Permit CITY TIGARD PLUMBING PERMIT
DEVELOPMENT SERVICES PERMIT #: PLM2005 -00392
c 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 8/16/2005 •
PARCEL: 2 S 112 C D -11300
SITE ADDRESS: 07727 SW ALDER ST ZONING: R -12
SUBDIVISION: HAMBACH GROVE LOT: 011 JURISDICTION: TIG
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
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Owner: FEES
LEGEND HOMES Description SW 69TH AVE # 100 escription Date Amount
PORTLAND, OR 97223 [PLUMB] Permit Fee 8/16/2005 $36.25
[TAX] 8% State Surcha 8/16/2005 $2.90
Phone : 503- 620 -8080 Total $39.15
Contractor:
MARTIN SANDERS GROUNDS MAINTEN
PO BOX 307 •
NORTH PLAINS, OR 97113 - REQUIRED ITEMS AND REPORTS
Phone : 503- 647 -5567
Reg #: LIC 5742
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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 By: Permittee Signature: sp ._
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.
Rug 16 05 08:27a Martin Sander 503 -647 -9151 p.4
1�1r. n ��
Plumbing Permit Applicatlto, � _ 'V 'En n 1..01; o r i r. 1 � r ()NIA .
City of Tigard U aac�ey: t6 _O)- �� Pennit �1�� 7()`� r/() 3�j ' ,�
13125 SW Hall Blvd., Tigard, OR 97223 AJ� 1 2OP �^.' Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 y � ; . Date/By[ O1herPcrmitNo.:
24- Hour Inspection Line: 503.639.4175 •I l' Date R / Juri) / ® See Page 2 for
Internet: www.ci.tigard.or.us CITY OF Tina Notified/Method: - i / Supplemental Information
TYPE OFIWORK DIVISION FEE* SCHEDULE
,New construction ❑Demolition Forspeda! information use checklist
Description J Qtv. ( Ea. I Total
❑ Addition/alteration/replacement ❑ Other: New I- 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) barn 350.00
SFR (3) bath 399.00
❑ Accessory building ❑ Multi - family
Each additional bath/kitchen 45.00
❑ Master builder ❑Other: Fite sprinkler ( sq. 2) i Page 2
3016 SITE INFORMATION AND LOCATION Site utilities
• Job site address: "' - 7 2 :1 . j Pc e S _t Catch basin or area drain 16.60
City /State/ZIP: 7 i ti d, 0 .R C Z 2- Li Drywell, leach line, or trench drain 16.60
no.: I Project name: H.o_
Suite/bldg. /apt_ ;,,., hrx.r,k Footing drain {no, linear ft : ) Page 2
Manufactured home utilities 110.00
Cross street/directions to job site: Manholes 16.60
Rain drain connector 1 6.60
Sanitary sewer (no. linear ft.: _______) Page 2
Storm sewer (no. linear IL: ) Page 2
Subdivision: E bG L't L 5s N,.., 3 I Lot no.: 1l Water service (no. linear ft.: ) Page 2
Fixture or item
Tax map /pareei no.: Absorption valve 16.60
DESCRIPTION OF WORK Backflow preventcr Page 2 K
Backwater valve 16.60
(Anc n :se / n Clothcswasher 16.60
(� Dishwasher 16.60
Drinking fountain 16.60
PROPERTY OWNER ] ❑TENANT
Ejectorslsump 16.60
Name: Legg e Arve D
' , c lt Expansion tank 16.60
Address: J ( 2 - 1 SS S - L9 Th . W e t b(') Fixture/sewer cap 16.60
City /StateZIP• °p-r -1(- ta-x ra D P. '-{ -] 7-23 Floor drain/floor sink/hub 16.60
Phone: (5D3) ( ?_AD - u RZj Fax: (S S9 g - g9 00 Garbage disposal 16.60
ID APPLICANT ❑ CONTACT PERSON Hose bib 1660
lee maker 16.60
Business name: CL r t `c4 pA . zs (7)1DDLJY) t S t- Interceptor /grease trap 16.60
Contact name: jLdi t d �l Sti o 0�- Medical gas (value: $ ) _ Pagc 2
Address: r C0 . �� >...,<, 3 -7 Primer 16.60
City /State/ZIP: 8 ,3 4-te‘ e i re; -1.1 O 9 - 7 / S� Roof drain (commercial) 16.60
Y Fax :: (5 5) T ow e r avatory 16.60
Phone: (S03) (a
- 5 (' 1 r ylS� Tub/shower /shower pan 16.60
E -mail: Urinal 16.60
CONTRACTOR J Water closet 16.60
Business name: it-44 e 1 li ,S 4, f-, /'n � Water heater 16.60
Address: P , a . 3-. C, "`�"�� Other:
/State/ZIP: � ? Subtotal
Ci
tY N � . ( ct- ;V S f JI1 / 7 (-� ? Minimum permit fee: $72.50
Phone: (50& ( -f 7 - 5 � b -) Fax: (509) ( L7 •- _ ctl S i Residential backflow minimum permit fee: $36.25
CCB Lie.: 5 [ 1 1. - Plumbing Lie. no.: Plan review (25 %ofpermit fee)
7 7 State surcharge (8% of permit fee)
Authorized signature : ,/� TOTAL PERMIT FEE .,0 -��5
- Print name • Date: 4 . g - US This permit application expires ifs permit is not obtained within
/�� -�C " �� 180 days after it has been accepted as complete.
*Fee methodology set by Tri- County Building Industry Service Board.
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CITY OF TIGARD
BUILDING DIVISION PERMIT #: PLM2005 -00392
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 8/16/2005
Phone: (503) 639 -4171 �' ���fii�(��
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 8/22/2005 TIME: 7 :10AM PAGE: 5
SITE ADDRESS: 07727 SW ALDER S T CLASS OF WORK:
SUBDIVISION: HAMBACH GROVE LOT #: 011 TYPE OF USE:
PROJECT NAME: HAMBACH GROVE
DESCRIPTION: Backflow preventer for irrigation.
OWNER: LEGEND HOMES. PHONE #: 503 - 620 -8080
CONTRACTOR: MARTIN SANDERS GROUNDS MAINTEN PHONE #: 503 - 647 - 5567
Inspection Request Scheduled For: Date: 8/22120055 Pour Time:
Code # Inspection Description Confirm # Contact # Message
399 Plumbing final 014028 -02 503 - 047 -5567 N
Corrections /Comments / Instructions:
1
1
x PASS n PARTIAL APPROVAL ❑ CANCEL _ NO ACCESS
FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: 4- 1 -A-- o cl A- 1--- Date: _ k/2 4/0( Phone #: (503) 718-