Permit CITY TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT PERMIT #: PLM2008 - 00180
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 4/30/2008
PARCEL: 2S103AD - 07800
SITE ADDRESS: 12652 SW 108TH TERR ZONING: R -4.5
SUBDIVISION: MILESBROOK LOT: 009 JURISDICTION: TIG
PROJECT: MILESBROOK
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
BUENA VISTA CUSTOM HOMES
5665 SW MEADOWS RD. STE 150 Description Date Amount
LAKE OSWEGO, OR 97035 [PLUMB] Permit Fee 4/30/2008 $36.25
[TAX] 12% State Surch 4/30/2008 $4.35
Phone : 503- 443 -6033 Total $40.60
Contractor:
TRUSCAPES INC
21600 NW ANBERWOOD DR.
HILLSBORO, OR 97124 REQUIRED ITEMS AND REPORTS
Contact # : PRI 503- 969 -2144
FAX 503 -531 -9216
Reg #: LIC PLUS BACKFL
PLM 7962
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: A,C, Permittee Signature:
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 28 08 05:58p PENIUK 503- 352 -4607 p.2
• • �.
Plumbing Permit Application
•
Building Fixtures C`V C.
FOR Ol- F1('F- I •:L O\L1
City of Ti and Received
- g DataBy_ if. , , , ` 'crania N - 4 (0 4 ,
III • 13125 SW Hall Blvd., Tigard, OR 97223 c 2008 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 � 1 t+ DateBy: Ot her Permit No.: ^AW?„...G( '
Inspection Line: 503.639.4175 ("TV !� Date riti R e ady ,B y : luris 0 See Page 2 for
TIGnS D Internet: www.tigard-or.gov ( • ' r 1 R 14aedlMcthnd: SapplemeutalInformation
TYPE OF WORK , . < $ N. FEE* SCHEDULE
IgNew construction ❑ Demolition For special information use checklist
Description I Qty. I Ea Total
❑ Addition/alteration/replacement • ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (1) bath 249.20
01- and 2- family dwelling ❑ Commerciallindustrial : SFR (2) bath 350.00
❑ Accessory building ' ❑ Multi- family SFR (3) bath 399.00
Each additional bath/kitchen 45.00
❑ Master builder ❑ Other:
Fire sprinkler (•• sq. ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities
Job site address: ) 2 6 5 ., S W 1 0 8 44 Catch basin or area drain 16.60
City /Stale/ZIP: 1)6(4p 0k Cf ) 2.23 Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: l i Project name: / ' bl , < Footing drain (no. linear ft.: ) Page 2
- 1 Manufactured home utilities 1E0.00
Cross street/directions to job site:
Manholes 16.60
Rain drain connector 16.60
Sanitary sewer (no. linear ft.: 1 Page 2 ,
Storm sewer (no. Iinear R: ) Page 2
Subdivision: f ILES g ph OK Lot no.: Water service (no. linear ft.: 1 Page 2
Fixture or item
Tax map /parcel no.:
Absorption valve 16.60
DESCRIPTION OF WORK Backflow preventer ( Page 2 ,D 7. SS
1 M S' U g A W � ('J O E Vf CE fVI !-, (( A-n ON Backwater valve 16.60
) Clothes washer 16.60
Dishwasher 16.60
PROPERTY OWNER 1 El TENANT
Drinking fountain 16.60
R I) Ejectors /sump 16.60
Name; A'V NA V IS T\oL. & j S /1 &OM ES Expansion tank 16.60
Address: '5196c SW An E f 7 OUV S ? Fixture /sewer cap 16.60
City/State/ZIP: ` L 4 O. e 60 04 l i Q 3 S Floor drain/floor sink/hub 16.60
Phone: (� 3 ) 4 3 - Lb 3 3 Fax: ( ) Garbage disposal 16.60
g APPLICANT ❑ CONTACT PERSON Hosc bib 16.60
Ice maker 16.60
Business name: TIM qi PES, 1,(,C Interceptor /grease trap 16.60
Contact name: j P PEN 0.4 /� n l� �1/� Medical gas (value: $ ) Page 2
Address: 21bao !ViAi rplMgERWOOU YK.• Primer 1 16.60
City/State/ZIP: LL5 e Q / DA "1 " r �, Roof drain (commercial)
{� � r� ( Sink 16.60
i
Phone: (�" 3 ) b 1 - a if �{ + F ax:: c 3) 5 of k� Tub/shower'shotiverpan 16.60
E -mail: f Urinal 16.60
CONTRACTOR Water closet 16.60
Business name: S' � es, / c t, C. �y ~ Water heater 16.60 •
Address: 2, 1 / 1 DO l 1 -meE f u tl7 uOQO Other:
Subtotal
City/State /ZIP: Hi UL5 o 1. chi 2y
Minimum permit fee: S72.50 �
L
Phone:{?) 91,1 - d i c( y j Fax: 0-0D 3 I - q2 r 6 Residential backflow minimum permit fee: $3625 Z c,
CCB Lie.: "N # �R 6 Plumbing Lie. no.: Plan review (25% of permit fee) ✓
Stale surcharge (12% of permit fee) (' 3>
Authorized signature: 'Q' TOTAL PERMIT FEE t
� n � p ��, (t l7
Print name: J 'E j S 'EN( J( J. Date: q- 2b p ' Q p This permit application expires if a permit is not obtained within
180 days after it has been accepted as complete.
*Fee methodolcev set by Tri- County Building Industry Service Board.
CITY OF TIGARD - - 7 T
BUILDING DIVISION � PERMIT #: PLM2008 -00180
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 4/30/2008
Phone: (503) 639 -4171 I1ItL
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 5/28/2008 TIME: 7:00AM PAGE: 9
SITE ADDRESS: 12652 SW 108TH TERR CLASS OF WORK:
SUBDIVISION: MII..ESBROOK LOT #: 009 TYPE OF USE:
PROJECT NAME: MILESI3ROOK
DESCRIPTION: Installing backflow preventer.
OWNER: BUENA VISTA CUSTOM HOMES, PHONE #: 503-443-6033
CONTRACTOR: TRUSCAPES INC PHONE #: 503.969"2144
Inspection Request Scheduled For: Date: 5/263/2008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
399 Plumbing final 070451 -03 503- 710 -7360 N
Corrections /Comments /Instructions:
--- /AL
7 ry es — L r c .
( "6
❑ PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
X FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Date: C // Phone #: (503) 718- 2-4Z�
CITY OF TIGARD -
BUILDING DIVISION PERMIT #: PLM00 8-00180
Alk 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 4/30/2000
Phone: (503) 639 -4171 j ' l +�
Inspection Requests (24 Hrs.): (503) 639 -4175 I L.
INSPECTION WORKSHEET FOR DATE: 6/11/2008 TIME: 7:00AM PAGE: 41
SITE ADDRESS: 12652 SW 108TH TERR CLASS OF WORK:
SUBDIVISION: MII.ESBROOK LOT #: 009 TYPE OF USE:
PROJECT NAME: MILESBROOK
DESCRIPTION: Installing backflow preventer.
OWNER: BUENA VISTA CUSTOM HOMES, PHONE #: 503-443.6033
CONTRACTOR: TRUSCAPES INC PHONE #: 503 - 969.2144
Inspection Request Scheduled For: Date: 6/11/2008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
399 Plumbing final 071191 -01 503-710-7360 N
Corrections /Comments /Instructions:
D RAiir_e_ ITe c
�f.e-cJL y,,.../ .
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: T ki 'h^^A l N‘b.,,-,- Date: 6 I (1 VOTE Phone #: (503) 718-