Permit 7 CITY OF TIGARD
- PLUMBING PERMIT
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COMMUNITY DEVELOPMENT PERMIT #: PLM2008 -00231
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 5/22/2008
PARCEL: 2S103DB -11200
SITE ADDRESS: 11240 SW ARBRE CT ZONING: R -4.5
SUBDIVISION: GENESIS NO. 3 LOT: 065 JURISDICTION: TIG
PROJECT: CLUKEY
Project Description: Installing backflow preventer.
CLASS OF WORK: ALT 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
GLENN CLUKEY
DEBORAH A Description Date Amount
11240 SW ARBRE COURT [PLUMB] Permit Fee 5/22/2008 $36.25
TIGARD, OR 97223
[TAX] 12% State Surch 5/22/2008 $4.35
Phone : Total $40.60
Contractor:
BEAVERTON PLUMBING INC
13980 SW TUALATIN VALLEY HWY
BEAVERTON, OR 97005 REQUIRED ITEMS AND REPORTS
Contact # : PRI 503- 643 -7619
FAX 503- 643 -7620
Reg #: LIC 12889
PLM 34 -4PB
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.
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Issued =• . / _ ermittee Signature: GYM
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.
M.:)'8 2 1 08 -1 1 -: 55a Beaverton P l u m b i n g Inc 5036437620 p . 2
r r Plumlbin2 Permit Application
Building Fixtures colt OFFICE' USE ONLY -
City of Tigard R ECEIV � ee, e,l
crmii Nn.:
.s 1.1 125 SW Hull lilvd., 'I'hnrd, Olt 97223 1lalcnt [,�� �
... I'Lm Review
i a Phony: 503.(139.4171 Fax: 503.595.196
9NAY 21 20t?� Unlc,liy: Other Pennil No.:
TIGARD Inspection Line: 511:4.639.4175 = I},tr 1(ca,ly /fly: huin. VI Syr Pngt• 2 for
Irllernet: WWW,ti gtnrd-W-,gov �+ I I gyp. F iii. FEE* SCHEDULE
Nulifurl /Method. Supplemental Ir,fonnnl'
TYPE OF WOl7K
l r t' "' F I ' ' .... information checklist construction
_._.
Inscr I •.. Oly ... I I-.:1, — 1 Total
Ei t lddition /ullcratiou /replaeuam;nt ❑ Other: Ncw I- 2- family dwellings (includes 100 It. for each utility evntieIion)
CATEGORY OF CONSTRUCTION SIR (I) Nth 249.2(1
(l I - and 2- family dwelling 0 Commercial /industrial SFR (2) bath 350,00
❑ Accessory building ❑ Multi - family SFR (3) bath 399,00
Each additional bath /kitchen 45,00
❑ Master builder ❑ Other;
Fire sprinkler (_ sq, 11,) Page 2
.10B SITE. INFORMATION AND LOCATION
site. ulililies
Job site address: 11240 SW ARREF: ('OUR'f Catch basin or area drain 16,60
City /State /ZIP':'17GARD, OREGON 97223 Drywell, hatch line, or irench drain I(1.(11'1
Sulle/bldg. /apt. no.: I rujtict Came: ('Ll1KEY
Footing drain (Ile. lineal* R.: I Page 2
Manufactured ionic utilities 110.00
Cross street /directions tujoh site
Manholes 1 6,6(1
Rain drain connector 16.60
Sanitary sewer (no, linear IL: ) Page 2
Storm sewer (nu. linear ll.: 1 Page 2
Subdivision: l,ol alo.t Water service (no. linear It.: ) Page 2 '
Fixture or item
Tax map /parcel 1lO.:
Absorption valve 16.60
DESCRIPTION OF WORT: Bttckflow preventer 1 Page 2
INSTALL BA(:KFLOW DEVICE Backwater valve 16.60
