Permit 4
CI TY OF TIGARD PLUMBING PERMIT
.�; DEVELOPMENT SERVICES PERMIT #: PLM2004 -00301
' DATE ISSUED: 7/1/2004
-- 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS: 14627 SW 126TH AVE PARCEL: 2S109AD -10000
SUBDIVISION: MCCLINCY MLP2001 -00008 ZONING: R -7
BLOCK: LOT: 001 JURISDICTION: TIG
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
Remarks: Irrigation backflow preventer.
FEES
Owner:
Description Date Amount
CRINO CUSTOM HOMES
3 MONROE PKWY STE P [PLUMB] Permit Fee 7/1/2004 $36.25
PMB 335 [TAX] 8% State Surcharl 7/1/2004 $2.90
LAKE OSWEGO, OR 97035 Total $39.15
Phone : 503 244 - 0052
Contractor:
JOHN DARBY LANDSCAPE INC
13867 SW BENCHVIEW TERRACE
TIGARD, OR 97223 REQUIRED INSPECTIONS
Phone : 579 5298 RP /Backflow Preventer
Final Inspection
Reg #: LIC 7110
PLM 12319LCL
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.
Issued By: `� Permittee Signature: i ,o/ — �
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
r
FR :
X _JrlV DARBY LANDSCAPE INC FAX N0. 5035246613 Jun. 25 2004 05: 40PM P3
lldl]�r; `�,XiUt'e� FOR OFFICE USE ONLY
Plumb Per mit A li ea ti oil Received //Plum 09 -1)-0-301 Date/B :CO O . ° t 1 • - Permit No'.�,./ -
Planning Appr• at Sewer
City of Tigard Date/Ely: Permit No,;
Plan Revicw Other
13125 , Oregon Hall Blvd, Date/By: Permit No.
Tigard, Oregon 97223 Post - Review Land Use
Phone: 503- 639 -4171 Fax: 503 -598 -1960 8 ,,,,,, i ,.,,. .,. I t y; Case No.:
1 � $1 See Page 2 for •
Internet: wWtr+•ci.tigard e; .�.. Contact la a Information.
Inspection Request: 503- 639 -4175 Name/Method: , Supplemental
. .�. .., s � ,R r.1� iiti, a °LZC ..
" " "" e'chec t
: .;� ' °- *t5OYIlEDi7i�`�ftir;s �:eciat'iII�oXma kIst '
,r.. - .�. . TY'i',E`,Q1�'. U ...,. - ,-,_ .. �� Fee(ea.) "total
. :< LL` Demolition ' '� <F Description Qty
� New construction • - :, .' ,, „r_,�'•��..'. i1i 1 ' ell'ia � -•�.: .
lacement [� r . ',.' ", ;: ,R : " .: �. V'„ ,,:.,:� .
PI Addition/alteration/re Other: .•.. : ti4 �' ti t'�.g? {u u tiii . Cp niae C tlOii
' CATEGORY OF C1aNS`d RC).0 IU1N 'r.:. '3 ;::, : f SFR (1) bath 249,20
1 & 2 -Famil dvt/ellin 1 ❑ Commercial/Industrial ^ SFR (2) bath _ 350,00
Accesso Building ❑ Multi - Family SFR (31 bath 399,00
■ Master Builder • • Other: additional h/k p 5 0 0
- Hach addi al bat itchen -
T;R'�I1IFORMA'T ON•"and.:LQW..1I AN' Fire s•rinklcr �1 .. ft.:
••:.',,';,.. ��OD SX • �I � �.,y�' �:i� � u, 1 e , �a �I�J � 1
. I I ' �. '5;., i:.53 • t °�!;ls; ;Sias aUtilities r' �;�,..• �av, : ..
Job site address: t r� +� yl�
Suite #: Bldg. /A • t. #: _Catch basin/area drain
D ell/Icach lint /trench drain
Project Name: - Footin drain (no. linear 8 -) Page 2 ,
Cross street/Directions to job site: Manufactured home utilities 110.00
Manholes 16.60
Rain drain connector _ 16.60
Sanitary sewer (no. linear ft.) Page 2
Lot #:
Storm sewer (no. linear ft.) Page 2
Subdivision: Water service no. linear ft4 age 2
uR� ; c . ...a ,
;,:,: k �, ! . ''4'i'x n' 1
Tax ma• /•arcel #:
r..,.. 0 `e. �•TJQROF.. W d AbSO � •t1 i` iVC
%>�q%{<^�tP;'� ^ 37e`�u "+el:
Backflow preventer Page 2 _
t l Backwater valve 16.60
in, �' �` " 1.1 �� t Clothes washer 16,60 , w
Dishwasher 16.60
Drinking fountain 16.60
10 &FROr O ? ! r^ .4 Wi' iTElf i Z tt: .:di ', 'i . V i •r Ejectors/sump 16.60
11 : 1 I / Expansion tank 1 G.60
1?ixture/sewer cap 16.60
Address: • �• 1 1 ' ► ■...i. 1 . t t • Floor drain/floor sink /hub 16,60
.�..
�
• ' s' J . �u �� Garbage disposal 16.60
Phone: _ . e i____ ' Hose bib 16.60
�►.t ,' l`(: AG xC, 14100.1! t :i •414: Ice maker 1 6.60
a _ interceptor /grease trap 16.60
Medical g s - - value: $ R
Address: - .-� - primer 1 G.60
City /State /Zip: ' 16.60
Roof drain (commercial)
Phone: Fax: Sink/basin/lavatory 16.60
B -mail: ` - Tub /shower /shower, pan 16.60
,, �:T. - :�::s:rt , Urinal 16.60
.:.,,..., .,� ..:. ; G.tp .: -'TQ)<2 ,:...., . ;;,. :',�.:,::,.;:
Water closet 16.60
�
Business Name: . , a 4 ►ii .. I►.M, * at : ' , • Water heater 16.60 "
Address: �.�, .� Other, - -
�. Other: �, .,.,.
r :' F ;"eS ;yK 'i I tt1 k Y,[1 it vail; git,:n :r. :
Phone: hi - �1 g ..:ry. -
� i } 0 Plumb.
CCB Lic. #: _ Subtotal $
x iC. #: Minimum Permit Fee $72.50 $
igns zed
S e aj e Residential Backflow Minimum Fee $36.25
Si >naturc: Dste Plan Review (25% of Permit Fce) $
State Surcharge (8% of Permit Fee) ._$
(Plea print name) �� �- Z. - TOTAL PERMIT FEE $ 39 ,
Notice: This permit application spires If a permit is not obtained within All new commercial buildings require 2 sets of plans with isometric Or
180 days after It has been accepted as complete. riser diagram for plan review.
*Pee rnethodoloaY set byTri- County Building Industry Service tioard,
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