Permit C ITY OF TIGARD PLUMBING PERMIT
° Y COMMUNITY DEVELOPMENT PERMIT #: PLM2008 -00182
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 4/30/2008
PARCEL: 2S 103AD -07100
SITE ADDRESS: 12591 SW 108TH TERR ZONING: R -4.5
SUBDIVISION: MILESBROOK LOT: 002 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 SW MEADOWS RD #150 escription 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 $40.60
Contractor:
TRUSCAPES INC
21600 NW ANBERWOOD DR.
HILLSBORO, OR 97124 REQUIRED ITEMS AND REPORTS
Contact # : PRI 503- 969 -2144
FAX 503 -531 -9216
Reg #: LIC PLUS BACKFL
PLM 7962
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 0001 -0010 through OAR 952 - 0001 -0100. You may obtain copies of
these rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By:
y: Permittee Signature:
Call 503.639.4175 by 7:00 a.m. for an inspection that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Apr 28 08 05:58p PENIUK 503 - 352 -4607 p.4
Plumbing Permit Application R1 E E D
Building Fixtures A PR •
2 9 20 . FO R OFFICE 1. O NLI ,.
Received �`
City of Tigard / T'J'� Permit No.: ,(� Wf'
II a y 13125 SW Hall Blvd., Tigard, OR 97223 O$ iE -pi, R • .y�ew
Phone: 503.639.4171 Fax: 503598.1960 tf e 1 s x irIA if ; tDn B other Permit No
y 9 c atio7 ex.
_
inspection Line: 501639.4175 BU %L R r HI See Page for
TLG. \P.D Internet: www.tigard- or.gov Notified/method: Supp
temeutat Information
TYPE OF WORK - FEE" SCHEDULE
kl construction 0 Demolition For special information use checklist
Description Qty. I En. 1 Total
❑ Addition/alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (I) bath j 249.20 I
1 -and 2- family dwelling ❑ Commercial/industrial ( ) bath 350.00
SFR (3) bath 399.00
❑ Accessory building I ❑
1 Multi Tamil y • Each additional bath /kitchen 45.00
❑ Master builder l ❑ Other. Fire sprinkler (___ sq. fl.) Page 2
JOB .
-. E INFORMATION i AND LOCATION Site utilities
Job site address: ;,, 0' DAY I u 0 { � .' Catch basin or area drain 16.60
City /State /'LIP: ( p n O . (J) 2 3 Orywell, leach line, or trench drain 16.60
-1 S Fooling drain (no. linear ft.: ) Page 2
Suite/bldg./apt. no.: Project name: /�
Manufactured home utilities 110.00
Cross street/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
��) Water service (no. linear ft.: _ ) Page 2
Subdivision: ill ((,Esg OC
) OK Lot no.:
i Fixture or item
Tax map /parcel no.: I Absorption valve 16.60
DESCRIPTION OF WORK Backflow preventer Page 2 7. SS
bki Si)I U, g A C LO w D VJ C fog (g.gI (, {}.7) WA/ Backwater valve 16.60
Clothes washer I 16.60
Dishwasher 16.60
Drinking fountain 16.60
KPROPERTY OWNER ❑ TENANT Ejectorslsump 16.60
Name: SU r' NA V +S'f GU SFt)/h ( ES Expansion tank 16.60
Address: '(p ( S w mettoowS 0 • Fixture /sewer cap 16.60
City/State/ZIP: LA-K- OSWe(0, Ge. ' 103S Floor drain/floor sink/hub 16.60
Phone: 61)3 ) `S 3- („1)33 Fax: ( ) Garbage disposal 16.60
Hose bib 16.60
'APPLICANT 0 CONTACT PERSON Ice maker 16.60
Business name: rru S cA pes LLc Interceptor/grease trap 16.60
Contact name: 7114/.1 9 f k) i i,{ . ( /} Medical gas (value: $ ) Page 2
Address: 2! 10 0 p r 1 A) W D '� W 0 QU ; p K. Primer 16.60
H I S � n � Z Roof drain (commercial) 16.60
City/State/ZIP: t ! � �[ Sink/basin/lavatory 16.60
Phone: ( ) �) q b q - . r y Fax:: ( 3) S 3 1- f a ( Tub /shower /shower pan 16.60
E -mail: Urinal 16.60
CONTRACTOR Water closet 16.60-
Business name: VA S GArr E'S, (2 C I� Water heater 16-60 1
Address: 2,( DO AAA/ ii eCPw000 OR, Other: •
Q Subtotal
City /State/ZIP: �f (., D o R), OQ g l 2) p Minimum permit fee: $72.50
Phone: ( 3) t �[. � � �
1 � ( "1 F ( 3) S 31- 92 f 6 Residential backflow minimum permit fee: $36.25 3 6,,)-5-
S Plan review (25% of permit fee)
CCB Lie.: # q �j Plumbing Lie. no.: 35
• ,� State surcharge (12% of permit fee) GI,
Authorized signature: .(�C/ TOTAL PERMIT FEE IV, (yo
Print name: r\ 1 ,P E� jf L( - - Date, (--t - p , p This permit application expires if a permit is not obtained within
lfJ 0 180 days after it has been accepted as complete.
*Fee methodology set by Tri- County Building Industry Service Board.
CITY OF TIGARD %.
BUILDING DIVISION PERMIT #: PLM2008 -00182
13125 SW Hall Blvd., Tigard, OR 97223 � DATE ISSUED: 4130/2008
Phone: (503) 639 -4171 � l 11 ) 13 /
Inspection Requests (24 Hrs.): (503) 639-4175 V
INSPECTION WORKSHEET FOR DATE: 5/28/2008 TIME: 7:00AM PAGE: 11
SITE ADDRESS: 12591 SW 1013TH TERR CLASS OF WORK:
SUBDIVISION: Mil.ESf3ROOK LOT #: 002 TYPE OF USE:
PROJECT NAME: MILESBROOK
DESCRIPTION: !rid ailing bad di preventar.
OWNER: BUENA VISTA CUSTOM HOMES, PHONE #: 503-443-6033
CONTRACTOR: TRUSC.APES INC PHONE #: 503- 969 -2144
Inspection Request Scheduled For: Date: 5/28/2008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
399 Plumbing final 07(1451-01 503-710-7360 7360 N
Corrections /Comments /Instructions: •
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0 . ip_A i ---- &; - 5 — . -
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/ SS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED
14; Inspector: Date: `J Z P hone #: (503) 718