Clothes washer 16.6(! - - - --
Dishwasher 1 6.60
El PROPERTY OWNER ❑ 'I'F;NAN'l' Drinking fountain 6.60
Ejectors/sump 1 6.60
Nunic: C.1.1.1KEY
Expansion tank 16.60
Address: 11240 SW ARIIRE COURT Fixture /sewer cap 16.60
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C ily/ Slate /ZIP: TIGARD, 012EGON 97223 Floor drain/1100r sink/hub 16.60
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Phone: (503)670.7918 Fax: ( ) Garbage disposal 16.60
® APPLICANT ❑ CONTACT PERSON I lose bib 16,6(1
- lee maker 16.60
Business name: REA VERTON Pl,IIMinI IN(: '- --
hncrcepior /�,reavc IFit[i 16,60
Contact munc: SI I SAN DEAN Medical gas (value: $ ) -- Page
Address: 13980 SW `I'IIAI,ATIN VALLEY II WY Primer 16.60
—
City /Slane /ZIP; BEAVERTON, OREGON 97005 Roof drain (commercial) 16,60
— tiink /basil /lavatory 1660
Phnnc: (503) (,43.7619 Fax:: (5030 643.7620 :....-- .-,— .- .- ---_ - -- -- -- _
-- " ° 'I eh /shower /shower pan I6,6I1
E -mail; beavTplumb(Zraol.eom Urinal 16.60
`.
CONTRACTOR Water closet 16.611
Business name; IIEAVERTON PLUMBING. INC Watencvaler 16.60
Address: 13980 SW'I'UALA VALLEY IIWY Other:
City/Stale/ZIP: lit ?AVERTON, OREGON 97005 . Suhtntal
Minimum permll Ice: .$72,5(1
Phone: (503) 643.7619
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Pax; (503) 643.7620 ltesidenti: I I, icktlow minimum permit fee: ¶3ti,'2S '36.25
I Plumbing Lie. no.: 34-4PR
C(,:13 I.ic,: 128111 — n review (25'%, of permit Ice)
a g Plan
State .anchargc((2')1ofpernlit 4.35
A uthuriied sib nature, `.'-1., r C-1r k ( -
�Jv -'�LJ. V`L `LY
TOTAL PI :IZMrr rHl{ 40.60
Print name: SIJSAN DEAN Date: 05/21/2008 This permit application expires if a permit is not obtained within
180 days after it has been accrptcd ON complete.
'Tee methodology set by'I'ri- C'onnty Huitdinc, lndusu'y Serv Board.
I,taui41lasii'ei ntitalPLPl I' -Pa nail App iue 1Z127106 (#(15 l c5'!(,;u■1 /WIItJ)
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CITY OF TIGARD
BUILDING DIVISION .
PERMIT #: PLIVI2008-00231
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 5/22/2008
Phone: (503) 639-4171
Inspection Requests (24 Hrs.): (503) 639-4175 IL
INSPECTION WORKSHEET FOR DATE: 5/29/2008 TIME: 7:00AM PAGE: 40
SITE ADDRESS: 11240 SW ARBRE CT CLASS OF WORK:
SUBDIVISION: GENESIS NO. 3 LOT #: 065 TYPE OF USE:
PROJECT NAME: CLUKEY
DESCRIPTION: Installing backflow preventer.
OWNER: CLUKEY, GLENN PHONE #:
CONTRACTOR: BEAVERTON PLUMBING INC PHONE #: 503-643-7619 •
Inspection Request Scheduled For: Date: 5/29/2008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
395 Misc. inspection 070468-01 503-M3-7619
B ac to„ iaL
Corrections/Comments/Instructions:
r to
P LA."-tAt t ov-N
Cot 9A,J
PASS I I PARTIAL APPROVAL LII CANCEL I I NO ACCESS
pi FAIL 0 CALL FOR INSPECTION ADDITIONAL FEES ASSESSED
Inspector: 03 Date: 21 jo r Phone #: (503) 718-