Permit CITY OF TIGARD
PLUMBING PERMIT
DEVELOPMENT SERVICES PERMIT #: PLM2005 -00123
0111 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 3/25/2005
PARCEL: 1 S 134AC -02624
SITE ADDRESS: 11175 SW BOXWOOD CT ZONING: R -4.5
SUBDIVISION: ENGLEWOOD NO.3 LOT: 181 JURISDICTION: TIG
Project Description: Irrigation backflow preventer
CLASS OF WORK: OTR GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS:
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
MAHONE, GARY R + APRIL H Description Date Amount
11175 SW BOXWOOD CT
TIGARD, OR 97223 [PLUMB] Permit Fee 3/25/2005 $36.25
[TAX] 8% State Surcharl 3/25/2005 $2.90
Phone : 503 - 590 - 4441 Total $39.15
Contractor:
DOWN TO EARTH IRRIGATION
13075 SW PACIFIC HWY REQUIRED ITEMS AND REPORTS
TIGARD, OR 97223
Phone : 503 684 - 3500
Reg #: LIC 8169
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- 99 or 1- 800 - 332 -2344.
Issued By: ,i_f of /d, Q ( Permittee Signature: pi a.„7 . 14/' -
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.
t
FROM : REC1V Jun. 07 2002 12:54PM P1
., e - 1
Building r'ixtures 2 5 2005
Plum bin Per mit ,A,nnlicati FOR OFFICE USE ONL .
City of Tigard CITY OF TIG • 11 1 A ►� R °ce" `d �3 a %
Da Permit era.: I 71-01 4 . 00 13
13125 SW Hall Blvd., Tigard, OR 972 n Rai
Phone: 503.639_4171 Fax: So3.598.19t6 DI •� Z! . yew Other t NQ -
24- Hour Inspection Line: 503.639.4175 ;1 �1
Intcatlet www.ci igard.or us '� Date Ready/ay: r`Q1° El See Pa 2 for
Notificd/Me had_ r / 8iepplemeotal Information
� ' 4 . � . „r, .o $.a$.C: a. 3- �' }q, .. r �1 � t . ` . - ._�:• - n�i:2: v `4 _ ?.�.��a �, + X - '. . : ^X:'5� ,. � Y
_ � F• �, i °.� 1 ?r ..
rig';
❑ New construction ❑ Demolition For special In oruttion use checklist.
f ❑ Dcscri.tion MI Ea. Total
Other: New 1- 2-fa
rainy dwellings (includes 100 ft. for each utility connection)
3 - , ! `� `1a s o -,',; o 'M '.''K' j c et.,9 , W A? , 2.4 SFR (1) bath 249_20
`C' 1 - and 2-fataily dwelling p Commercial/industrial SFR (2) bath 111 350.00
o Accessory building ❑ Multi -may s (s) bar1, 399.Op
Each additional bath/kitchen 45
❑ Master builder ❑ Q: 45.00 1
y 7 y i. } � \�C�Q" .. 3' %�`�?. ' M ` 3 y t L +r .; �e Firespr et( -° - - ■ Pagc
n-- � Site utilities
Job site address: / 75 s 7 .� ^ ` ` IM Catch basin or area cram Mill 16.60
City/State/ZIP: .-••
1 / Drywell, leach line, or trench drain Mill 16.60
•
Suite/bldgJapt. no.: Project name: Footing drain (no. linear #t.: ) Page 2.
