Permit `~; & 'CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT PERMIT #: PLM2008 -00262
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 6/11/2008
PARCEL: 2 S 103 C D - 07100
SITE ADDRESS: 13890 SW 118TH CT ZONING: R -4.5
SUBDIVISION: CREEKSIDE PARK LOT: 002 JURISDICTION: TIG
PROJECT: GROVER
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
JERRY & JU GROVER
13890 SW 118TH CT Description Date Amount
TIGARD, OR 97223 [PLUMB] Permit Fee 6/11/2008 $36.25
[TAX] 12% State Surch 6/11/2008 $4.35
Phone : Total $40.60
Contractor:
JOHN DARBY LANDSCAPE INC
13867 SW BENCHVIEW TERRACE
TIGARD, OR 97223 REQUIRED ITEMS AND REPORTS
Contact # : PRI 503 -579 -5298
FAX 503 -524 -6613
Reg #: LIC 7110
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 - / 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.
Fk : JOHN ARBY LANDSCAPE INC FAX N0. : 5035246613 Jun. 10 2008 04:37PM P3
lutnbina Permit A Hendon - V.D
Building Fixtures C • .
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13125 SW 1 FOR OFFICE USE fJr'4
13113' Of laU Blvd., w1 1 Received a ' � r "
Call vd Tigard, OR 97223 J� DD alit No,. aI'�7 �p )5
B Phone; 503.639,4171 Fax: 503.598.1960 `tIGp,R Plan at RCNCW ""t/
ins eCtion Li ne: 503 639.4 Or S1® D ata / Other Perurit No •
TtGAIi 7 p 1 -
k Internet: www.tigard- or.gov CS C v Ready 113y:
,� �} date R ca@ /f�
,` Nonfled /Method: See Peke 2 for
? L Sp on
' %� ./..; TYPE OF '4V4 • � rr C � Icmentgl Info rmot
9
"a . r '- , , ■ ' . a .,,, ?,L,F.) ' :SCI1 DULt:T 0,s1 kn
U New construction ❑ Demolition Fors eclat in ormalion use checklist
ii; 'ddition/alteration/replacemcnt vescri. .! Ea. Total
,;,- •:.;:,
New I- 2-family dwellings (includes 100 R. f
Other:
N
- - ��.x
'� i'"_;R4 k,,� .frt0 c.`"' "r, CATEGORY .OF 1 C ONSTRU I ' t �'' ;:b +:; for each 9. 2ity connection)
•, . ,_ , . CT ON �: , ,;;i .� / ,� , SFR (1) bath za9.20
-g 1 • and 2- family dwelling Q Commercial /industrial SFR (2) bath 350.00
Accessory building ❑Multi - family
SFR (3) bath 399.00
(=I Master builder Q Other: Each additional bath/kitchen 45.00
:.";"=:;$i'. " : < ' e •'.;.;' Fire sprinkler ( . sq. R.
Pa e 2
.4 si'uc; \`;:ti:� �tr0B SITE INFORMATON I AN L r ; I a mr g • : r Site utilities Job site address: ' ♦ r
� � Catch basin or area drain 16 60
City/State/ZIP: • B' , * 1 .' . ,► c
16.60
Suite/bldg. /apt. no.: ' 'roject name: - Footing drain (no. linear ft.: ) - Page 2
Cross street/directions to job site: Manufactured home utilities 110.
