Permit CITY TIGARD PLUMBING PERMIT
� . a � I � DEVELOPMENT SERVICES PERMIT #: PLM2005-00169
'�.��I DATE ISSUED: 4/27/2005
A 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 - 4171 PARCEL: 2S112CD - 10300
SITE ADDRESS: 07871 SW ALDER ST ZONING: R -12
SUBDIVISION: HAMBACH GROVE LOT: 001 JURISDICTION: TIG
Project Description: 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
[PLUMB] Permit Fee 4/27/2005 $36.25
[TAX] 8% State Surcha 4/27/2005 $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
•
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: f���i Permittee Signature: 2 p
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.
Apr 26 05 01:13p Martin Sander 503-647-9151
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rf Plumbine Permit Application
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A r I\ 2 6 2 OA Ftentimed l.lit 1.1F1-1( F. I'1 (MI - 1
i City of rftwp </ 7 -Of- punt " \, )yd/ & q
f 13125 SWat Tigard, OR 97723 Ptiot Review
Mom: 503.639.4171 Fa= 503.55 OF TI' , 41 f - . 1 1 D31`187" Other Parris No.:
24- Hour rnspeasion Line 503.639.41b -4J: 2.:... Due Bcadyffty: Airk, pa Sc. ri 2 far
Interact www.ci.tigastiocna U 11,/ 1 it 7 N NothiitsPhicsoic i sapplesmastal laterasaimo
1 - 4 ilr " " - f3- 'Z:P:gt '::: ! 2* . 7:01thi. '- tiCIO.W'! 1. = 6 ,, '....:
For spa* I inforstuaima" a:re clestkfist
15.rew commaction . , Ei Demoutic • Descrisnlon 1 Q ty. I E I Total
0 Additiessfallesnlionixepineernent 0 Otb rhn'ei dwellings (inch/des 100 ft. for each utility coanction)
: *1:2: _r• '.. TiVOTTRil.,:vi'--1:Fx!" Fik SEAM bans 2020
1.-- • :: -.,--: - C'7-4:;.tiv*vzil-Wri4all'ali,- •
El 1- and 2-trauly dwelling 0 ConarsercialfindusIrisl SFR (2) bats • 350.00
SFB. CO bath 399.00
0 Accessory building Cl Pitulti.famey
Each additicand bathAritaben 45.00
0 Master builder 0 Otber: -
Ere sprinkler (____ sq. lt.) retie 2
-rxece.clscski.ach ' • • .-ix - , , .„4 ., .-
Job site addict= - 71;c1 ( _ a S\ AI Pk L4):t 51.12.1- C.ottb basin or area drain 16.60
Ctty)Surterl.1?: V ora ,..1 o. 6 11 Z Z-"i . Drivel. leach line, er trench chain 16.60
Footing drain (no. linear it: ____,..) Page 2
Suitehldglapt no.: r Project man= II a r..-- h ,
m.f......4 borne utilities 110.00
,
Cross strecs/directiotts hob sit= Manholes 16.60
Rain drain connect= 16.60
Ssailiasy sewer (no. linear ft.: _____) Par 2
Scan acwcr (no. Howie ft: ) Page 2
Stibdivisi= 4+a 4 k- Le 3 e_n J $> LI-Gt. on I .., Warr scrvicc (no. line= Et.: ) , Page 2
Fluor* or Item
"fax nrap/parcel no.: Abotaptio0 valve 16.60
Px-r,.15,;;:",;gfinititiciiS17.1430ki-dglkinelf.Vir::::•T r:_i. : r.-:: --- 13adcBow
prevenler 1 P n e 2 3(, .2-5
-
• • lyr .. cvt-Ko n Msi u. Backwater yawn '. 16.60
Cloth= washer , 16.60
Dishwasher 16.60
-we 01113 Drinking f tain 16.60
4 4143t1.-30064110WWiP4ILINSA4114,0112- l e k4r4: 414:3Z. - -
main= Lece-rv.,:k i _. Expansion tank 16.60
, '
Address: i j i
, c c SW - Futitathewer cap 16.60
Gly/IP: - isc.,,r-c, 0 12 91 2-z-3 Floor chairs/floor aink/hub 16.60
- Slider2 GRANIV diaposa 16.60 .
P hync (9)3 ) , Z-C, - : en50 FaX: ( 51e- e ?OD 16.60
" ". - % • . '"--.:: . Huth bib
" gl : V:Cri.= -: : 7 117-.A. c ''.;='• l aark6.■. ' - - .... '
BUSilIM MID= H a terr 11 - E&< 17 ck k-azvvf-. talereeptortgrease trap 16-60
Contact aam= 1(.„_--t-1 ei c ,-,„, t-t a... - v - , Medic.* gas, (value: S ) Fen 2
Address: P . 0. - 1 6D - x 0-1 Primer 16.60
CityiSta2c 3--h ela - 01 ......_ 9-7 03 Roof (commercial) • 16.60
SinlYbasinflavarory 16.60
Them (SD3) 6 (-(-) - ss - 7 i IFax: : ag ) 6, 'I "7 - 1/si Tobishowerishower pan 16.60
E qua a : nw .i... 0 . 1 s ,...,, a l ... ,_,s ...-...,../Ajfr c'tel.4C. e...tarze 11.4 ii urim 16.60
''''..kii0:1"-M.1.41714:_fc.:.ii,:4-..- ,. ,. - . ,, . .... .,.441 412 si Water closet 16.60
lins Dal= iqa"--"MI c.', noke-fr, 61120.a.4 H41.-,,... J' Water hcatcr ., 16.60
Address: IP Other:
Subtotal
City/StareiZIP: (0 & .p. f t s-- CIZ 9 ---/ is - 3 mini.. permit Sac S7740
Phone (3 ) & 'I7 - Ci, 53 6., '7 Fax (S ( ` - 7 - /-5.1 Residential backflow minimum psmit RA: 536.25
CCB Lic.: s-7 LI -z ,, Plumbing Lie._ no.: Plan review (25% of perrnit fee)
surcharge (11% of woo:a fee)
Authorized sigma= State s
l'OTAL PERMIT FEE
1 Prilir lume: HA r Yt , Cee o (Geg-e3 I Daus y/24/0 - TM: permit application capircs ir a pt t lust alitasand within
1110 days niter it has beesa accepted to complete.
*Fee ineth0601661 Selby Tri-County Building Indusay Service Bout .
rlassiinot%PanegaInfal-PcnaitApp.b. 12410 440.44i6TOWN2/COMMEM
CITY OF TIGARC
BUILDING DIVISION PERMIT #: PLM2005.00169
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 4/27/2005
Phone: (503) 639- 4171 �u4po�i;���i I ��
• Inspection Requests (24 Hrs.): (503) 639 -4175 : 33
INSPECTION WORKSHEET FOR DATE: 4/28/2005 TIME: 7:24AM PAGE: 55
SITE ADDRESS: 07871 SW ALDER ST CLASS OF WORK:
SUBDIVISION: HAMBACH GROVE LOT #: 001 TYPE OF USE:
PROJECT NAME: HAMBACH GROVE
DESCRIPTION: Backf low device.
OWNER: LEGEND HOMES, PHONE #: 503- 620 -8080
CONTRACTOR: MARTIN SANDERS GROUNDS MAINTEN PHONE #: 503- 647 -5567
Inspection Request Scheduled For: Date: 4/28/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
325 RP /backflow preventer 005569.01 503-209-5346 N
Corrections /Comments /Instructions:
i
1
X -PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
y'jj'� f 1
Inspector: / / o Date: J Phone #: (503) 718 -.