Permit r 4 CITY OF TIGARD
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PLUMBING PERMIT
I COMMUNITY DEVELOPMENT PERMIT #: PLM2008 - 00149
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 4/9/2008
PARCEL: 2S112CC - 22200
SITE ADDRESS: 15731 SW 81ST AVE ZONING: R -12
SUBDIVISION: GAGE FOREST LOT: 029 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: �' ?; /1-! 0. Permittee Signature: �// TXr.//V
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.
PlhmbMng Permit A
�� Building Fixtures FOR (ti 1.1(1 I tii ()NI . • : (
City of Tigard an c) � ` �,� Received
ll 1 . 9 �® � Date /8y; 1171.A & Permit - �/ IJ VV E • 01/ -
I
13125 SW Hall Blvd.. Ti_: F� ■ � 97
• Phone: 503.639.4171 Fax. S03.59 `1: i \ �p► Rk�%` Other Permit No.: r7 ? f
,t ` Date/By,
Inspection Line: 503.639.4175 G ` �`�`
1 I �. � A R U ` f day J , See Page 2 for
SCiletitill Internet w iw.tigard- or.gov
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® New construction emOlition Pot special l►flormarlon use checklist
Description J Qty. I Ea. j Total
❑ Addition/alteration/replacement J ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
��. �r ::', - ..•:. - SFR (I) 24
... ..,c . � ,... ,, - .
.... ..,. .. ....,,.... `�
. ,. . �. O 920
® I- and 2- family dwelling ❑ Commercial/industrial SFR (2) bath 3 50.00
Access building g (] Multi - family SFR (3) bath 399.00
El Master builder ❑ Other: Each additional bath/kitchen 45.00
r. r , , ;,:: ,• . , r, . Fire sprinkler (.. sq. ft.) Page 2
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Site utultles
Job site address: 15731 SW SI Ave. Catch basin or area drain 16.60
City /State/ZIP: Tigard, OR 97224 Drywell, leach line, or trench drain 16.60
SUiteibldgiapt no.: Project name: Gage Forest Footing drain (no. linear ft.: ) Page 2
Cross street/directions to job site: Manufacttued home utilities 110.00
_ Manholes 16.60
Rain drain connector 16.60
Sanitary sewer (no. linear ft.: „___ _) Page 2
Storm sewer (no. linear ft.: ) Page 2
Subdivision: Gage Forest Lot no,: 29 Water service (no. linear tl : ) Page 2
_... _.._. Fixture Or item
Tax map/parcel no.: -,
y., /;� Absorption valve 16.60 _
A.:•WORK
ltd .�'•� .�.
�,. J �;, I . �`' flow preventer 1
. ,:�.. ��.' < •, '�- .. ', „ . ... �.., ,. ,.,. " . ';,= ,� ,. Back p Page 2 27,55
Irrigation System Installation Backwater valve 16,60
Clothes washer 16.60
Dishwasher 16.60
- Drinking fountain 16.60
r.,. R4R'<,(}9lrAiR1 >' " ... , ..., .. . ....., ,.. _ - _ 16.60
: .......... Ejectors /sump
Name: JT Roth Construction Expansion tank 16.60
Address: 12600 SW 72° Ave. Fixture/sewer cap 16.64
City / State/ZIP; Tigard, OR 97223 Floor drain/floor sink/huh 16.60
Phone: (503)639 -2637 Fax: (503)624 -0239 Garbage disposal 16.60
Hose bib 16.60
!; , `' r:, , ? ,...a :,�;� ';a:; Icerneker
... .... .. : ': 16.64
Business name: Forest Landscape Inc. Interceptor/grease �p 16.60
Contact name: Vanessa Medical as (value: $ ) Page 2
Address: 40437 NW Verbnort Rd. Primer 16.60
City/State/ZIP: Forest Grove, OR 97116 Roof drain (commercial) 16.60
Sink/basin/lavatory 16.60
Phone: •(503) 357 -3808 Fax:: (503) 359 -1908 16.60
Tub /shower /shower prim
E -mail; Urinal 16.60
,
_ Water closet
16.60
Business name: Forest Landscape, Inc. Water heater 16.60 w
Other
Address: 40437 NW Verboort Rd. -
Subtotal 27.55
City / State/ZIP: Forest Grove, OR 97116 _ Minimum permit fee; $72.50
36,25
Phone: (503) 357 -3808 Fax: (503) 359 -1908 4 Residential backflow minimum permit tic: $3625 ..__.
t..l3 Tic.: LCI3 8253 .l, r„ - Plrmnbing Lie- no.:
Plan review (25% of permit fee)
C
Q�1C SL �+ State surcharge (12•x, of permit fee) 4.35
W
Authorized signature: .) ` TOTAL PERMIT FEE 40.60
Print name: Vanessa Castaneda Date: 4/9/08 , This permit application expires it a permit is not obtained within
180 days after it bat been accepted as complete.
"Fee methodology set by Tn-County Building Industry Service Mourn_
ImundinBseeits\Ptia- termaApP.aoe t212r/06 440- 4616T(acmcoadivi o)
90/00 3EVd ONI 3dVOSQNt71 IS3d0d 80616SEEOS LO :EZ 800Z/80/00
CITY OF TIGARD
BUILDING DIVISION. PERMIT #: PLM2008.00149
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 419/12008
Phone: (503) 639- 4171o'd ?�
Inspection Requests (24 Hrs.): (503) 639 -4175 " I I_ -
INSPECTION WORKSHEET FOR DATE: 4/22/200 TIME: 7:00AM PAGE: 47
SITE ADDRESS: 1573 SW 81ST AVE I CLASS OF WORK:
SUBDIVISION: GAGE FOREST LOT #: 029 . TYPE OF USE:
PROJECT NAME: GAGE FOREST
DESCRIPTION: Installing backfIi w preventer.
OWNER: JT ROTH CONSTRUCTION, INC., PHONE #: 503-639-2639
CONTRACTOR: FOREST LANDSCAPE, INC /' PHONE #: 603 -357 -3608
Inspection Request Scheduled For: .. Date: 4/2212008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
'395 Mk; inspection 068696 -01 503.806. 0602 Y
Corrections /Comments /Instructions:
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•
•
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die PASS PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector Date: c-- � � Phone #: (503) 718 - Z_-6.
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