Manholes 16,60
Rain drain connector 16.60
Sanitary sewer (no, linear ft.: ) _ Pa 2
Storm sewer (no. linear ft.: ) Page 2
Subdivision: Lot no.: Water service (no. linear ft.: ._) OZOI
Tax snap /parcel no.: Fixture or item
> "`' ' - `fc. ?': 1�SCRIPTI wr Absorption valve 16.60
'i ON; OF W ORK 1 w' �Y 1, Backflow preventcr Page 2 6 ; r l � „ : ? :
1► ui /'
,. . rni --
111110.11 ► 1 , /•! A/ A. i [ 1 Backwater valve 16.60
��� Clothes washer 16,60 al
Dishwasher 16.60
S;S > ?<- ::.�• , ; ,.r'pROp ER • Ty: '. O ;v:'`M';'.' ',;.'' ��. r , .,.,ej.:� Drinking fountain
w
: WNER',.. .,.. ", ?:a : r' ;!: >i ' ANT 1G
s:. r. r :.. Ejectors/steep
Name: .� f L( C _ n 16.60
1 �_I i 'Y'c �� � � � , Expansion tank 1 6.60
Address:
1$ QC� (5_I/S1 r' r Fixture /sewer cap 16.60
City /State/ZIP: E ti. ' # P _ _W Ploor drain/fioor sink/hub 16.60
Phone: Q • � i i Fax: ( ) Garbage disposal _ EMI
:? 4_''• ?'' Q? APPLICAN'T.' ; .'' ' z - , ' i ^ '❑;C ONTACT PERSON v I e bib 16.60
;.,. ice maker 16.60
Business name: cleh MP w ,:,•4 )# r�;�' 'C� interceptor /grease trap 16.60
name! nae: `-' Medical gas (value: $ ) ■ Page 2
Address: e. Primer 16.60 ii
City /State/ZIP: T Roof drain (commercial) 16.60
Phone; ( ) Fax:: ( )
Sink/basin/lavatory !6.60
- Tub /shower /shower pan 16.60
E -mail: Ir Urinal 16.60
}'mar _ ., 1.. _. ONr1 LVf a.a V[ .'.'l ,;y : .
; T , , . ";. � , . .. � � .. .1 , .. Water closet ■ 16.60
Business name: 1 ' • 0 / .
� l � � 1 11 � �a �� t� ��. . r Water heater 1660
-
�RR ni : it r , • ,Other. -
��`LI
aa e rI Subtotal
j Minimum pen tcc: 572.50
Phone: 1� • om a , aL3 Residential backflow minimum permit fee: 536.25 3rQ,r
CCB Lie.: , Plumbing Lic. no.: Plan review (25% of permit fee
-- - State surcharge (12 %ofpermit fee) 3
Authorized si nature: �/�
& '1 ` TOTAL PERMIT FE mv- 1401 GO
Print name: VII ,��C,� llutc: t om' , This perm application expires if a permit is not obtained within �V
180 days after it has been accepted as complete.
*Fee methodology set by Tri- County Building Industry Service Board
1:43utYilinglftsmit $NLMF- PcrmitApp.d0C I. /27/06 440 -0GIGT(IU10<1COMJWi ='8)
, -
CITY OF,TIGARD
BUILDING DIVISION
AO PERMIT #: PLM2008-00262
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 6/11/2008
Phone: (503) 639-4171 .4011 11114lei
Inspection Requests (24 Hrs.): (503) 639-4175 AJJ, ■ 111.
INSPECTION WORKSHEET FOR DATE: 7/8/2008 TIME: 7:00AM PAGE: 49
SITE ADDRESS: 13(390 SW 118TH CT CLASS OF WORK:
SUBDIVISION: CREEKSIDE PARK LOT #: 002 TYPE OF USE:
PROJECT NAME: GROVER
DESCRIPTION: Installing backflow preventer.
OWNER: GROVER, JERRY & JUDY PHONE #:
CONTRACTOR: DARBY LANDSCAPE INC, JOHN PHONE #: 503-579-5298
Inspection Request Scheduled For: Date: 7/8/2008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
399 Plumbing final 072307-01 . 503-579-5298 N
Corrections/Comments/Instructions:
¶c F- e tr---\-- , ....C-c,, c ‘R. v oil v-\
L.,l.4.-A
X PASS r7 PARTIAL APPROVAL III CANCEL fl NO ACCESS
I I FAIL CALL FOR INSPECTION III ADDITIONAL FEES ASSESSED
, A
—
Inspector: (.3 Date: --) )11 . 0T Phone #: (503) 718-