Permit -
CITY TIGARD PLUMBING PERMIT
/ri DEVELOPMENT SERVICES PERMIT #: PLM2006 -10060
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13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 6/27/2006 PARCEL: 2S112CB -05500
SITE ADDRESS: 15310 SW 82ND PL ZONING: R -7
SUBDIVISION: ASHFORD OAKS NO. 2 LOT: 069 JURISDICTION: TIG
Project Description: Backflow preventer for irrigation.
CLASS OF WORK: OTR 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
JUNE RANDELMAN
15310 SW 82ND PL Description Date Amount
TIGARD, OR 97224 [PLUMB] Permit Fee 6/27/2006 $36.25
[TAX] 8% State Surcha 6/27/2006 $2.90
Phone : 503- 620 -0943 Total $39.15
Contractor:
OWNER
REQUIRED ITEMS AND REPORTS
Contact # :
Reg #:
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: "(2..Q.e.,
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.
503601 7566 GE SECURITY 03:06:07 p.m. 06 27 2006 1 /1
Plumbing Permit A uu lie pnCEIVE II FOR OFFI(F. I SE (1 \"l.1
City of Tigard Received % permit N o•: /
1 3125 SW Hall Blvd.. Tigard. OR 97223 JUN 2 7 2 6 Date/B : 0 1 L _ti !_ si6P -- /0660
Plaa Review
Phone: 503.639.4171 Fax: 503.598.1960 %
24- Hour Inspection Line: 503.639.4175 OF TI! . ' ' I C I 1 Date /By: Other Permit No.:
Internet: www.ci.tigard.or.us UILD p _ Note Notified/Method: J.4‹ Supplemental See Page for
BUILDING NotiE)ea/Method: _ f I(G� Supplemental lnrormation
TYPE OF WORK FEE* SCHEDULE
❑ New construction ❑ Demolition For special information use checklist.
Description I Qty. 1 Ea. I Total
Is Addition/alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (I) bath 249.20
04- and 2- family dwelling ❑ Commercial/industrial SFR (2) bath 350.00
❑ Accessory building ❑ Multi - family SFR (3) bath 399.00
❑ Master builder Each additional bath/kitchen 45.00
❑ Other: Are sprinkler ( sq. ft.) Page 2
JOB SITE INFORMATION AND LOCATION
Site utilities
Job site address: ) s • b -p( L A-. - Catch basin or area drain 16.60
City / State/ZIP: �1 .5� W 0 g.. C 1 a- P- . .. Drywell, leach lint, or trench drain 16.60
Suite/bldg./apt. no.: u f Project name: / Footing drain (no, linear ft.: ) Page 2
Manufactured home utilities ■ 110.00
Cross street/directions to job site: A cS,,ij4L
Manholes 16.60
Rain drain connector 16.60
Sanitary sewer (no. linear ft.: ) Page 2
Storm sewer (no. linear ft.: ) Page 2
Subdivision: A-sk r D t_5 Lot no.:
Water service (no. linear ft.: ) Page 2
Fixture or item
Tax map /parcel no.:
Absorption orpU 16.60
ESCRIPTIO N: OF WORS .. Backflow pre venter Page 2
V I-S ( 4 0„4- ^Po tr.) Q. St-1K s Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
fountain Drinking o 16.60
;.:...:; ;l Pt' �"Y: :.:: ;: T&NMI ' , Ejectors/sump 16.60 •
Name: .5'U A 42-- R & cl a>L Expansion tank 16.60
Address: is I 'Q 5 -s.) 8-,„_ 11...4- ) L, Fixture/sewer cap 16.60
City /State/ZIP': r 5 c..._ � g- 61 7d 2- / Flo or drain/floor sink/hub _ 16.60
Phone: ($b5) blo 9 L.L.3 Fax: (5v3) 6 q 1- 7 s"6 6 Garbage disposal 16.60
Hose bib
Q APPLICANT ° :. 1660
[] CONTACT PERSON:.
Ice maker 16.60
Business name:
Interceptor /grease trap 16.60
Contact name: Medical gas (value: $ ) Page 2
Address: Primer 16.60
City / State/ZIP: Roof drain (commercial) 16.60
Sink/basin/lavatory 16.60
Phone: ( ) I Fax: ( ) Tub/shower /shower pan 16.60
E -mail: Urinal 16.60
CONTRACTOR Water closet 16.60
•
Business name: ktrY•e -- O lk.:,,`¢••• Water heater 16.60
Address: Other:
City /State/ZIP: Subtotal
Minimum permit fee: $72.50
Phone: ( ) Fax: ( ) Residential backflow minimum permit fee: $36.25 3 C, . �
CCB Lic.: Plumbing Lic. no.: Plan review (25% of permit fee)
State surcharge (8% of permit fee) .5 0
Authorized signature: -
` TOTAL PERMIT FEE
Print name: "j v.-NIL I f , h , rte Date: C. / . 7/ u,(, 1 This permit application expires if a permit Is not obtained within
180 days after it has been atxxpted as complete.
*Fee methodology set by Tri- County Building Industry Service Board.
is Building \Pennitx'PLM- PermiiApp.duc 06x)3 440- 4616TnIUM/COM/WEB)
CITY OF TIGARD • • -
BUILDING DIVISION PERMIT #: PLM2006.10060
13125 SW Hall. Blvd., Tigard, OR 97223 DATE ISSUED: 6/27/2006
Phone: (503) 639 -4171 ` i° "n I�I
. Inspection Requests (24 Hrs.): (503) 639 -4175 . �"" IL ,
•
INSPECTION WORKSHEET FOR DATE: 7f1212006 TIME: : 1
7:05AM PAGE
SITE ADDRESS: 15310 SW B2ND PL CLASS OF WORK:
SUBDIVISION: ASHFORD OAKS NO. 2 LOT #: 069 TYPE OF USE:
PROJECT NAME: RANDLEMAN
DESCRIPTION: RacktloW preventer for irrigation.
OWNER: RANDELMAN, JUNE PHONE #: 503"620"0943
CONTRACTOR: OWNER PHONE #:
Inspection Request Scheduled For: Date: 7/12/2006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
395 Misc. inspection 033000 -01 503-691-7635 N
Corrections /Comments /Instructions:
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■ PARTIAL APPROVAL El CANCEL El NO ACCESS
"ASS H
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: v te: O47 Phone #: (503) 718- ///(
CITY OF TIGARD
BUILDING DIVISION PERMIT #: PL.M200C- 10060
13125 SW Hall,Blvd., Tigard, OR 97223 DATE ISSUED: 6121/2006
Phone: (503) 639 -4171 IV
' Inspection Requests (24 Hrs.): (503) 639 -4175 " _-.
INSPECTION WORKSHEET FOR DATE: 6/3012006 TIME: 7:01AM PAGE: 8
SITE ADDRESS: 15310 SW 82ND PL CLASS OF WORK:
SUBDIVISION: ASHFORD OAKS NO. 2 LOT #: Kg TYPE OF USE:
PROJECT NAME: RANDLEMAN
DESCRIPTION: Backflow preventer for irrigation.
•
OWNER: RANDELMAN, JUNE PHONE #: 503'620.0943
CONTRACTOR: OWNER PHONE #:
Inspection Request Scheduled For: Date: 6130/2006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
- 395 Misc. inspection 032517 -01 503. 691.7635 N
Corrections /Comments / Instructions:
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P7 4o 7S ,i--7. � 42.. AC F-4_01,_./ pg. cni e _
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❑ PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
IL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: G1111 Date: C ZO' b 6 Phone #: (503) 718- 26Vr