Permit ♦ .
111 � CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT PERMIT #: PLM2007 -00430
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 9/20/2007
PARCEL: 2 S 114AD -02800
SITE ADDRESS: 16650 SW 89TH PL ZONING: R -12
SUBDIVISION: WAVERLY ESTATES LOT: 027 JURISDICTION: TIG
PROJECT: BOUDREAU
Project Description: Install backflow device.
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
KATHY BOUDREAU
16650 SW 89TH PL Description Date Amount
TIGARD, OR 97223 [PLUMB] Permit Fee 9/20/2007 $36.25
[TAX] 8% State Surcha 9/20/2007 $2.90
Phone : 503- 437 -3797 Total $39.15
Contractor:
CASCADE LANDSCAPE & IRRIGATION INC
PO BOX 754
SHERWOOD, OR 97140 REQUIRED ITEMS AND REPORTS
Contact # : PRI 503- 625 -4112
FAX 503- 625 -0739
Reg #: LIC 7832
SUP ALL PHASE &
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 c- ling 503.246.6699 or 1.800.332.2344.
Issued By: /� ����/ � � Permittee Signature: pp � ( '� I t Cm
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.
.09/20/2007 10:53 5036250739 r CASCADE LANDSCAPE PAGE 01/02
A licatio FCE ° E " ,'�►1: <;l llc i ,l OM P1umbl .. Permit
City of Tigard ;007 a e/s A D? 5 L permit No,: 1 J[ Z p o -4s• L •
`, 13125 SW Hall Blvd., Tigard, OR 97223. ,iI_ i tUfilip Plan Review Oiler Permit No.:
if ph one; 503.639.4171 Fax: 503.51 ILU NC DIVISION Date/By � /BY. 8
, , Inspection Line: 503.639.4175 I y r see Page 2 far ,
Internet: www_tigard- or,gov . onA-�� e. I '� a
wYG:a -7 '. 7 « .,t.; i , f � 4 w. 'N 4 719E ,:aK : S � .. 4 4'.3 E 'l r7 1, \,, '
. -
. 1 .. 0r 4 4 \ `14 s� ?. ` V
`` dd r'" y. j� ` N?N t : ! ' - A a 'l i r cL k � ,. _ . 7i . . $ •
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For special information use checklist
[] New construction 0 Demolition Description I Qty- I Ea Total
El Additioaeration/replacement 0 Other back flow y dwellings (includes 100 ft. each connection)
n/lt
. , _ ... New l- 2-fsm ch utility
it dwe lin in $fora tonne 'on
aA x. { ,•, t , ... . ^::, wk' ti.Fya - ,v.`, �;, ? 249.20
L v iE k. ' ] k .:w�-t .0� `.R 4,' : ''i , ',�4,k.S'4 3. 4'.' o\,` „ `• SFR (1) bath
, " �'�v.'� 1.. 1:1 \: :'`':, ii �:hi\ .. .. , � 1•'nv4. !S.'\�..:.-"1�'�:�.: •..�. C:�1,..:ti ( )
❑ 1- and 2- family dwelling ❑ CommerciaVindu$ttial SFR (2) bath 350.00
SYR (3) bath 399.00
❑ Accessory building ❑ Multi - family
Each additional bath/kitchen 45,00
El Master builder ■2 Other. residential Aire sprinkler ( sq, ft) Page 2
,,,:i,V4i', ..r•aF;p .., .*: .;/ . t.:. %�! .a .: sit utilities
Job site address: / / V V V _
��r Catch basin or area drain 16.60
City /State/ZIP: i pi 6t r 0 c--4 Drywell, leach line, or trench dram 16.60
Suite/bldg. /apt no.: Project name: BACKFLOW Footing drain (no. linear ft.: Page 2
Manufactured home utilities 110.00
Cross street/directions to job site; Manholes 16.60
Rain drain connector 16.60
Sanitary sewer (no. linear £t.: _1 Page 2
Storm sewer (no. linear ft.: ____) Page 2
Subdivision: Lot no.:
Water service (no. linear ft.: _) I Page 2
Fixture or item
Tax map/parcel no.:
P/p 16.60
Ab so r p ti on valve
.;f --; a: _.ti41 . ks; �.u. : Bat p 1 Page 2 _6(0.
