Permit C ITY OF T I GA R D PLUMBING PERMIT
-- ,, l DEVELOPMENT SERVICES PERMIT #: PLM2005 -00237
At 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 6/3/2005
PARCEL: 2S112CD-10500
SITE ADDRESS: 07833 SW ALDER ST ZONING: R -12
SUBDIVISION: HAMBACH GROVE LOT: 003 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 : 503- 620 -8080 Total $39.15
Contractor:
MARTIN SANDERS GROUNDS MAINTEN
PO BOX 307
NORTH PLAINS, OR 97113 REQUIRED ITEMS AND REPORTS
Phone : 503- 647 -5567
Reg #: LIC 5742
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 0001 -0010 through OAR 952 - 0001 -0100. You may obtain copies of
these rules or direct questions to OUNC by calling 503 - 246 -6699 or 1- 800 - 332 -2344.
Issued By: � ° Permittee Signature: � —C_. `Q
Call 503 - 639 -4175 by 7:00 a.m. for an inspection that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Jun 02 05 12: 57p Martin Sander 503-647-5151 P - 1
, .
Plumbing Permit AflibVeCtiSti Fo$: (.1ft I. SF ciNt \ .
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City eirT*ard
9. 56 4, NoSpl‘v 7
1317-5 SW IbB Blvd. Tigard, OR 97223 11 1 t,A 0 ,,..., Plan Review
Phone: 503.639.4171 Fax: 503.590_1960 31.11`a Onus Pcnnittru4 .‘ 31 sq
24- Hots inspect:1cm Line: 503.639.4175 f GP■ ' 4 1 „,. Date Readyfily: in 65 511. Page2 ler
lois:met www.eitigard.oeus G ON %../ T - - NotithdO4stbed: --)/ Supplemental latarnestiest
4 ingitig 3": • :: :' .j . :1; . 4 ; : ' .. 4 .. ::',. **: :.,!1 '.-- . 7: :- !■: 1 1;:, ,-,I i - % ; 5: .•:.-1=;:--:,:i - . :.. .1.. -..f... .
Forrecial tiler:amigo tar ckseldha
New consUresiara . 0 Demolition
DescriPlIal I QW- l ea- i Thial
0 Asiditiorstalltration/stplaeetnent 0 Other N 1.. 2..fi dwalszo Onekidts 1000. for cad, utility connection)
- .!:.1.4 . 1 . 1T- ... :7.7.7 . 7 -;IT' ,47 7',7 : 7 1- 77.7: ._ 11 -- 1Z......,'-_::::;m 7-4_;:k SFR (1) bath 249.20
* 1- and 2-1konly dwelling 0 Cricansentitlfunlostrial SFR (2) bads . 350.00
SFR (3) bath 399.00
0 Accessory building ' 0 Multi-haft
Each 1diici1 bath/kitchen 45.00
0 Master btelder 0 Other
-
Fire sprinkler ( _ sq. It) Page 7
Mr liffi --: 1411 *-.-: . iir.is4ikI W 41 •00 '... ..'lif • ; " i ; r ,• 1 Site taolities _
Job site addresse -7 g - 33 .5 i-) imd.e.. r Sirer41 Catch basin or arca drain 16.60
' 16
.
/Sate/ZIP: 771a rc p / 0 ../. q DtPms leach line, or trench drain 16.60
•
Suite/bldg./apt. no J pro nimc R xis , t _ c__H doz... Footing drain (rio. linear R.: ______) Page 2 , ,
Manufissured tonne utilities 110.00
Cross strceIldirections to job site
Manholes , 16.60
Rain drain connactor 16.60
Sanitary sewer (no. linear O.: ) Past 2
Sidon sewer (no. linetir IL: ) Page 2
Wasx sal-ice (no. linew ft.: ) Page 2
Subdivision: HA i,(4.4=NA m e_ 2 ci___ / 106:- J Lox-- 3 _
Fixture or items
Tax map/parcel no.:
Absorption valve I 16.60
qM
Wi;iikhatdr*WgetWr
;•!...t.W; . : .,_. . .... _. . - ., .), . ..., _ ' ,. : : . 4 . Aa.. • , - . - Ruckfttnv prevenhu EteS;ktarsEizib / Pal1s 2 ":-."' .2-5
/ ii / R42/ 67+ ri /)71.) Backwater valve 16.60
Clothes washer 16.60
r
Dishwasher 16.60
' • g,11 --; ..,,,•3,-1:.•_'.',.-q...;-f.'-xmi,u-.1,....1...s.t...,...,.1.;iti,i-.1 r wr i e.11...13.-:_m-: Drinking fountain 16.60
Eitammaimp 16.60
Names Z.. " h P - - --- -__5 Expansion lank 16.60
Address: /a 75 S S L-1) &? 771 -7 41-1 / 8. • . Futarre/sswer cap 16.60
City/Stare/ZIP: 7.,__
0--- 9 - 1 .7-2_,2, Floor dminitloor sink/hub 14.60
Phone : (5`3 ) C..7 Z - 0 -- K c_ KO Fs= (..b3) sei g - GsYbaCe di6Pcda/ 16.60 _
4 '4 e'"' •Ild■Vm.3•Ml___ ' • • • - , fr : ..-• • • . - • Hogie bib 16.60
Businen =tow pe---mr, Sx..Q__s (-- s 14ecNikt . bleceptor/grease trap 16.60
Ccastact name t ..-..4..xlcx - Medical gas (value; S _ } Plitc 2
Addre Primer 16 ss: e. 0 e> -,-.)>< 0
city/staid tOt7-t Piec_tx\ s i 0 9 •3,3 Roof drain (commeirial) .
16.60
Sinkvbssin/Invutery 16.60
Pim= (5i 04 - c.S 1, 7 I Fax::( ) (7 ` 17 - - // , --S i Tubishowerlsbower pan 16.60
E-mail: . _ Urinal 16.60
• ::: - .Wi l ; - .VIA.. 1 .01 : .;: WrisOitttr-04 A P Water close 16.60
1111.5 =MG ket f 7i5) , cct . ,,4 6 r o c , ) , i t- Water heeler 16.60
Address: 1). () . (2., ,, ,.,-- --._- -,-_-. ---) _ Other: i t
City/State/ZIP: LD 2.)-1 e '' / 0 ( 9 7/ 33 Subtotal /
Minimum persnit fee S72_50
Phone ( 503) b tt 7 - -SS 0 7 Fax. ( ) 6: ->7 - c/1....C7 Residential baeldlow minimum permit Rs: 53615 -
MB Lic.: 5 7 ,-/ 20 70 - Plumbing tic no.: Plan review (25% ofperniit fee)
Stine =range (I% of permit fee) -r-
im:M=20 signature .• TOTAL PERMIT FEE
Print name: i.c.,.ve.-,...-1,11 S l .i ..-c I Ow= 6 --/- 62 1 'Tbis pernatt application aspires 'if a persak k nor ablmlnad within
180 days atter it tins lacca accepted es completes
*Fee methodology set by Tri-County Building Industry Service 130L1
e1lheldintWitteMPI,Werrtanmalm 12to emeitt6T(101112tatat/W1115)