Permit CITY TIGARD PLUMBING PERMIT
` COMMUNITY DEVELOPMENT PERMIT #: PLM2008 - 00088
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 3/4/2008
PARCEL: 2S 112CC - 19700
SITE ADDRESS: 15758 SW 81ST AVE ZONING: R -12
SUBDIVISION: GAGE FOREST LOT: 004 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
TIMBERLAND HOMES INC
12670 SW 68TH AVE Description Date Amount
TIGARD, OR 97224 [PLUMB] Permit Fee 3/4/2008 $36.25
[TAX] 12% State Surch 3/4/2008 $4.35
Phone : 503- 620 -8860 Total $40.60
Contractor:
HERITAGE LANDSCAPE GARDENING
11709 SE WOOD AVENUE
MILWAUKIE, OR 97222 REQUIRED ITEMS AND REPORTS
Contact # : PRI 503 - 317 -7152
FAX 503- 794 -8619
Reg #: PLM 6963
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 0001 -0010 through OAR 952 - 0001 -0100. You may obtain copies of
these rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued B -- — Permittee Signature: <:=Y –P
Call 503.639.4175 by 7:00 a.m. for an inspection that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Mar 04 08 12:44p Stephan 5037948619 p.2
,Plumbing Permit Applica '
Building Fixtures 'E CEIVED FOR OFI I( t SI.: ( )N1.
City ofZigard MAR - 4 2008 Receiv d - •
lilt - 13125 SW Hall Blvd., Tigard, OR 97223 ` Persia tan: �� . e .. •`.
Phone: 503.639.4171 Fax: 503398.
Plan Review OdrePermitNo.
inspection Line 503.639.4175
CITY OF T IG ARD l Y AP-am-7- '�
Internet www.tigard.or gov Page 2 for
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New construction ❑ Demolition Description I Q. I Ea I Total
New I- 2- family dwellings (includes 100 ft. for each utility connection)
0 Addition/alteration/replacement 0 Other SFR (1) bath 249.20.'
CATEGORY OF .CONSTRUCITON` :' SFR (2) bath 350.00
' Jl- and 2-family dwell 0 Commercialfindust ial SFR (3) ham 399.E -
0 Accessory building 0 Multi -family Each additional bat$lldtcbe�h 45.00
Fire sprinkler (_ s9• ft) Page 2
0 Master builder 0 Other site utilities
JOB SITE INFORMATION AND LOCATION ...
Catch basin or area drain 16.60
Job site address I S 7 S g S .., 'r Drywall, leach line, or trench drain . 16.60
City/State/ZIP -r-,-c.,, prix. c , R Footrrrg drain (no. linear R: _) Page 2 ,
Suite/bldg apt no : I Project name: / f ^ _ _ , r Manufactured home utilities 110.00
�ZSf Manholes 16.60
Cross street/directions to job site Rain drain connector 16.60
. Sanitary sewer (no. linear R: __) Page•2
Storm sewer (no. linear ft.: ) Page 2
Water service (no. linear R: 1 Page 2
Fixture or item
subdivision: G A c; e �'t „_, s y I Lot no.: Lt -
Absorption valve 16.60
Tax map/parcel no.: o ter
Backfl w peeves I Page 2 34 , 2 s
DESCRIPTION. OF :WO :.: `:.. Backwater vaire 16.60
Clothes washer 16.60
Dishwasher 16.60
Drinking fountain 16.60
'ect;ns/swn 16.60
Expansion . PROPERTY OWNER: 0: - TENANT : `,
ion 16
Name: T+wRf ALA Njo Hu h a..s, a c, Frame/sewer cep 16.60
Address: i 26 7 O S i:..i ( Sin' 71D tr Floor drain/0oor sink/hub
16.60
City/State/ZIP: '774 cl OZ. 97 2_ Z3 Garbage disposal 16.60_
Phone: (S 63) C ' 2.o- g. gbc Fax: ( Sg - (3) Hose bib _ 16.60
.. .....
Ice maker
16.60
APPLLCANT ': - 0 CONTACT PEItSOI+ii.-- : -.. Interceptor/grease trap 16.60
Business name: /1 Li4-1 T 6 4 ! 1 t c_ C .1.1‹, 1 As e . Medical gas (value: S ) Page 2
Contact name: S e - 5te.n6atrx.J(t_ Primer 16.60
Address: II.7O9 S E- Iirx.h�1F Roof drain (commercial) 16.60
Cit M. rr,.141- 11 0 9._ 7Z2 z Sink/basin/lavatory _ 16.60
Tub/shower/shower pan 16.60
Phone: (.503) 7 1 y ° 13 619 ( Fax:: ( ) Urinal 16.60
E -mail Water closet 16.60
CONTRACTOR: Waterheaoer
16.60
Business name: A A-S Aikt.‘I ' Other. -
Address: Subtotal
Minimum permit fee: $72.50
City /State/ZIP: Residential backliow minimum permit fee: $3625 3b .
Phone: ( ) Fax: ( ) Ptmr review (25% of permit fee)
CCB Lic.: Plumbing Lic. no.:
State surcharge (12% of pe nit fee) % '
Authorized signature: TOTAL PERMIT FEE S s c. I , 1<0
Print name:5 ��.i r . 1 .t �i5 �- is 190 days after it bas been accepted as complete. permit application expires if a permit is not obtained wh�h
n S I Date: 5 9 / og I This
1 11
*Fee methodology set by Tri -County Building Industry Service Board.
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