Permit . ,
.4
71 , .4... OF TIGARD PLUMBING PERMIT
° , COMMUNITY DEVELOPMENT PERMIT #: PLM2008 -00181
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 4/30/2008
PARCEL: 2S103AD -07400
SITE ADDRESS: 12667 SW 108TH TERR ZONING: R -4.5
SUBDIVISION: MILESBROOK LOT: 005 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 Description Date Amount
5665 SW MEADOWS RD. #150
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: Permittee Signature: .....,_...c- i� / 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.
Apr 28 08 05:58p PENIUK 503 - 352 -4607 p.3
Plumbing Permit Application '! y BF ED
Building Fixtures 2 9 oFFlcr US.t• ONLY'
Ci of Tigard APR !� 20( t D c / ed t . / / 1 (f ar r- . Permit No.: PG✓ ?wt ci I ° �
atelBy -( Q t [�
• 13125 SW Hall Blvd., Tigard, OR 97223
` � Review � qty} -�� y �
Phone: 503.639.4171 Fax: 503.598.1960 CITY OF- �:�- 4 I G i s D � Other Permit No. :!^ 3- a " W �W
Inspection Line: 503,639.4175 I ) t s ' � B � �Da'te'R'c�ad luri : H See Page 2 far
TrG.,1l;II internal: vtM1Vw. azdor. av ,I
lig p, N
BUILD Supplemental Information i
TYPE OF WORK . FEE* SCHEDULE_
,New construction ❑ Demolition For special information use checklist
Description I Qty. I Ea. I Total
❑ Addition/alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
• CATEGORY OF CONSTRUCTION . SFR(1)bath 24920
l- and 2- family dwelling ❑ Commercial /industrial 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. fl.) Page 2
JOB SITE INFORMATION AND LOCATION
- site utilities
Job site address: i a (D C) 7 Sw / 0 � Catch basin or area drain 16.60
City/State/ZIP: 1) ( p p..° a k (F )2.2 3 Drywell, leach line, or trench drain 1 6.60 .
I / _ Footing drain (no. linear fl.: ) Page 2
Suitelbldg. /apt, no.: l Project name: r (ef &er.,(
Manufactured home utilities 1 10.00
Cross street/directions to job site:
Manholes 16.60
Rain drain connector 1 6.60
Sanitary sewer (no. linear ft.: _..__ I Page 2 '
Storm sewer (nu. linear IL: ) Page 2
Water service (no. linear ft.: ) Page 2
Subdivision: (,S 1) °K Lot no.: - Fixture or item
Tax map /parcel no.:
Absorption valve 16.60 •
DESCRIPTION OF WORK p p p Backflow preventer Page 2 .7. 5 S
3 kgr Li, gA (1f OW DEVICE fog IP4f 41-7)0W Backwater valve 16.60
Clothes washer I 16.60
Dishwasher 16.60
Drinking fountain
PROPERTY OWNER 1 I=I TENANT
L� Ejectors/sump 16.60
Name: CV EWA IS !1'1 M S I N r�r� A) rr OM e S Expansion tank 16.60
Address: 'c(p S SIN Ni E oviS Fixture/sewer cap 16.60
City /State /ZIP: L-prYL" OS (,1J e 6o l 0 (i--)03.5 Floor drain/floor sink/hub 16.60
Phone: (9)3 ) 4 3 - (k 3 3 Fax: ( ) Garbage disposal 16.60
' Hose
g APPLICANT
Ice
❑ CONTACT PERSON bib 16.60
�,
e t /
Ice maker 16.60
m
Business name: I em ] 12 E.! � ...C. Interceptor/grease trap 16.60
Contact name: 1 >r-g'1<- f f2 fJ 144 K �. Medical gas (value: $ ) Page 2
Address: 2110 o 0 ijw /1 M g }[Ztl 1)Q)) DQ . Primer 16.60
' i G S p n ! n (d i Roof drain (commercial) 16.60
City/State/ZIP: /( LtN dit -1 Z ? r Sink/basirblavatory 16.60
Phone: ( ) q(011_ . (Lj I � Fax: : ( 3) 5 ^ 3l� g e� � b
Tub/shower/shower pan 16.60
E -mail: Urinal 1.6.60
CONTRACTOR ; Water closet 16.60
Business name: 1 '' _ ' 5 CA-9 ES, U. L 1 Water heater 16.60
Address: 2, / (0 0 0 kkAf 4MeCAW° g, _ Other:
/State/ZIP: HI LLsBOAu, op . 71 r 2y
Subtotal
City/State/ZIP: y / Minimum permit fee: $72.50
Phone;(?) 9 (7 q- a, r y Fax: (p3) '3)- 7 2(b Residential backflow minimum permit fee: $36.25 3 Gr 01
CCB Lie.: L•, 3 # ") q Plumbing Lie. no.: Plan review (25% of permit fcc)
State surcharge (12% of permit fee) t 35'
Authorized signature: f ./41_64.
� _6 TOTAL PERMIT FEE
Print name: i a
�_ _ ��~___ 4444 iv i UK - . Q w
This permit application expires if a permit is not obtained t thin
D ate: �1 )j
180 days after it has been accepted as complete.
*Fre mnthndnlnnv set by Tri- County Building Industry Service Board.
f
CITY,OF TIGARD
B JILDING DIVISION 4:V PERMIT #: PLM2008 -00181
13125 SW Hall Blvd., Tigard, OR 97223 "./ DATE ISSUED: 4/3012003
Phone: (503) 639 - 4171
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 5/28/2008 TIME: 7:00AM PAGE: 10
SITE ADDRESS: 12.67 C SW 108TH TERR CLASS OF WORK:
SUBDIVISION: MILESBROOK LOT #: 005 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: 5/28 /2008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
399 Plumbing final 070451 -02 503-710-7360 N
Corrections /Comments /Instructions:
5
/a_ suJJ
/3 '70
r
ASS PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
I FAIL fl CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
k/& C' / �S 7--Y23.4
Ins
Inspector: Date: / 2 �/ ° Phone #: (503)
P ) 718-