Permit C ITY OF TIGARD PLUMBING PERMIT
DEVELOPMENT SERVICES PERMIT PLM2005
I 13125 SW Hall Blvd., Tigard, OR 97223 503- 639 -4171 DATE ISSUED: 6/10/2005
PARCEL: 2S112CC -13600
SITE ADDRESS: 08427 SW BONAVENTURE LN ZONING: R -12
SUBDIVISION: TANIA PARK LOT: 011 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
LEE, GORDON D
8427 SW BONAVENTURE LN Description Date Amount
TIGARD, OR 97223 [PLUMB] Permit Fee 6/10/2005 $36.25
[TAX] 8% State Surcha 6/10/2005 $2.90
Phone : 503- 209 -9227 Total $39.15
Contractor:
ALL NATURAL LANDSCAPE LLC
PO BOX 2815
CLACKAMAS, OR 97015 REQUIRED ITEMS AND REPORTS
Phone : 503- 740 -0852
Reg #: PLM 7883
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.
.ra
Issued By: Permittee Signature: j � (a \ 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.
Robert Lussier 5035580768 p.2
Plumbing Permit A lieaitiot>� IV ED • : FOR OFFICE USE ONLY
irl City of Tigard �° � � Deceive - PennitNa^�'� ‘455--c./.0.2.517
131 SW Hall Blvd., Tigard, OR 97223 Plan Review /
Phone: 503.639.4171 Fax: 503.598.1960 ��� 200 �!<ma I
Date /By: Other Permit No.:
24-Hour Inspection Line: 503.639.4175 , � = •1 � I Date Ready/By: � Tunis: See Page 2 for
w•
Internet ww.ci.tigard.or_us CITY OF TI(3A' :, _ ,� J Notified/Method: I ( LO f _ Supplemental information
Ti'P 9 , kD} RKOIVISIU FEE* SCHEDULE
New construction ❑ Demolition For special information use checklist
Description I Qty. I Ea. I Total
❑ Addition /alteration /replacement ❑ Other: New 1 - 2- family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (l) bath 249.20
d 2- family dwelling ❑ Commercial /industrial SFR (2) bath 350.00
SFR (3) bath 399.00
❑ Accessory building ❑ Multi family 45.00
Each additional bath/kitchen
❑ Master builder ❑ Other: Fire sprinkler ( sq. ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities
Job site address: q 1) (3 Ot, _,c 1 , -k- �,YiL u-__A5L., Catch basin or area drain 16.60
City /State /ZIP: L e -� 0 t_, c >,P'\ �('3 D LI Drywell, leach line, or trench drain 16.60
lG Footing drain (no. linear ft.: ) Page 2
J
Suite/bidg. /apt. no.: ( Project name:
Manufactured home utilities 110.00
Cross street/directions to job site: Manholes 16.60
1 r 1 c�� rte../\. Rain drain connector 16.60
Sanitary sewer (no. linear ft.: ) Page 2
Storm sewer (no. linear It: ) Page 2. _
Water service (no. linear ft.: ) Page 2
Subdivis ion: 1 Lot no.:
• Fixture or item
Tax map /parcel no.: Absorption valve 16.60
DESCRIPTION OF WORK Backflow preventer / Page 2
S 1.11` l r ° J•� S- `C:1''1 Backwater valve 16.60
1 Clothes washer 16.60
Dishwasher 16.60
Drinking fountain 16.60
ROPERT7' OWNER ❑ TENANT 16.60
Ejectors sump
Name: €- L ov �( o rl � I Expansion tank 16.60
Address: `. lrl,�, P-t)G V Q) Fixture /sewer cap 16.60
City / State/ZIP: Floor drain/floor sink /hub 16.60
�� .2o7 _ Garbage disposal 16.60
Phone: ( Fax: ( ) 16.60
� [-lose bib
( iZ PLICANT ❑ CONTACT PERSON
Ice maker _
Business name: pi\ \ �F_A - i k._ 1,N4 -k t.- interceptor /grease trap 16.60
Contact name: t2 vkj P o`1 Medical gas (value: $ ) Page 2
Address: a u I'S- Primer 16.60
e l ) ►� r) S U Roof drain (commercial) 16.60
City / State/Z1P: /� I S
Sink/basin/lavatory 16.60
Phone: (t'b$) - 4,4D - O ySa. Fu: :(S 3) SS - b - 4 .6 8
-A Tub/shower /shower pan 16.60
E -mail: Urinal 16.60
CONTRACTOR Water closet 16.60
N Business name: c c,. p___. Pt C. is l.J C) t) Water heater 16.60
l �' Other: I I I
Address: . (>, f8u c�P.) L
a Subtotal
City /State/ZIP: (f) 1 4 '" k 0g- c "J'-4 ' 01 S Minimum permit fee: $72.50
Phone: (S - 4-L' b '+ S-'-- Fax: ( 56,3) SS -- OZ 6 Residential backflow minimum permit fee: $36.25
,-�, Plan review (25% of permit fee)
CCB Lie.: .- --r `8 _ Plumbing Lic. no.: t \, 6 1 9,
State surcharge (8% of permit fee)
Authorized signature: _.._ .._ TOTAL PERMIT FEE 3y', /. '
Print name: \i Ya t v i `C / r.-u-1:> S t , g_ 't_ Date: ( '� I p This permit application expires if s permit is not obtained within
180 days after it has been accepted as complete.
*Fee mcthodoloev set by Tri- Countv Building Industry Service Board