Permit Ilh CITY OF TIGARD
II PLUMBING PERMIT
COMMUNITY DEVELOPMENT PERMIT #: PLM2007 - 00382
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 8/23/2007
PARCEL: 1 S134CA -FB011
SITE ADDRESS: 11218 SW 118TH TERR ZONING: R -4.5
SUBDIVISION: FEHRENBACHER NO. 2 LOT: 011 JURISDICTION: TIG
PROJECT: FEHRENBACHER NO. 2
Project Description: Backflow preventer 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
PAYS CUSTOM HOMES INC
17278 SW SONNET WAY Description Date Amount
KING CITY, OR 97224 [PLUMB] Permit Fee 8/23/2007 $36.25
[TAX] 8% State Surcha 8/23/2007 $2.90
Phone : 503- 475 -5041 Total $39.15
Contractor:
BLAZER LANDSCAPE
13995 SW FERN ST.
TIGARD, OR 97223 REQUIRED ITEMS AND REPORTS
Contact # : PRI 503 - 998 -1507
Reg #: PLM 6872
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 �. ��
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.
Plumbing Permit Application
. .Building Fixtures �e FOR OFFICE USE ONLY
J
II City of Tigard R EC ice.. I V �' Received ^ p
r. • Date/By. I ��D 1 �� Permit N�d� �„ v�0/ _ 0630°
■
13125 SW Hall Blvd., Tigard, OR 97223
Plan Rcview
Phone: 503.639 4171 Fax 503.598.1960 AUG '
2001 Date/By: Other Permit No.:
Inspection Line: 503.639.4175
TIGARD Internet: www ngard- or.gov ^ Date Ready /By: Jul ® See Page 2 for
CITY OF TIGARD Notified/Method' f Supplemental Information
TYPE OF WOR SUILDING DIVISION FEE* SCHEDULE
P. New construction El 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 249 20
t I- and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 350.00
❑ Accessory building ❑ Multi - family SFR (3) bath 399.00
❑ Master builder Each additional bath/kitchen 45.00
❑ Other: Fire sprinkler ( sq. ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities
Job site address: ( 1 2- l b 5 I `c } --rQrit Catch basin or area drain 16 60
City /State /ZIP: l i J GIa/� (� R 97 Z 2 11 • Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: I Project name: r n e/) La Tr Footing dram (no. linear ft. _ ) Page 2
V(l� Lt icy" JI ir, Manufactured home utilities 110.00
�,
Cross street/directions to job site: D t :, ` ( , .
Manholes 16.60
Rain drain connector 16.60
Sanitary sewer (no. linear ft.: ) Page 2
Storm sewer (no. linear ft. ) Page 2
Subdivision: Lot no.: Water service (no linear ft.. _ ) Page 2
Fixture or item
Tax map /parcel no.: ,
Absorption valve 16.60
DESCRIPTION OF WORK .
Backflow preventer / Page 2
1- rt C = lei :) ' (_ kf l (2)k) Backwater valve . t 16 60
Clothes washer 16.60
Dishwasher 16.60
PROPERTY OWNER
Drinking fountain 16.60
❑ PRO 1=1 TENANT
� I , Ejectors /sump 16.60
Name: G IY� Expansion tank 16.60
Address: j 7 Z7 S 1
..- cy./e-�- �.tl L � Fixture /sewer cap 16.60
ti
City /State /ZIP: Ki � l c --`/ '1 q12,2, Floor drain /floor sink /hub 16.60
Phone: ( ,) 2 / C.
S Fax: ( ) Garbage disposal 16 60
❑ APPLICANT ❑ CONTACT PERSON Hose bib 16.60
/ Ice maker 16.60
Business name:
� 7:2, - Lcc y p e Interceptor /grease trap 16.60
/S
Contact name: `1 j cite fe( ! Medical gas (value: $ ) Page 2
Address: j j ( (.) 5 41 ( Cz C , Primer 16 60
g City /State /ZIP: eaUL Cie r r n �i Roof drain (commercial) 16.60
97�
Phone: (5} )) 8K^ ! s 07 Fax: : ( ) Sink/basin/lavatory 16.60
Tub /shower /shower pan 16.60
E -mail:
Urinal 16.60
CONTRACTOR Water closet 16.60
Business name: Z. 1 c % , S , ` _ e _ Water heater 16.60
Address: 0((? ,S l.:1 a S 'r ':or C f, Other:
City /State /ZIP: / ✓L> L )Ch 0' ' f Subtotal
� let( Subtotal
permit fee: $72.50
Phone: (�} �) j ! - , `) Fax: ( ) Residential backflow minimum permit fee $36.25
CCB Lie.: U Plumbing Lie. no.: Plan review (25% of permit fee)
Authorized signatur a
State surcharge (8% of permit fee)
TOTAL PERMIT FEE VI , 15
Print name: 1,/ Ir'„ v Date: c -70 —7 This permit application expires if a permit is not obtained within
180 days after it has been accepted as complete.
*Fee methodology set by Tn- County Building Industry Service Board.
1 \Permits\PLMF- PerrniiApp doc 12/27/06 440- 4616T(I0 /02 /COM/WEB)
CITY OF TIGARD PLM 200 - 7- oo3 ?Z
r «_
BUILDING DIVISION PERMIT #: 1►ST'81e'
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: //1712007
Phone: (503) 639 -4171 ��ml�Nl�l
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 9/14/2007 TIME: 7:00AM PAGE: 6
SITE ADDRESS: 11218 SW 118TH TERR CLASS OF WORK:
SUBDIVISION: FEHRENBACHER NO. 2 LOT #: 011 TYPE OF USE:
PROJECT NAME: FEHRENBACHER NO. 2
DESCRIPTION: New SF.
• OWNER: PAYS CUSTOM HOMES INC, PHONE #: 503 - 475 -5041
CONTRACTOR: PAYS CUSTOM HOMES INC PHONE #: 503-475-5041
Inspection Request Scheduled For: Date: 9/14/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
399 Plumbin final 055752 -02 503 - 840 -7332 N
Corrections /Comments /Instructions:
•
Ca. re fq .01
PASS ❑ PARTIAL APPROVAL ❑ CANCEL NO ACCESS
FAIL ❑ CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED
Inspector: Q ( '1' i l L---- Date: e l / / ( - f / -C 7 Phone #: (503) 718