Permit C ITY OF TIGARD PLUMBING PERMIT
itto
DEVELOPMENT SERVICES PERMIT #: PLM2005 -00368
c 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 8/9/2005
PARCEL: 2S 104 D D -09400
SITE ADDRESS: 13515 SW 129TH AVE ZONING: R -4.5
SUBDIVISION: MOUNTAIN HIGHLANDS NO. 3 LOT: 052 JURISDICTION: TIG
Project Description: Irrigation backflow preventer.
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
YORESEN, KIRK E + LINDA L Description Date Amount
13515 SW 129TH
TIGARD, OR 97223 [PLUMB] Permit Fee 8/9/2005 $3625
[TAX] 8% State Surchar; 8/9/2005 $2.90
Phone : 503 789 - 4716 Total $39.15
Contractor:
TREE CARE UNLIMITED
P.O. BOX 1566 REQUIRED ITEMS AND REPORTS
LAKE OSWEGO, OR 97035
Phone : 635 - 3165
Reg #: LIC. 5659
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 503-246-609 or 1- 800 - 332 -2344.
Issued By: I% _ � 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.
08/05/2005 10:05 FAX 5035981960 CITY OF TIGARD 0 002
Building Fixtures
CEEPITOCY
Plumbing Permit Applicattson " ' 1 .I •1r�l; 1)1 11 l 1 • Si r)N_i i'; 3 v 4
City of Tigard V '' 0 9 nO5 Reo� vad 9 Permit N. ,/.4720,415__,49
13125 SW Hall Blvd, Ti Dste/By. !-��
!� OR 97223 wan Review
Phone: 503.639.4171 Fax: 503598.1960 ��. ;.( Date/Br Other PermltNo.:
24 -Hour Inspection Line: 503.639.4175 GliTY OF -40-
ww.ci.tigard.or.us _-1 e u SU p M Informs
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❑ , "w construction ❑ Demolition For spedvJ Information use checklist
Description I Qty. >I Ea. I Total
U Addition /alteration /replacement ❑ Other
t `� ti � New 1 -2- family dwellings (includes 100 ft for each utility connection)
+� + :'t^ i g:)c 1 "c °.: °: o .- 1, t torkL / SFR 1)bath 24920
1;1 1- and 2- family dwelling ❑ Commercial /industrial _ SFR (2) bath 350.00
❑ Accessory buildiiab ❑ Multi - family SFR (3) bath , 399.00
Each additional bath/kitchen 45.00
❑ Master builder ❑ Other.
�� ,;}� y Fire sprinkler ( sq. R) Page 2
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�'� ,• 6 Site utilities
Job site address: 43.57 /2 . 7`'
- t . . Catch basin or area drain 16.60
City/State/ZIP: ; ' ■ e-e: A O= . 2 3 Drywell, leach line, or trench drain 16.60
Suite/bldg.lapi no.: project name: Footing drain (no. linear ft.: ) Page 2
Manuthetured home utilities 110.00
Cross street/directions to job site: nn Manholes 16.60 _
/a 6 /T 5 Rain drain connector 16.60
y `S i . fit a e_ ..-' , Sanitary sewer (no. linear ft: _ ) Page 2
Storm sewer (no. linear ft.: ) Page 2
Water service (no. linear R.: ) Page 2
Subdivision: : I Lot no.:
Tax map/parcel no.:
Fixture or item
:4i' , � ,� y . , , Absorption valve 16.60 /
° " . . . •• 4 ,, ' L Baeknow preventer / Page 2
e
-4- ill ?Q� - 1. , �/9i/A 7 ' Y°LYC • Backwaaervalve 1 16.60
/ Clothes washer 16.60
Dishwasher 16.60
h • p r. Mf :::.:-J �; M1 -+r ,; �� ,.;, Drinking fountain 16.60
Name: �
Nam : .;a:' Ss'9.�'t+ i,rl �ar r3l:' : •.... a Ejed...wsump 16.60
`^•- -I � - " Expansion tank 16.60
Address: /357 3"---c="7//// . ! /2 C9 f"L- `ke • Fixture /sewer cap 16.60
City/State/ZIP: -7--- G y t9 7ZZ Floor drain/floor sink/hub 16.60
Phone: (3) t r - 7 , Fax: (
Garbage disposal 16.60
c,i .. .;,iq V, -` �: : ` '� ; 07, :r,+�! �.�a. ;t, +NW. °'f rr •'.'�•r1t� ^�7 k`t' % 4 r ",e + S a " , wa Hose bib 16.60
11(( y I :.i... r ' \ g' r l ,• k: ✓ '7i e 5; .1' x, _
Ice make 16.60
Business name:7C`o -e fi ct x �, t A p- u Z 9- Interceptor /grease bap 16.60
Contact name: a V e - `� f Medical gas (value: $ ) Page 2
Address: .0 / C. Primer 16.60
City /Statc/ZIP: La le 625-W9--9C) 9 7) 3 Roof drain (commercial) 16.60
Phnnr. & al--- 3/6> 5 t 3) /y 35"--A5-4/ Sink/basin/tavatory 16.60
Fax:"
E-mail: Tub/shower /shower pan 16.60
yy Urinal 16.60
., ti T'rF'a I . •l " . 6 * hL !, °1 1?Nvu' 'il'N- a ' S'i
Water
.i r U: � >p ' .:11 closet 16.60
_
Business`nanic: C�fn e- iz..5 &- bUY-e Water heater 16.60
Address: Other:
City/Statc/ZIP: / / e l I f� '7 v / Sobtotal
• M - Minimum permit see: $72.50 2
Phone: ( ) Fax: ( ) .. ho z4 Residential backflow minimum permit fee: $3625 7 .
CO3 Lie.: 6,26 3 J Plumbing Lie. no.: l'37 q Plan review (25% of permit fee)
Authorized signature: State surcharge (8% of permit fee) Z. • 9 0
i i _ TOTAL PERMIT FEE ,, 3 9 /s
Print name j��� / , Date: r _ 3 This permit application eXpires if a permit is not obtained within
ISO days after it has been accepted as complete.
*Fee methodology set by Tri -County Building Industry Service Board.
is\& dlding\Porntib \PLMy.PermitApp 06105 44046161 loicarcOIWWEH)
AUG -05 -2005 11:27 5035981960 97% P.02
CITY OF TIGARD
BUILDING DIVISION ` • PERMIT #:
PLM2005- 00368
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 8/9/2005
Phone: (503) 639 -4171 /,a +dglp�I�
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 9/2/2005 TIME: 7 :07AM PAGE: 47
SITE ADDRESS: 13515 SW 129TH AVE CLASS OF WORK:
SUBDIVISION: MOUNTAIN HIGHLANDS NO. 3 LOT #: 062 TYPE OF USE:
PROJECT NAME: YORESEN
DESCRIPTION: Irrigation backfiovr preventer.
OWNER: YORESEN, KIRK E 4- LINDA L, • PHONE #: 503 - 789 -4718
CONTRACTOR: TREE CARE UNLIMITED PHONE #: 635 -3165
Inspection Request Scheduled For: Date: 9/2/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
325 RP /backflow preventer 014869 -01 503-635 -3165 N
Corrections /Comments /Instructions:
PASS ❑ PARTIAL APPROVAL n CANCEL ❑ NO ACCESS
n FAIL I I CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED
p av t \ v
Inspector: 1 � � Date: °'1 21-tie Phone #: (503) 718-
, ,