Cross street/directions to job site: Manufactured home utilities 1 10.00
Manholes 16.60
Rain drain connector • 16,60
Sanitary sewer (no. linear ft.: ) Page 2
Storm sewer (no_ linear ft.: ) Page 2
Subdivision Lot no.: Water service (no. linear ft.: ) Page 2
.. Fixture or item
Tax map /parcel 120.:
�. rr r: , . ,., Absor ption valve 16.60
_ ��1 lire
1.> ,S p � ,� � +�,., ', 44 F' ' . 4 Y ® IC
•° it"¢. " e_ n�� L
4 7 " ,, � • - �i r : t : • L "c`
- , Ractdlow preventer
' . j ✓' \nr t& #en.A. C ! 3 !O dek Backwater valve 16.60 MEIN
� `' J . Clothes washer MI 16.60
Dishwasher 16.60
n'll�ire. ° � f - K „ g lift 9 Ta r je :' "r''EM y. Drinking fountain 16 -60
� r Ejectors/sump 16.60
Name:
Ow k ! , n p _ Expansion tank ME 16 - 60 MIME
Address: A • • 1 ` L ° , • Fixture/sewer cap 16,60
City /StatdZll': `� / Floor drain/floor sink/hub iiii 16.60
,!a `
Phone ( _ s • • y( F ( ) 8 e ■ 16 -60
� W 1 , c y i 3 a l " , Hose bib 16.60
` y � � t i y't e1s' f p 1 " � ' lee maker
Ell 16-6°
Business name: _ Interceptor/grease 16.60
Contact name: A Medical gas (value: $ ) page 2 MIN
Address: O - IIIPINI Primal 16.60
01y/State/ZIP: '- [ �J��,I�SS Roof drain (commercial) 16.60 IMIll
Phone: grI III — t C Fax:: ( ...a a6 t 8717 Sink/basin/lavatory MO 16 -60
13-mail:
Tub/shower/shower pan 16 -60 IIII
' . ...w °' Oi k .. C O's Urinal
2.0 R cr Ap ' �� d !1� . � w , r r S; /1..2;7.., .. "�`. - r 41; , , e .P' _ s 16.60
k 1-. `= :;�;..� '� e Water closet 16.60
Business name: rti Water heater MI 16.60
Address: 1/ • Other EMI
City/State/ZIP: ---7,--, A .. Subtotal
Phone: ( ) IsTj Fax: ( ) 6 Q Minimum permit fee: $72.50
V / Residential backflow minimum permit fee: $36.25
air:
rPlsi>; gi'tn'ho.: ir 3 Plan review (25% of permit fee)
Authorized signature: ` + r State surcharge (8% of permit fee) MIIIMI
TOTAL PERMIT FEE Ki�
Print name: L. . Date 'a j �� This permit application expires if a permit Is not obtained within
180 days after it has been accepted as complete.
*Fee methodology set by Tri- County Building Industry Service Board.
isN3tulaoPts nia\PIMP- Peamtapp_de0 12/03 ' 440- 46isr(tevozecomorsa) .. Y
CITY OF TIGARD PLH C _o 6 , Z�
BUILDING DIVISION ' S.. PERMIT #:
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED:
Phone: (503) 639 -4171 Azoiltm ��N �I
Inspection Requests (24 Hrs.): (503) 639 -4175 �_
INSPECTION WORKSHEET FOR DATE: 71 0 /0 (P TIME: PAGE:
SITE ADDRESS: 1 1 7 S 'J X W CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME:
DESCRIPTION:
OWNER: PHONE #:
CONTRACTOR: PHONE #:
Inspection Request Scheduled For: Date: Pour Time:
Code # Inspection Description Confirm # Contact # Message
Corrections /Comments/ Instructions:
III PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
I FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
�A L
Inspector: Date: v/ t 0 706 Phone #: (503) 718- �
- .
CITY OF TIGARD , ?
...,.
„ A
BUILDING DIVISION PERMIT #: P1.142006-00123
13125 SW Hall Blvd., Tigard, OR 97223 ___ DATE ISSUED: /9
Phone: (503) 639-4171 4,1414111111,
Inspection Requests (24 Hrs.): (503) 639-4175
INSPECTION WORKSHEET FOR DATE: 2/10/2006 TIME: 7:04AM PAGE: 76
, i , SITE ADDRESS: 11175 SW BOXWOOD CT CLASS OF WORK:
SUBDIVISION: ENGLEWOOD NO.3 LOT #: 181 TYPE OF USE:
X) PROJECT NAME: MAHONE
DESCRIPTION: Bat Preventer 219/06 THIS PERMIT IS REINSTATED FOR PURPOSE OF FINAL
INSPECTION FOR A PERIOD OF 30 DAYS.
OWNER: MAHONE, GARY R + APRIL li, PHONE #: 503-S90-444i
CONTRACTOR: DOW TO EARTH IRRIGATION PHONE #: 503-613i1-3500
Inspection Request Scheduled For: Date: 21 1 0 / 2 0 0 6 Pour Time:
Code # Inspection Description Confirm # Contact # Message
399 Plumbing final 026621-01 W3-684-3600 N
Corrections/Comments/Instructions:,
-s-- va&
) 0
0 -
C PA _ . .- . ..-,-- Ai ,
I
4 .
55 ‘,L) c
Tic) b P(Pre<_ ' w 0 7 E ' t 0
,"/ 1 -- -
CQ--(•.A •7+0 \KI6LI-_
7. co
mi
. ,
,i.ASS n PARTIAL APPROVAL fl CANCEL 111 NO ACCESS
• ,-
• iT11,._.,•,,.,.,. I I CALL FOR INSPECTION ' ADDITIONAL FEES ASSESSED
Inspector: .k7 ( k • Date: 2/1 6e Phone #: (503) 718- I