Permit CITY TIGARD PLUMBING PERMIT
DEVELOPMENT SERVICES PERMIT #: PLM2005 - 00239
I DATE ISSUED: 6/3/2005
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 PARCEL: 2S112CD - 13800
SITE ADDRESS: 07844 SW ALDER ST ZONING: R -
SUBDIVISION: HAMBACH GROVE LOT: 036 JURISDICTION: TIG
Project Description: Installation of backflow device.
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
LEGEND HOMES
12755 SW 69TH AVE #100 Description Date Amount
PORTLAND, OR 97223 [PLUMB] Permit Fee 6/3/2005 $36.25
[TAX] 8% State Surcha 6/3/2005 $2.90
Phone : 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
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: � >;Z , / Permittee Signature: 7,e,-t.
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.
Jun 02 05 12: 53p Martin Sander - _
503-847-9151 P • 3
---
. . . Rc•C1EV\I
Plumbine P e n i t i t A p t ) wation rut of rit' E. i. sF c...1.! •
City of Tigard ca "
0....
0 ° ' Th.,. ,_.•..,..,.......
eatelBy: 4, .„280) - 60 . 411
13125 SW Hall Blvd_ Tigard, OR 97723
\ 0 )%p Plan Re.iae
Phone: 503.639.417i Fax: 501590.19R i O. I .., .. 4 ' . • A cruder (Rex PerratNak \S-1;200 0
24- Hour triapessioa Line: 503639.4175k.) ' rol..........4 • i /
lute:net www..atigard,r,rja. Mill- `-' „... - DIM Readailly:
1.1066ed/Meeock 11 fri to Zar...6..
•
' Irtar3.-. -- ; ,: •-:-..AtgEA,..c13201 - ..... ..... - • --,. -- •
For spade hafersessives me disoldist.
New consmaction ... 0 Demolition
DestaiptIon i Qtv- 1 Ea. I TomI
1:1 Additionlallciationfrepleeement 0 Other Pew 1- 2-fastoly dwellings (includes 100 ft. for oath utility connection)
SPII ( bath -- 249.20
.4.7 -----
. 1- and 2-eacculy dwelling 0 CommereiaVinclustrial SFR (2) bath . 350.00
SFR (3) badi 399.00
0 Accessory baikling El mubi-famay
Each additional bath/kitchen 45.00
0 Master builder C3 Other
stninkter ( aq. ft) Pellc 2
Job site arldenec ' 7 g? S t-N-/ A/V.2,r- Stve-L i- Catth basin or ama drain 16.60
City/Stead / ii/ a r / 0 IZZ 7 2-2-cl Drywel leach lit,e, OC nensh drain 16.60
SuitebldgJept. no.: I Ptoject Dam= /..-/A 64, c _ H c i . 01 _____) Page 2 ,
Manufacttned borne 'META= 110.00
Cross strees/dirtxtions to job sit= Manbtdes 16.60
Rain drain connect/sr 16.60
Sanitary sewer (no. linear ft: __,) Page 2
storm sewer (no. linear 12.: ____) Page 2
Mao- service (no linear ft - ) Page 2
Subdivision: Ay , c 4 4 8A-c,,-/ (1 2 / 1,..)6.- 1 Lot no.: )3 . -
Maitre or item
Tax map/parcel no.: Absorption 1 16.60
Xit-7::: - B.±6. (iies;ku / F 2
L /1 / / 6'4 7 liA) Hatawater valve - r .) 16.60
Clothes washer 16.60
, Dishwasher 16.60
'..1. ...- -...:.•, vrkgt;tr..z..,.tihini:-:-.1.0.1.,_345:....:71:1. Drisking fumble 16.60
Ma= t- • ------ 6 -- 11/ 1 / Scansion tank 16.60
Address: / 7, 5.5 5 LA) 6:,? TH AV. . Fixturerewer cap 16.60
OWSTOTOrZIP: - 7 - i'5 c C.:) - 9 - 1 .-z_7 _:-7, Floor drain/floor sink/hub 16.60
norm (5 C 2_,e,2 - Kc)K0 pax ("I:23) sci g - "I 00 Garbage disposal 16-60
7 1 - i -4111 me. li bib
staw,,.- . . - -1 a Salit :'-il" '_‘..,,_.43 . .:. - - . .....,..>_. 1.14 II 0. 16-60
16.60
Business ten= Paf
S- r\a■sz...rS ( r\)(.2 e: 1 S t-( . Interceptor/grease trap 16.60
Conn= name: 1, k ct ."--411C\ Media gas (value: S ,) Page 2
-,
Address: F. c_i e, ,-,< D---) Primer 16.60
C4t iVp C 9 1,6Lly\ s. c 9 j se.3 Roof drain (commercial) . 16.60
Sink/basin/lavatory 16.60
Ph (S i'3 ) 0 4 /7 - .S e, '7 I Fax:' ((.8 ) L2`
Tub/shower/shower pan 16.60
E-mail: Urinal 16.60
.1.j 4.':; ..i W
i Mr closct 16-60
Businen nams: 1-(a../ 7'0-) , ce _ /17c/)i ds Hi water hestrr 16.60
.-.
Address: P ii . -..› i:, .,. ..'"" Z.> "? Other:
O
Subtotal 3 0 S'
City/Staat/ZIP: K ,-( P VA 5 C. Lcx..... . ..) 97/ 33 M
1-
. i Minimum permit fee , s : S72.50
Phone (5 f L I . 7 - SS 0 7 Fax: ( -5:$ ) ' cil--C/ Residential backllow minimum Permit fee: 536.25
CCB Lie.: 3 7 4/2_. Plumbing Lie_ rm.: Plan review (25% of permit fee)
State surcharge (11% of permit fee) I
Authorized simian= „...... ,./r TOTAL PERM TT FEE 31 i / S
Print name: /...e...---//e....-...--/-71 , ,... I Datr 6 - / - 0 i This penult application expires if a permit is war :bras nest within -
100 days after it tuts bees aracePted sr cOmPlet4-
*Fee methodology set by Tri-County Building Industry Service SCoill •
CAB.Adinowrohstn.X4.1....dapp.a. leo) .40.441sr1i0ratrompsoral