Permit CI TY OF TIGARD PLUMBING PERMIT
DEVELOPMENT SERVICES PERMIT #: PLM2006 -00158
1I DATE ISSUED: 4/25/2006
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171
PARCEL: 1 S135AA -AC001
SITE ADDRESS: 10480 SW 90TH AVE ZONING: R -4.5
SUBDIVISION: ASHBROOK CONDOMINIUMS LOT: 001 JURISDICTION: TIG
Project Description: Backflow preventer for irrigation. Common water.
CLASS OF WORK: OTR GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: MF 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
MATRIX DEVELOPMENT
12755 SW 69TH AVE, SUITE 100 Description Date Amount
TIGARD, OR 97223 [PLUMB] Permit Fee 4/25/2006 $72.50
[TAX] 8% State Surcha 4/25/2006 $5.80
Phone : 503- 620 -2020 Total $78.30
Contractor:
ANCTIL PLUMBING INC
16900 SW MERLO RD
BEAVERTON, OR 97008 REQUIRED ITEMS AND REPORTS
Contact # : PRI 503- 642 -7323
.FAX 503- 642 -7755
Reg #: LIC 24184
PLM 26 -162PB
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: �� f �. Permittee Signature: (Zgyp ,k)
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.
APR 01 :49P FROM: RNCTIL PLUMBING 5036427755 TO: 5035981960 P.1
�1 1�.1 az.DOS V
• Plumbine Permit App l f ; i Hilt oil I It 1 l `•1 ()N1.1
c City of Tigard \C v i� nr�r v -,zy O C'-p - Permit Nd *\,9 U9 oO
13125 SW Hall Blvd., Tigard, OR 97223 00` Ran Review
Phone: 503.639.4171 Fax: 503.598.1960 AAD G , L� . D� Other Permit No.:
24- Hour Inspection Line: 503.639.4175 Fir >a t
Internet: www,tigard-0r.gov �I') Date Ready/By: lXts'r' f 0 See Page 2 for
, ..1 . 't 1 ii . I t Jt_ Notified/Method _ 1 U f SuPpleaeatai taror>satioa
!'�''.'1:'. t . ' '1.'he':7:ac 0 r • l • vl 4 r tG "w :; :" � C :=3i a�.•t
- ..a <'.,� TYPE,�OR WORK �t�,���l'�;.,�1: 415
� � ?' - PEE •j8CHEDULL`� F•,; ��'f - 1
311 construction R1 :11 .' For speciallnformationusechecklit
/ Description I Qty. I Ea. I Total
❑ Addition/alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 IL for each utility connection)
' ,':,*/-1 W. ''-'-' - '' "' CATEGORY OP' CONSTRUCTIONa't9,5h''. Wdf' : .''' +'' r
,,, ; SFR (1) bath 24920
❑ I- and 2-family dwelling commercial /industrial SFR (2) bath 350.00
❑ Accessory building 4ulti- family SFR (3) bath 399.00
❑ Master builder Each additional bath/kitchen 45.00
❑ Other:
i.- R+�<I -k` l�- .1� h vi - iM"l'l�• Fire sprinkler( sq. 11-) Page2
°.+:, l 1' JOB SITE INFORMATION AND LOCATION i'°' ' {' R 4 _
s: /
(/ Site utilities
Job site address: 0 T $X a 5 (..&) t 01 AVE Catch basin or area drain 16.60
City/State/ZIP: Drywell, leach line. or trench drain 16.60
Suite/bldg./apt. no.: . 1 Project name: A - 5 1ftN ,-- bd x, cove, 0 ° ' Footing drain (no. Iinesi R: ) Page2
Manufactured home utilities 110.00
Cross strcet/directions to job site: Manholes 16.60
Rain drain connector 16.60
Sanitary sewer (no. linear ft.: ) Page 2
Storm sewer (no. linear ft.: ) Page 2
Subdivision: I Lot no.: Water service (no. linear ft.: ) Page 2
Fixture or item
Tax map /parcel no.: Absorption valve 16.60
DESCRIPTION 01 :1 - '.; 4'4'' 1 ' 1 Back how preventer ":::----> 1 Page 2 ( ��, 4.10 Q
- ' # C 16 1O fr w D eVI E - te., Backwater valve 16.60
f rr t (� A 51541501 Clothes washer 16.60
t/ f Dishwasher 16.60
' ? PROPERTY OWNER l b 13 TENANT Drinking fountain 16.60
( `� Ejectors/sump 16.60
`
Name: .. C iil t eV] el 4 , Expansion tank 16.60
Addr 5 C. 6 r , (Jo i •,)'' pw :vF , 2 205 Fixtureiscwa cap 16.60
City /State/ZIP: (A4,46 eJ �E o
3 p 0 / 9 63S- Floor drain/floor sink/hub 16.60
Phone: ( ) ax: ( ) Garbage disposal 16.60
Hose bib 16.60
NT
❑ APPLICANT ' ' ❑ CONTACT PERSON 1 `
Ice maker 16.60
Business name: -
Interceptor /grease trap 16.60
Contact name: Medical gas (value: S ) Page 2
Address: Primer 16.60
City/State/ZIP: Roof drain (commercial) 16.60
Phone: ( ) {_Fax: : ( ) Sink/basin/Iavalory 16.60
E-mail: Tub/showa /shower pan 16.60
Urinal 16.60
CONTRACTOR Water close) 16.60
Business name: A AVC 1) 1 vni 6 1 -P MC, Water heater 16.60
Address: J °! Q 0 S (,t) e K (/U � 0 J Other:
City /State/ZIP: 7)64(493 N OR. ci'oe,C, Subroul 1-2. 5b
Minimum permit fee: 572.30
Phone: C 3 (P�Z... '3-Z 3 Fax: (�3i L C,(Z �� ' Reside ntial backflow minimum permit fee: $36,25
CCB Lic.: 24 ($ l.{ Plumbing Lic. no • Zt� ) �,7 Plan review (23 ° /.of permit fee)
State surcharge (8% or permit fee)
Authorized signature:
t TOTAL PERMIT FEE �-fA -30 1
Print name: /74.- t/ C jt 7.-- Date: L1i2CP ()CO This permit application expires If a permit la sot obtained within
ISO days after it has been accepted as complete.
•Fee methodology set by Tri -County Building Industry Service Board.
•
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CITY OF TIGARD 'LH S(1406 00 ig
BUILDING DIVISION A PERMIT #:
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED:
Phone: (503) 639 -4171 knoly
Inspection Requests (24 Hrs.): (503) 639 -4175 ' 1.
INSPECTION WORKSHEET FOR DATE: / \'5 /0 (0 TIME: PAGE:
SITE ADDRESS: 10 L 3S b V �) CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME:
DESCRIPTION:
OWNER: PHONE #:
CONTRACTOR: PHONE #: G ,4aq , '7 ! 4
Inspection Request Scheduled For: Date: Pour Time:
Code # Inspection Description Confirm # Contact # Message
C4A 1 (AA rk VI ( 6A C NiLc)
Corrections /Comments/ Instructions:
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4,1f -ASS n PARTIAL APPROVAL n CANCEL I :1 ACCESS
H FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Date: `3/ a Phone #: (503) 718- Z y Z4