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Permit CITY TIGARD PLUMBING PERMIT DEVELOPMENT SERVICES PE DEVELOPMENT PLM2006 -00501 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 10/23/2006 PARCEL: 1S134DB-09200 SITE ADDRESS: 11055 SW 113TH TERR ZONING: R -4.5 SUBDIVISION: STONECHASE LOT: 016 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 [TAX] 8% State Surcharl 10/23/200E $2.90 [PLUMB] Permit Fee 10/23/200E $36.25 Phone : 503 - 619 - 4668 Total $39.15 503 - 526 - 2084 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 =669 �1 00 332 -2344. G.__ - Issued B . -��' -w -'� i- 4 Permittee Signature: r 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. fn• ( 2 r" 00V)--) r Plumbing Permit Application FOR OFFICE USE O\LI' . City of Tigard Received lC '- L' U/D (DAT, Permit No.: e.1� /,006 -G) i/ 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review Phone: 503.639.4171 Fax: 503.598.1960 / /N �n�rp:���4 +, < Date/By: Other Permit No.: 24- Hour Inspection Line: 503.639.4175 ,.•' I� Date Ready/By: r r"' �@� fa See Page 2 for Internet: www.ci.tigard.or.us Notified/Method: ;....7.•--",.. f I v- Supplemental Information �a:,:u;;i °r!a, ,:v`.+ - .x;��t. <;: r's; ,> < +r - ^ ° ;s•:- a�tY E' W RK' :iiiz<g:0.4. :',.' i:'�Rioii-�;�+'`rti k-.0 , e • i '. wail,., vita ` .0 ,,,::.;. ... . . . , .. . OF O f' iie(.f!,.f ... ;.�_, .'.n.15l yc .. ;-i��... ?nf. 6- .ei' °TS• - ,. .1� .- - . - -�r._ .. . For special Information use checklist [ew construction ❑ Demolition 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;,,0'•''. 0 SFR (I) bath 249.20 1 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 budder ❑ Other: Fire sprinkler ( sq. ft.) Page 2 JOB SITE INFORMATION AND LOCATION,.;: i , : : ; ".; .' Si utilities Job site address: ) I 0 C� c 1 ) 1 , Catch basin or area drain 16.60 City /State /ZIP: / 1 vv4 6 V q i di--1 Drywell, leach line, or trench drain 16.60 Suite/bldg. /apt. no.: . name �r (h, Footing drain (no. linear ft.: ) Page 2 � Manufactured home utilities 110.00 Cross street/directions to job site: AIor_h 1 -f ./ 1/6,. 9 _/,2 5/ Manholes 16.60 Rain drain connector 16.60 Sanitary sewer (no. linear ft.: ) Page 2 Storm sewer (no. linear ft.: ) Page 2 Subdivision: ne_ has ei Lot no.: Water service (no. linear ft.: ) Page 2 Fixture or item Tax map /parcel no.: Absorption valve 16.60 / DESCRIPTION OF WORK" „ ` "" � ,,i ;;k'; ;;; ,, ,;•,.. _ Backflow preventer / Page 2 Z/L� &-frndn 3ti S. (40 . ������ /�(,v Pinta( Bac kwater valve 16.60 Clothes washer 16.60 Dishwasher 16.60 Drinking fountain 16.60 ❑ PROPERTY OWNER ❑. TEN • f / Q ' • _ .. • J '' . Ejectors/sump 16.60 Name: ( ur . k wl r) � •7 [,� v /r • & LL Expansion tank 16.60 Address: C , J c j . ,,i .4 f Fixture/sewer cap 16.60 City/State /ZIP: ` -e 4 ( n /( � 9705 y Floor drain/floor sink/hub 16.60 Phone: ( .5 - 0 &N....4/66? Fax:a)3 )J 6,2..E 9i/ Garbage disposal 16.60 Hose bib 16.60 ❑ APPLICANT, a : ;.. fir C ❑ ONT A C T= PERSO ; : .i„ ' Ice maker 16.60 Business name: �� r'I / �A 5- 1 m 41710 /, /. interceptor /grease trap 16.60 Contact name: A n (. / Medical gas (value: $ ) Page 2 Address: q jib) eiz ve A Primer 16.60 City/State /ZIPt. ref: 199( 7005 y Roof drain (commercial) 16.60 Phone:5O� l 1\ ) / LI ` 6& d � __!! Fx:: (5 CLJ� U �y�, L ' Ro 0 rY p Sink/basin/lavto • 16.60 � Tub /shower /shower pan 16.60 E-mail: Urinal 16.60 v, CONTRA Q .,;, ; ;, ; _ :t'r':a';4 ".z,: ....,,. , Water closet 16.60 • r:. Business name: m �� 6 ` , ( f D ,,,,,„i Water heater 16.60 Address: �V. 6 (X 7 q'I !!JJ Other: City/State /ZIP: , Aig n o w W /el 8� - 9/, � yq _O 7L�L[ Subtotal `s / Minimum permit fee: $72.50 Phone:. �� -� ! 6e,,7 Fax: 3 (a._ 9 93 _ 5 3 _ Residential backflow minimum permit fee: $36.25 J ermit fee Plan review (25% of CCB Lic.: Plumbing Lic. no.: ( permit fee) ,/ State surcharge (8% of permit fee) Authorized signature: ' / / TOTAL PERMIT FEE Print name: inane_ / „, , �� Date: /O a0 -06, This permit application expires if a permit is not obtained within 'J [ tJ �`' / 180 days after it has been accepted as complete. *Fee methodoloev set by Tri- County Buildine Industry Service Board. , CITY OF TIGARD * Ptti ' o - Ooso 1 BUILDING -DIVISION PERMIT #: 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: Phone: (503) 639 -4171 A hA Inspection Requests (24 Hrs.): (503) 639 -4175 : ' . �� INSPECTION WORKSHEET FOR DATE: TIME: PAGE: SITE ADDRESS: I 1 ©6 i `, ¶L - Z. . CLASS OF WORK: SUBDIVISION: LOT #: . TYPE OF USE: PROJECT NAME: DESCRIPTION: ' OWNER: PHONE #: CONTRACTOR: PHONE #: Inspection Request Scheduled For: Date: Pour Time: ~ 'N Code # Inspection Description Confirm• # • Contact # Message — Ag ( .. Corrections /Comments /Instructions: ‘"Ttcl 12e.ra-ff ciiiii2,140t4 --6 b o A.. . 4 . , , ,.. , . ____ . . 0 ..„ . . . v, .. . • . . • „..„. , , ..... . ,. .. ... . . .., .....:• . . • . L' • r9 _ j • R I • ' ` p 4 PASS. ; „ ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS a � FAIL d 1❑ GALL FOR INSPECTION - ❑ ADDITIONAL FEES ASSESSED f ` - i p I nspector: ( , T Date: I e 07 Phone #: (503) 718- i lA i /17_ /r c, , l • t 7 F1l u _ F.. -