Permit { CITY OF TIGARD
COMMUNITY DEVELOPMENT PLUMBING PERMIT
PERMIT #: PLM2007 -00375
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 8/23/2007
PARCEL: 1 S134CA -FB010
SITE ADDRESS: 11190 SW 118TH TERR ZONING: R - 4.5
SUBDIVISION: FEHRENBACHER NO. 2 LOT: 010 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.
REQUIRED ITEMS AND REPORTS
TIGARD, OR 97223 3
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 -0 01. You may • • . copies of
these rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By: Ljr; , 41 Permittee Signature: , A I A 4‘,„
WV 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.
•
Plumbing Permit Application
Building Fixtures RECEIVED FOR OFFICE USE ONLY
City of Tigard Received • ,
= `r g DaDate/By. 01 Permit N p� L # t ? —
�
a 13125 SW Hall Blvd , Tigard, OR 9 0 7 Pl an Re view „ /
Phone 503.639 4171 Fax: 503 501 200 Date /By: Other Permit No:
Inspection Line: 503 639 4175 C ITY OF TIGARD Ready/By: y: ® See Page 2 for
TLG A R D Date Read /Q ions
Internet. www.tigard- or.gov �,�}}� �{ " Notified/Method • Supplemental Information
TYPE OF�i'ORK ` FEE* SCHEDULE
0 , 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 249.20
1- 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 LQ ATION Site utilities
Job site address: I (� 0 `5� t J
I I C t/ / I � "W/ y Catch basin or area drain 16 60
City /State /ZIP: ---/T Ti �ja 0 R C0 Z�� Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: �/ I Project name: � LC(Cf.� _ Footing drain (no. linear fr. ) Page 2
re n�/ /
T ' 011 T Manufactured home utilities 110 00
Cross street/directions directions to job site: 9(:� y �/ ��� I ( , rt
Manholes 16.60
Rain drain connector 16.60
Sanitary sewer (no. linear ft.: _) Page 2
• Stonn sewer (no linear ft : ) Page 2
Subdivision: I Lot no.: Water service (no. linear ft : _) Page 2
Tax map /parcel no.:
Fixture or item
Absorption valve 16.60
DESCRIPTION OF WORK Backflow preventer / Page 2
If", - ic-A 0 ✓i .�F l � Backwater valve . 16.60
Clothes washer 16 60
Dishwasher 16.60
❑ PRO PERTY OWNER TENANT Drinking fountain 16.60
Name: 12, C.\ 1.] C J A V / Ejectors /sump 16.60
V Expansion tank 16.60
Address: 17Z7 S , Of / f Lti Fixture /sewer cap 16.60
City /State /ZIP: Ki - l ` -N./ r'i 7 Floor drain /floor sink/hub 16.60
Phone: (�(� ) --/ Ks Cw Fax: ( ) Garbage disposal 16.60
El APPLICANT ❑ CONTACT PERSON Hose bib 16 60
Business name: i , . . �� ��� ��
Ice maker 16.60
- C �( Interceptor /grease trap 16.60
Contact name: 6 L€ 6
I � r �- er Medical gas (value: $ ) Page 2
C{�
Address: / 3 V / b ' 6 ciS p -� C , Primer 16.60
City /State /ZIP: d ec(��- l`Yl I' ( ) C/ C l 6 77 ()OR Roof drain (commercial) 16 60
Phone: / tc_ r c07 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.IS ice .er 2� c ,e_, r Water heater 16.60
—
Address: I70( () S4' (aS :op ` C_ I TT Other:
-
Subtotal
City /State /ZIP: /� L�CrLiCil- OK c7 i �
q (�q c « 'iL
Minimum permit fee' $72.50
Phone: (G-0,.) I - , Fax: ( ) Residential backflow minimum permit fee: $36.25 -.aS
CCB Lie.: U � - J
Plumbing Lie. no.: Plan review (25% of permit fee)
q State surcharge (8% of p fee)
Authorized signa : (
4 1T FEE 39 - j
TOTAL of permit er
Print name: L ' Date: u -7 -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 Tri- County Building Industry Service Board.
r\ Building \Permits\PLMF- PermrtApp doc 12/27/06 440- 4616T(10/02/COM /WEB)
i
CITY OF TIGARD .,
.....
BUILDING DIVISION PERMIT #: P1.M2007-00375
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 8123/2007
Phone: (503) 639-4171
Inspection Requests (24 Hrs.): (503) 639-4175 A111141111( --
INSPECTION WORKSHEET FOR DATE: • 11115/2007 TIME: 7:01AM PAGE: 16
SITE ADDRESS: 11190 SW 118TH TERR CLASS OF WORK:
SUBDIVISION: FEHRENBACHER NO. 2 LOT #: 010 TYPE OF USE:
PROJECT NAME: FEHRENBACHER NO. 2
DESCRIPTION: Backflow preventer for irrigation
OWNER: PAYS CUSTOM HOMES INC., PHONE #: 603.475_6041
CONTRACTOR: BLAZER LANDSCAPE PHONE #: 603•998-1507
Inspection Request Scheduled For: Date: 1 in (i/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
399 Plumbing final 059727-10 5038404332 N
Corrections /Comments/ Instructions:
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71 n PARTIAL APPROVAL n CANCEL n NO ACCESS
fl FAIL CALL FOR INSPECTION E ADDITIONAL FEES ASSESSED
Inspector: eA(JZ __ Date: C l st-1 Phone #: (503) 718- ___ _______
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