Permit CITY OF TIGARD
PLUMBING PERMIT
' '' � COMMUNITY DEVELOPMENT PERMIT #: PLM2007 -00280
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 6/29/2007
PARCEL: 2S112CC-00200
SITE ADDRESS: SW NO ADDRESS ZONING: R -12
SUBDIVISION: GAGE FOREST LOT: JURISDICTION: TIG
PROJECT: GAGE FOREST
Project Description: Installation of backflow prevention device for irrigation system for common area of subdivision.
CLASS OF WORK: OTR GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS: 1
OCCUPANCY GRP: 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
GAGE, DOROTHY DARLE NE
GAGE, M A ABRECHT, M G Description Date Amount
8000 SW 54TH AVE [PLUMB] Permit Fee 6/29/2007 $72.50
PORTLAND, OR 97219 [TAX] 8% State Surcha 6/29/2007 $5.80
Phone : Total $78.30
Contractor:
PEAK LANDSCAPING
2200 NW CORNELIUS PASS RD STE
HILLSBORO, OR 97124 REQUIRED ITEMS AND REPORTS
Contact # : PR1 503 -533 -8173
FAX 503 -53 -8176
Reg #: PLM 8339
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 ■ ... - i Center. Those rules are set forth in OAR 952 - 0001 -0010 through OAR 952 - 0001 -0100. You may obtain copies of
t - e rules or direc'qu s - to OUNC by calling 503.246.6699 or 1.800.332.2344. , 1 c.E_________
Issued By: } # 1 L� I / \ Permittee Signature:/ ' /��
Call 503.639.4175 by 7:00 a.m. for an inspection that bu • d. y.
This permit card shall be kept in a conspicuous place on the job site unti omple on oft e project.
Approved plans are required on the job site at the time of each inspects. -.
,Plumbing Permit Application FOR OFFICE USE OILY ° ` -'
11111 City of Tigard Received / • Q� Permit No • /yy7.. ODo�g0
13125 SW Hall Blvd., Tigard, OR 97223 Date /By: Ut ow!
Plan Review
Phone: 503.639.4171 Fax: 503.598 .1960 Date /By: Other Permit No.:
TIGARD Inspection Line: 503.639.4175 Date Ready /By: I El See Page 2 for
Internet: www.tigard or.gov Notified /Method: Supplemental Information
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s K I New construction I=1 Demolition For special information use checklist.
7a Description I Qty. I Ea. I Total
❑ Addition /alteration /replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
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' :- r';° CATEG'OR3 ` OI . GOIYSTRC3GTIO1Vr :;;,` ``: '' ; SFR (1 ) bath
249.20
1 -and 2- family dwelling ❑ Commercial/i>ndustrial SFR (2) bath 350.00
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❑ Accessory building ❑ Multi- family SFR (3) bath 399.00
Each additional bath/kitchen 45.00
❑ Master builder ❑ Other:
,,fi;., „h „s,v Fire sprinkler ( sq. ft.) Page 2
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Job site address: 5CAD n et• 5LD q-1 Catch basin or area drain 16.60
City /State /ZIP: 1,, c\c,rg2-- 1 O e_ Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: I Project name: Footing drain (no. linear ft.: -) Page 2
Manufactured home utilities 110.00
Cross street /directions to job site:
Manholes 16.60
Rain drain connector 16.60
Sanitary sewer (no. linear ft.: -) Page 2
Storm sewer (no. linear ft.: -) Page 2
Water service (no. linear ft.: ) Page 2
Subdivision: Lot no.: Fixture or item
Tax map /parcel no.:
K u ,, Absorption valve 16.60
.,: ➢T SGIiIPTION°=OF>
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/ L O-D , .i -1p,", Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
x` ;y . -;:;: n Drinking fountain 16.60
PROPER I Y -t) .. m w '4Q ... I ENANT.F.. ' " '
< . . „, ,., _ ,;�rx•` �`: '� . ..... . Ejectors /sump 16.60
Name: Expansion tank 16.60
Address: Fixture /sewer cap 16.60
City /State /ZIP: Floor drain /floor sink/hub 16.60
Phone: ( ) Fax: ( ) Garbage disposal 16.60
-5' < `e� ?�',:'r „- Ark.:- 4 r; + ;s< 'rc :,:"x...: Hose bib 16.60
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. AP LICANT ); • ;41 r ` a . ` . ° eOLV'TAGT PERS Ice maker 16.60
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Business name: (.-cM . n � NL Interceptor /grease trap 16.60
Contact name: \ . JO Medical gas (value: $ ) Page 2
Address: . 2 ,... c . ,0, LA D C. tJ „ 2s. ioo Primer 16.60
City /State /ZIP: [1' k. Y�C/O i c 2 9 it ay Roof drain (commercial) 16.60
�� JJ `' Sink/basin /lavatory 16.60
Phone:
5-33 - e t -7 3 Fax:: (�3i � 33 _ g-1
Tub /shower /shower pan 16.60
E -mail:
Urinal 16.60
> :, `�'�� = >: >c:..... :- :,.... � � ., �-; ,.; �` 16.60
Business name:
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/%� ode V-?.- Water heater 16.60
Address: Other:
. City /State /ZIP: Subtotal - 2 c )..-6t! - 2 c )..-6t!
Minimum permit fee: $72.50 E-
Phone: ( ) Fax: ( ) Residential backflow minimum permit fee: $36.25
� 3 ')
�B Lic.: �" J 1 Plumbing Lic. no.: Plan review (25% of permit fee)
State surcharge (8% of permit fee) 6. TO
Authorized signature:
TOTAL PERMIT FF . 'x..)
Print name: Vv.., ,A63 Date: ,,,1 gl0 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.
1: \Building \Permits \PLM- PermitApp.doc 06 /26/06 440- 4616T(l0/02 /COM/WEB)
CITY OF TIGARD
BUILDING DIVISION PERMIT #: PLivI2007.00280
13125 SW Hall Blvd., Tigard, OR 97223 D ATE ISSUED: 6129/2007
Phone: (503) 639 -4171 ° 1 016i6i "i
Inspection Requests (24 Hrs.): (503) 639 -4175 - . ■ A'..
INSPECTION WORKSHEET FOR DATE: 7/3/2007 TIME: 7:03AM PAGE: 48
SITE ADDRESS: SW NO ADDRESS CLASS OF WORK:
SUBDIVISION: GAGE FOREST LOT #: TYPE OF USE:
PROJECT NAME: GAGE FOREST
DESCRIPTION: Installation of backflow prevention device for irrigation system for common area of subdivision.
Project is at the east end of Langtree St, east of Hall Blvd.
OWNER: GAGE, DOROTHY DARLE NE, PHONE #:
CONTRACTOR: PEAK LANDSCAPING PHONE #: 503- 533-8173
Inspection Request Scheduled For: Date: 7/3/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
395 hitisc. inspection 051359 -01 503- 533.8173 Y
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Corrections /Comments /Instructions:
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PASS n PARTIAL APPROVAL n CANCEL _ NO ACCESS
FAIL CALL FOR INSPECTION I I ADDITIONAL FEES ASSESSED
,k__ Inspector V Date: I Phone #: (503) 718 - 3/