Permit ` 1 L `' CITY OF TIGARD PLUMBING PERMIT
• DEVELOPMENT SERVICES PERMIT #: PLM2006 -10050
J I 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 3/27/2006
PARCEL: 2S110AA -CC001
SITE ADDRESS: 10799 SW CANTERBURY LN BLDG 32 ZONING: R -12
SUBDIVISION: CANTERBURY CREST LOT: 001 JURISDICTION: TIG
Project Description: Temporary sanitary and storm sewer connections for sales trailer.
CLASS OF WORK: NEW GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: B 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: 50 ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: 50 ft
Owner: FEES
CANTERBURY PLACE LLC Description Date Amount
109 EAST 13TH STREET
VANCOUVER, WA 98660 [PLUMB] Permit Fee 4/6/2006 $110.00
[PLMPLN] Plan Review 4/6/2006 $200.80
Phone : 503-221-1920 [TAX] 8% State Surcharl 4/6/2006 $8.80
Total $319.60
Contractor:
POLYGON NORTHWEST COMPANY
109 EAST 13TH STREET REQUIRED ITEMS AND REPORTS
VANCOUVER, WA 98660
Contact # : FAX 360 - 693 -4442
PRI 503- 221 -1920
Reg #: LIC 163013
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 e "- . 6699 r - 800 - 332 -2344.
Issue. By: � Au-4=r , Permittee Signatur /
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.
Qr ,..�.�� ..(.v u po� -�; •
Plum Permit Application '
pplication . . FOR OFFICE USE" ONLY' - - -
Received (,� p � p,,�/Jy�
City Of Tigard DDate/By: f ,P 7 C j 1 Q (/ -I, Permit No' I L! (ffti— /609)
a)9)
13125 SW Hall Blvd Tigard, OR 97223 I Plan Review s n^ _/ / 7
Phone: 603.639.4171 Fax: 603.598.1960 ( Date/By: Other I'ennit NI K.i/u/
24- I -lour Inspection Line. 603.639.4176 ' iI Date Ready/By: t ' 0 See Page 2 for
Internet: www.ci tieard.or.us Notified /Method I IB C- Supplemental Information
* , t °. PEE' ScI- IEDULE,
mo =x, �_ x.. .,.. �
For specia linformation use checklist.
❑ Ne\vconstruction Demolition
Description Qty. Ea. I Total
❑ Addition /alteration /replacement ® Other: Temporary Utilitirs New 1- 2- family dwellings (includes 10011. for each utility connection)
CATEGORY :'CONSTRUCTION SFR (I) bath 249 20
❑ I- and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 360.0(1
SFR (3) bath 300.110 1
❑ Acccssory building ® IMMlulti - family
Each additional bath /kitchen -13 00
❑ Master builder ❑ Other:
Eire sprinkler ( x1. It,) I'a_'e _
JOB„ SITE'; 'INFORM'ATION -. ANDk LCATION
�.� _ O. : *., . _ Site utilities ___J
Job site address: 10799 SW Canterbury Lane Catch basin or area drain 16.60 1
City /State /ZIP: Tigard, OR 97223 Drywell. leach line. or trench drain 1 10.60
Suite /bldg. /apt. no.: 32 Project name: Canterbury Woods Footing drain (no. linear ft.: 5(1) Page 2
Cross street /directions to job site: Canterbu Lane, off of Hwy 99 between Bull Mt Manufactured home utilities 1 10.00
Manholes 16.60
Rain drain connector 16.60
Sanitary sewer (no. linear ft.: 50) Page 2 55 9-!-).
Storm sewer (no. linear ft.: ) Page 2
Subdivision: Lot no.: 32 Water service (no. linear It' 50) Page 2 S S
O"
Fixture or item
Tax map /parcel no.: 14011 and 1500 / IAJ Cl- M Z 5 t \ 0 A A. Absorption valve 16 60
a
` OF.,W ;, ':tt " „Ms: '= ° ` 'Ar -. - .
A . -:, , >.;.. .. lA . A .y. - :: rt. Backtlow preventer Page 2
Temporary Water and Sewer connections to Sales Trailer Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
a Drinking fountain 16.60
® PROPERTY -OWNER' °,TENANT° -
Ejectors /sump 16.60
Name. Canterbury Place LLC Expansion tank 16 60
Address: 109 East 13th Street Fixture /sewer cap 16.60
City /State /ZIP: Vancouver, WA 98660 Floor drain /flour sink/hub 16.60
Phone: (503)221 -1920 Fax: (360)693 -4442 Garbage disposal 16 60
a , , , ..c. '”' -' - , ' , 10 -.;, '",t: Hose bib 16.60
APPLICAN - a' " ❑ C ON T A'G T� P E RS ON
r ep �. : >'
a ._ «,. �, - Ice maker
16.60
Business name:
Interceptor /grease trap 16.60
Contact name: Medical gas (value: $ ) Page 2
Address. Primer 16.60
City /State /ZIP: Roof drain (commercial) 16.60
Sink /basin /lavatory 16.60
Phone: ( ) Fax::( )
Tub /shower /shower pan 16.60
E -mail Urinal 16 60
CONTRACTOR Water closet 16.60
Business name: Poloygon NW Water heater 16.60
Address: 109 East 13th Street Other: Sewer Connection Fee
City /State /ZIP: Vancouver, WA 98660 Subtotal I/O ,. C
Minimum permit fee. $72.50
Phone: (503) 221 -1920 Fax: (360) 693 -4442 Residential backflow minimum permit fee' $36.25
CCB Lie.: 1631113 2_VV1 Plumbing Lic. no.: Plan review (25% of permit fee) '
State surcharge (8% or permit fee) • S- 4-4
Authorized sit mature: �t
n
TOTAL PERMIT FEE i it . W
Print name. Dana Hunt Date: This permit application expires if a permit is not obtained within
180 days after it has been accepted as complete.
*Fee methodology set by - Fri - County Building Industry Service Board
i.Aaui ldinL_A I'e, ntitsV I'LM -Pei muApp.doc U6/0' 440 -ac 101 i,a,''CUw, /w1 :15, - —
CITY OF TIGARD \ =' / k PI
BUILDING DIVISION . PE #: 6- / Q d �(
13125 SW Hall Blvd., Tigard, OR 97223
Phone: (503) 639 -4171 p i•
Inspection Requests (24 Hrs.): (503) 639 -4175 .1 '
INSPECTION WORKSHEET FOR DATE: TIME: /DATE/ISSUED:
PAGE:
SITE ADDRESS: / 0 l 9 acee.4- CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME:
DESCRIPTION:
,
OWNER: PHONE #:
CONTRACTOR: PHONE #:
Inspection Request Scheduled For: Date: �1 ! dv — t` Pour Time:
Code # Inspection Description Confirm Contact # Message
3 30 SAS S 7— 3g
Lv 7
Corrections /Comments /Instructions:
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Nd P I I PARTIAL APPROVAL _ CANCEL f ] NO ACCESS
I AIL I I CALL FOR INSPECTION (l ADDITIONAL FEES ASSESSED
Inspector: �Date: / # Phone #: (503) 718- may/