,. , . l: .. ...a;�•ir� �'Q��`. a , .s1.,. '
_, . kflow reverter
BACK -FLOW Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
�_ � t c .:. G . 1 , : ,._,. - .... ::. • �-.. k.. , ,;..s •.,: - , Drinking fountain 16.60
' '> , rN �i•'f p,;6 t� ^t f r • f°*; , ... t� \ , � ` 'ita1 ,t ;�
\ y r .-_t , ,•`• a ' „s .. . ,., ., ' •. \7'2: - .. .` t r Ejectors/sump 16.60
Name: i / /V
• D ud r ali ):acpansion tank 16.60
Address: ' g., • . Fixture/sewer cap 16.60
City /State /ZIP: 1 / ar i q7 Floor drain floor sink hub 16.60
Phone: (503) 7 - Gr' Fax: ( ) Garbage disposal 16.60 -
y .,.. h . ` •,' r ,.,...,., '"c: 7;Y ?P: ,, Hose bib 16.60
` .. y ip wn >..• • r c .. Z. AK '•
. .. �� .. ,. •". • ^r > ......�. � .. lcerrraker 16.60
Business name: CASCADE LANDSCAPE AND IRRIGATION INC Interceptor /grease trap 16.60
Contact name: BERNIE/LILY Medical gas (value: $ ) Page 2
Address; PO BOX 754 Primer 16.60
City /State/ZIP: SIIERWOOD, OR 97140 Roof draw (commercial) 16.60
Phone: (503) 625 -4112 - I Fax: : (503) 625 -0739 Sink/basin/lavatory 16.60
Tub /shower /shower pan 16.60
E -mail: C.ASCADELANDSCAPE@VERIZON.NET Urinal 16.60
; _ t „ `a . ; "•;s „ N, as' ,1.04' > _, ; 4 < ,,„ . :;fig: X.6:tit '
x'• ' , . <. � ` fit; : i3:- „ s a` i w '.... e ,�•�. Ss d <x -.�; t 4...• i ``y s, . water closet 16.60
..,. .., �'.1:.:CNra�. . \,.r -r, ..t� .., .. � .. .R: Yi�,c.a,- r S. �. .� +,�•
Business name: CASCADE LANDSCAPE AND IRRIGATION INC Water heater 16.60
Address: PO BOX 754 Other:
Subtotal -
city /state/zip: SHERWOOD, OR 97140 Minimum permit fee: $72.50
Phone: (503) 625 -4112 Fax: (503) 625.0739 - Residential backflow minimum permit fee: $36.25 , 25
CCB Lic.: 7832 Plumbing Lic. no.: Plan review (25% of permit fee)
State surcharge (8% of permit fee) .2 • lJ
Authorized signature: l / d j i1 TOTAL PERMIT FEE , 15
Print name: BERNARDO BRAVO Date: ' d () This permit application expires If a permit is not obtained within
180 days after it has been accepted as complete_
•Fee methodology set by Tri- County Building Industry Service Board.
a 11.41a:..ew.ra,'vdP1.M -V.n,, tA°n CI= 06 /26/06 440- 4616T0.0 /03/COhrlW $)
f
CITY OF TIGARD - t
BUILDING DIVISION PERMIT #: PLM2007 -00430
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 9120/2007
Phone: (503) 639 -4171 ./���Np1�����i II\
Inspection Requests (24 Hrs.): (503) 639 -4175 ... —
INSPECTION WORKSHEET FOR DATE: 10/912007 TIME: 7:00AM PAGE: 70
SITE ADDRESS: 16650 SW 89TH PL CLASS OF WORK:
SUBDIVISION: WAVERLY ESTATES LOT #: 027 TYPE OF USE:
PROJECT NAME: BOUDREAU
DESCRIPTION: Install backflow device.
OWNER: BOUDREAU, KATHY PHONE #: r.;0Y -431 -3797
CONTRACTOR: CASCADE LANDSCAPE & IRRIGATION INC PHONE #: 503 - 62541.2
Inspection Request Scheduled For: Date: 10/9/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
395 Misc. inspection 057160 -01 503 - 625.4112 Y
f,Na1 B Eo t.41
Corrections /Comments /Instructions:
D e.J : 64_ 1 4' 4 SR R.. -pi--t- 0,4,--r-
caves fifL
[PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
I FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: (n L--- 1 l(/4.. Date: , 0 11 j Q 7 Phone #: (503) 718 -