Permit • •N u CITY OF TIGARD PLUMBING PERMIT
C, COMMUNITY DEVELOPMENT PERMIT #: PLM2008 -00322
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 7/30/2008
PARCEL: 2S112CC - 22500
SITE ADDRESS: 15777 SW 81ST AVE ZONING: R -
SUBDIVISION: GAGE FOREST LOT: 032 JURISDICTION: TIG
PROJECT: GAGE FOREST
Project Description: Installing (1) 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 97223 [PLUMB] Permit Fee 7/30/2008 $36.25
[TAX] 12% State Surch 7/30/2008 $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.
^ r
Issued B / rte i
Permittee Signature: �� 4c.✓
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.
Jul 30 08 07:06a Stephan 5037948619 p.2
%-,blrnbing Permit Application {) . . .
Building Fixtures
Q� rFOR Fl ICE 1...'1...'-E 0\1.1 '\l.1
City of Tigard - C, �QO� n x "ea 7 .c_� . i unto.:
I3125 SW Hall Blyd., Tigard, OR 97223 A \\ 3 Plan R�riew 1 �+
ra ' Phone: 503.639.4171 Fax: 503.598.I G D�g Other Pemit No.:
I'! :13/%1;1)
Inspection Line: 503.639.4175 XS IN Daft Ready/By: m I El See page 2 for
Internet www_tigand -orgov C A C Notile T76 Supplemental Information
.TYPE OF. NYO v` -. For special informatkm use checklist
Description I Qty. I Ea I Total
,New construction ❑ Demolition Neer 1- 2- family dwellings (includes 100 ft. for each utility connection)
❑ Addition/alteration/replacement • ❑ Other: SFR (1) bath - - 24920
CATEGORY OF CONSTRUCTION - . SFR (2) bath 350.00
•
XI- and 2-family dwelling ❑ Commer>:ial industrial SFR (3) bath 394.00
❑ Accessory building ❑ Multi- family Each additional bath/kitchen 45.00
Fire sprinkler (_ sq. ft.) Page 2
D Master builder ❑ Other. Site utilities
-' JOB SITE INFORMATION AND. LOCATION Catch basin or area drain 16.60
Job site address: 161- S Z 5 g t s l A c 15 7 S S( ,4yr. Drywel 1, lead, line, or trench drain - 16.60
City/State/ZIP: ! ii �z `1 Z , 3 Footing drain (no. linear ft: ) Page 2
Manufactured home utilities 110.00
Suite/bldg./apt. no.: I Project name: pp Manholes 16.60
elf. Cross street/directions to job site: 5'! 4 ' /G,�cl�'e, e .2 - �^ •/ / Rain drain connector 16.60
Sanitary sewer (no. linear it.: _). . Page 2 .
Storm sewer (no. linear fl.: _I Page 2
Water service (no. linear ft.: �) Page 2
Subdivision: 6,----e, C r I Lot no.: ,3Z Potful re or item
Absorption valve 16.60
Tax map/pareel no.: Backllow preveater ( Page 2 0 17 . y5
n DESCRIPTION . OF WORK . Backwater valve . . 16.60
LYc.k %n ...... preJr�� . . Clothes washer 16.60
Dishwasher 16.60
Drinking fountain 16.60
Ejectors/sump 16.60
PROPERTY. OWNER. - I .. ' 0 'TENAN .
�1 Expansion tank 16.60
Name: Ta1�..1 t�
►Rlj H - t:5- 4. C-. . . Fixture/sewer cap 16.60
Address: j 26'7 o . S i s3 L ' C- . . Floor drain/floor sink/hub 16.60
City/State/ZIP: 7 j 3 Ci Q 9 7 2- 2. Garbage disposal 16.60
Phone: (S el) ry o -- ' n 0 . Fax: (S C ) .51 S - Cl o & 1 Hose bib
16.60
[ce.tnaker 16.60
❑ APPLICANT. ❑. CONTACT PERSON Interceptor/grease trap 16.60
Business name: HF.i T ii ei r_ 1 -A-Pr_ C I)F .a)> I nl e. Medical gas (value: $ ), Page 2
Contact name: • . Primer 16.60
Address: 11'7 0 S k- tjer,ll J1s3 Roof drain (commercial) . 16.60
Sink/basin/lavatory 16.60
I
City/State/ZIP: M. ,q tAK ► L 0 g.. 4 7 :zzZ
Phone: (..54.1-3) '7 s ci. - ,3 f j I Fax:: ( ) Urinal Tub/shower/shower pun 1(x60 •
Urinal 16.60
E -mail: Water closet 16.60
CONTRACTOR : _ Water heater 16.60
Business name: - .SAmc AS Afiek‘1r<' Other: - _
Address: Subtotal
Minimum City/State/ZIP: tmn
Residential backflow minim.�ut fee: $7250
permit faer�36. 5 -j �'- e..
Phone: ( ) Fax: ( ) Plan review (25% of permit fee) C)
CCB Lic.: Plumbing Lie. no.: 6 /G3 State (12% of permit fee) '
Authorized sit, _ / / �/ TOTAL. PERMIT FEE 1Ci
r 7 This permit application expires if a permit is not obtained within
Print name: � A/ rs Date: 2 180 days after it has been accepted as complete.
S72p .� S40c+/ *Fee methodology set by Tri- CountyBuilding Industry Service Boani.
FEE• =. SCHEDULE
E 19tu7&tePomitsPLMF- PermifApp.doa I2/f7/06 44O4616T(boo2/COMIWEn)
CITY OF TIGARD
BUILDING DIVISION PERMIT # : P1142008-00322
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 7/3012008
Phone: (503) 639 - 4171 kg A.
Inspection Requests (24 Hrs.): (503) 639 -4175 . ': till
INSPECTION WORKSHEET FOR DATE: 7/31/2008 TIME: 7:00AM PAGE: 14
SITE ADDRESS: 16777 SW B1ST AVE CLASS OF WORK:
SUBDIVISION: GAGE FOREST LOT #: 032 TYPE OF USE:
PROJECT NAME: GAGE FOREST
DESCRIPTION: Installing (1) baddtow preventer.
OWNER: TIMBERLAND HOMES INC, PHONE #: 503
CONTRACTOR: HERITAGE LANDSCAPE GARDENING PHONE #: 503. 317 -7152
Inspection Request Scheduled For: Date: 7 /31/008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
399 Plumbing final 073542 -01 503. 737 -9888 Y
Corrections /Comments /Instructions:
c 94,
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
n FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: c yN A _ A LA Date:? (3 (I IM) Phone #: (503) 718-