Permit CI TY OF TIGARD PLUMBING PERMIT
DEVELOPMENT SERVICES
l l 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 006 00497
DATE ISSUED: PERMIT #: PLM2 10/23/2006
PARCEL: 1S134DB-08100
SITE ADDRESS: 11136 SW 113TH TERR ZONING: R -4.5
SUBDIVISION: STONECHASE LOT: 005 JURISDICTION: TIG
Project Description: Residential backflow for irrigation.
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
GERRITZ BIGGI CUSTOM HOMES Description Date Amount
9550 SW BEAVERTON HILLSDALE HW
BEAVERTON, OR 97005 [PLUMB] Permit Fee 101231200E $36.25
[TAX] 8% State Surcharl 101231200E $2.90
Phone : 503 - 619 - 4668 Total $39.15
Contractor:
MARK BROWN LANDSCAPING
PO BOX 744 REQUIRED ITEMS AND REPORTS
VANCOUVER, WA 98666 -0744
Contact # : FAX 360 - 993 -5993
PRI 503- 234 -2667
Reg #: LIC 5192
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 50 246-6.•9 1 -810- 332 -2344.
Issued B � � � ": _34. Permittee Signatures _ /
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.
m yrdoos -oo 1ii
Plumbing Permit Application FOR OFFICE USE, OM.
City of Tigard Received /U '"' G( P / PermitNo.: a/114-02/9
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503 639.4171 Fax: 503.598.1960 „a Date/By: Other Pe it No.:
24- Hour Inspection Line: 503.639.4175 ._;111114W tub,
www.ci.tigard.or.us ^ ^ ^ - --� Date Ready/By: // • //)� S See Pe 2 for
Internet: www.ci.ti
g I Notified/Method: 1(s Supplemental Information
1• s '" -, - `FEE.. ; S(HEDUIE�=:�'.�';',`. -
TYPE OF - WORK;. - is: <,.. ;,+, •y�..r,'fi�i'r;M- �p'is;:,�� %s.�.t `'o.•
M ew construction ❑Demolition For special information use checklist
Description ( Qty. 1 Ea. 1 Total
❑ Addition/alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
CATEGORY. OF CONSTRUCTION,; `jsi °4?r; SFR (1) bath 249.20
Eli 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. ft.) Page 2
JOB SITE INFORMATION AND LOCATION,':;;;';';:;. ". ':' < ' Site utilities
Job site address: ) ) i 5 / - Tewace Catch basin or area drain 16.60
City/State /ZIP: fi Q 722-L- Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: ! ` o Project name h .e__, Footing drain (no. linear ft.: ) Page 2
�
f� Manufactured home utilities 110.00
Cross street/directions to job site: North �c0. 9.-/,215/ % , . 5 / 1-5, Manholes 16.60
Rain drain connector 16.60
Sanitary sewer (no. linear ft.: ) Page 2
Storm sewer (no. linear ft.: • ) Page 2
Subdivision: () e_ el has'. I Lot no.: Water service (no. linear ft.: ) Page 2
Fixture or item
Tax map /parcel no.: Absorption valve 16.60
DESCRIPTION OF• WORK< . ,;.; ' :1 ,,;,,;. i s
;��:., - .. : `: `� Backflow preventer / Page 2 3 4 , � 5
fi 0 D ZR. &,14 -no'1 .6 /Z1 e Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
Drinking fountain • • 1
❑ PROPERTY OWNER I , ' ❑ TENANT..., . • •..
, cp
Name: (, rt 1 l vt 5 j � c 7 0m 4T. . / :, Ejectors/sump •1
�i h_ � LL l. // �� ,. 16.60
Address: _5S , ) 0.. ✓c f l-/w • 16.60
City /State /ZIP: ' V - efion o/( 970(6 / •• , •• , ■ • •1 •
Phone: (,6 &/q--- ` Ul 6 Fax: �(l 3>� 6 --- /Z0 ?1/ Garbage disposal 16.• 1
0 APPLICANT. ,ti :::.1:; ❑.. C ,``'::
ONTACT =;PERSON; �
Business name: (2. 0 /• q ( l / , S /17 � 5 Interceptor/grease .:`
Contact name: � - / Medical
Address: m. • .! /�i., . . �_ .) , 16.60
City /State /ZIP ' •• • 16.60 -
1 / _ / .� ( %' /n �j 9 �- 79.5 �- � )
Phone: (50 ) (&- / - / 66 d f Fax:: (g0��t%) , _ .: :. 16.60
16.60 1
E -mail:
, Urinal .1
,' n coNTRA1O/t ,'. ..r i :t ..° r. '%a2r��m " ;' ;' :. i ' • • 1
m
Business name: >�� /']� � ��
1��(� __-
Address: Pa 80/' .� �L I" / Other:
City /State /ZIP: if n ,f w t/V : - yl'� Subtotal 4I
Minimum permit fee: $72
Phone:. 50.3 .4-ii--)
,4,'7 Fax: (00- 9 9 ? _5 % 9 3 Residential backflow minimum permit fee: $36.25 ,
-
CCB Lic.: . h rD Plumbing Lic. no.: Plan review (25% of perm fee) • Li
State surcharge (8% of permit fee) . . 0
Authorized signature: ' / / I TOTAL PERMIT FEE i-C
Print name: � L4 y/ L y /, Date: / 0 - X, This permit application expires if a permit is not obtained within
`J w' 120e � A 180 days after it has been accepted as complete.
*Fee methodoloev set by Tri- Countv Buildine Industry Service Board.
T .
CITY.OF =TIGARD
BUILDING DIVISION PERMIT #: PLM2006 -00497
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 10/23/2006
' Phone: (503) 639 -4171 Chu; rt,
Inspection Requests (24 Hrs.): (503) 639 -4175 ''�'.
INSPECTION WORKSHEET FOR DATE: 12/16/2006 TIME; , 7:04AF PAGE: 58
SITE ADDRESS: 1.136 SW 113TH TERR • CLASS OF WORK:
SUBDIVISION: STONECHASE LOT #: 005 TYPE OF USE:
PROJECT NAME: STONECHASE
DESCRIPTION: Residential backflow for irrigation. _
• OWNER: GERRITZ OGGI CUSTOM HOMES, PHONE #: ` 503 - 013.4068
CONTRACTOR: MARK BROWN LANDSCAPING PHONE #: 503. 2342667
Inspection Request Scheduled For: Date: 12115/2006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
3 9 9 Plumbing final 041055 -04 503 -718 -2433 N .
Corrections /Comments /Instructions:
- 7 --- / — 6tre:r C9'L .
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or ie/ t
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Now
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PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL n CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED
Inspector: ,,� Date: /2--/F5166 Phone #: (503) 718 - O
•