanitary sewer (no, linear ft.: •) Page 2 _
Storm sewer (no. linear ft.: ) Page 2
Subdivision: Gage Forest I Lot no.: 8 Water service (no. linear tt.: ) _ Page 2
Fixture or item
Tax map/parcel no.: Absorption valve 16,60
•
,.' ....: ; : +:r. ;... • I s R 1 ON {`NVQ a . } ? .. , v. . . ' . . ,k4;;;4,44..,.. Beckilow preventer 1 Page 2 27.55
Irlrigadon System Installation Backwater valve 16.60
r Clothes washer 16.60
Dishwasher 16,60
Drinking fouruain 16.60
' ;.�;: .... ' ±' -� � , . ,. ,.. ,. ;. ,... ...,._. c.r :. ' Erectors/ 16.60
:�`, � sump
Name: JT Roth Construction Expansion tank 16.60
Address; 12600 SW 72e Ave. Flxturc/sewcr cap 16.60
City/State/LIY: Tigard, OR 97223 Floor drain/floor sinklhub 16.60
Phone: (503)639-2637 Fax: (503)624 -0239 Garbage disposal 16.60 .
16.60
� - Hose bib
.itit, 4AIV . 7:? :;., :, ,. ,P,..' X'` .... '! . .,'; :,`: 16.60
.' , , . Tee maker
Business name: Forest Landscape Ina I nterceptor / grease t 16.60
Contact name: Vanessa Medical gas (value: $ ) Page 2
Address: 40437 NW Verboort Rd. Primer 16.60 •
City/Stare/ZIP: Forest Grove, OR 97116 Roof drain (commercial) 16.60
Sink/basin/lavatory 16.60
Phone: (503) 357 -3808 I Fax:: (503) 359 -1908 Tub/shower/shower pan 16.60
E-mail: Urinal 16.60
;;., ,`,. ( ::. ,: a ,rr:x, : , '; . 16.60
't < .�;�' p � ::;,�;;',,::; =•. ,'.., „.,..• . �; W a t er C lose[
Business name: Forest Landscape, Water heater 16.60
Address: 40437 NW Verboort Rd. • Other: - _
Subtotal 27.55
City/State/ZIP: Forest Grove, OR 97116 -- _, ___ Minimum permit fee: $72.50
36.25
Phone: (503) 357 -3508 Fax: (503) 359 -1908 Residential backflow minimum permit fee: $3625 _
Plan review 05% of permit fee)
CCB Lie.: I.CB 5253 P � Q ... Plumbing 1 ic. no.: 1 .....g 5 State sureeharge'(12% of permit fee) 4.35
Authorized signaiiire i , 1(,FiO O � TOTAL PERMIT FEE 40.60
prink name: Vanessa C a s t a n e d a ` Date: 4 / 9 / 0 8 p e r m i t
180 days after it has been accepted as complete.
*P methndnlnry cat by 'Fri-County Ruth Tnductry Service Rnard
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CITY OF TIGARD _
BUILDING DIVISION PERMIT #: PLM2008 -00147
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 4/9/2008
Phone: (503) 639-4171
Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 4/15/2008 TIME: 7:02AM PAGE: 11
SITE ADDRESS: 1606 SW 81ST AVE CLASS OF WORK:
SUBDIVISION: GAGE FOREST LOT #: 008 TYPE OF USE:
PROJECT NAME: GAGE FOREST
DESCRIPTION: Installing bacldlow preventer.
OWNER: .ff ROTFI CONSTRUCTION, INC., PHONE #: 603 639 - 2639
CONTRACTOR: FOREST LANDSCAPE, INC PHONE #: 503 - 357 - 3808
Inspection Request Scheduled For: Date: 4/15/2008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
395 Mit :c. inspection 069403.01 503. 806-0602 N
Corrections/Comments/Instructions:
C a,rt �b
X PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: " \lvd � Date: `A I 1 51 DC) Phone #: (503) 718-
•