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Permit C ITY OF TIGARD PLUMBING PERMIT , 4 1 ,E DEVELOPMENT SERVICES PERMIT #: PLM2005 -00363 All DATE ISSUED: 8/9/2005 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 PARCEL: 2S 112CD -14600 SITE ADDRESS: 07934 SW CAROL ANN CT ZONING: R -12 SUBDIVISION: REBECCA MEADOWS 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 KEYSTONE DEVELOPMENT INC. • PO BOX 476 Description Date Amount LAKE OSWEGO, OR 97034 [PLUMB] Permit Fee 8/9/2005 $36.25 [TAX] 8% State Surcha 8/9/2005 $2.90 Phone : 503- 635 -4736 Total $39.15 Contractor: NATURESCAPING 10950 S MAPLE GROVE RD MOLALLA, OR 97038 REQUIRED ITEMS AND REPORTS Phone : 503- 873 -8407 • Reg #: PLM 7075 • 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: Q ��,�� Permittee Signature: `' t ?.? • 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. • " ' Building Fixtures Plumbing Permit Applic ation E VE FOR ,OFFICE USE'.ON • City of Tigard 9 n r 9 z�/ Permit No:. \�`�a5 V)f� 13125 SW Hall Blvd., Tigard, OR 97223 AUG 0 9 20P pla Review / `` Phone: 503.639.4171 Fax: 503.598.1960 b „ I II li''? Date/By: Received Other Permit No.: 24- Hour Inspection Line: 503.639.4175 / W Date Ready/By "`' 0 See Pa e 2 for Internet: www.ci.tigard.or.us CITY OF TIG g Notified/Method: / Supplemental Information TYPE OF WORK VI V V FEE* SCHEDULE • For special information use checklist. �]' °New construction ❑Demolition 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 (1) bath 249.20 ❑ 1- and 2 -family dwelling ❑ Commercial /industrial SFR (2) bath 350.00 El Accessory building ❑ Multi- family SFR (3) bath 399.00 ID Master builder Each additional bath/kitchen 45.00 ❑ Other: Fire sprinkler ( sq. ft.) Page 2 - - ,JOB SITE "INFORMATION AND LOCATION Site utilities Job site address: 5Lti/G'.4.,,,,, , ,% Catch basin or area drain 16.60 City /State /ZIP: !fi A-,,c, Drywell, leach line, or trench drain 16.60 Suite/bldg./apt. no.: I Project name: QQ , . ,, Footing drain (no. linear ft.: ) Page 2 Manufactured home utilities 110.00 Cross street /directions to job site: f Manholes 16.60 /a'/r / Rain drain connector 16.60 Sanitary sewer (no. linear ft.: ) Page 2 Storm sewer (no. linear ft.: ) Page 2 Subdivision: !BC - " I Lot no.: wG .. 4 - Water service (no. linear ft.: ) Page 2 ✓sR Lac ,i/"> Fixture or item Tax map /parcel no.: Absorption valve 16.60 • • • ' ` DESCRIPTIONOF WORK • ' Backflowprevenfer Paget Backwater valve 16.60 Clothes washer 16.60 Dishwasher 16.60 . . Drinking fountain 16.60 PROPERTY :OWNER ` .... ❑TENANT Ejectors/sump 16.60 Name: A , ; ,'5 'z/ D z2I 7 "7 Expansion tank 16.60 Address: Itcb be-.2)( 976, Fixture /sewer cap 16.60 City /State /ZIP: /4 0.5,:r/e_?z ',) ©,c.... i .:703 r/ Floor drain/floor sink /hub 16.60 Phone: ( 2)3 ) 70 ,/ ._e15 .% Fax: ) Garbage disposal 16.60 Hose bib 16.60 . APP :•::❑ :APPLICANT: .. ' ❑ - CONTACT; PE RN S O • 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 Phone: Sink /basin/lavatory 16.60 ( ) Fax: ( ) Tub /shower /shower pan 16.60 E -mail: Urinal 16.60 • - CONTRACTOR . . Water closet 16.60 Business name: ,- _ s -,,� v �� Water heater 16.60 Address: 'C1 r� �� 5 ., z D Other: �) C1/2.- �� 03 Subtotal City /State /ZIP: ;42„,...A.,..4.„4, ! Minimum permit fee: $72.50 Phone: (j2 273_, 1 y 7 Fax: ( ) Residential backflow minimum permit fee: $36.25 CCB Lic.: 3 f : ;?c2 Plumbing Lic. no.: 70'7 Plan review (25% of permit fee) State surcharge (8% of permit fee) Authorized signature: TOTAL PERMIT FEE Print name: Kt:-/ •7-, L. 3 ` -R Date: 7 - 9 -�� - This permit application expires if a permit is not obtained within Jrr 180 days after it has been accepted as complete. *Fee methodology set by Tri -County Building Industry Service Board. i. \Building\Pennits\PLMP- PermitApp.doc 06/05 440-4616T(10/02 /COM/WEB) CITY OF TIGARD BUILDING DIVISION fi PERMIT #: PLM2005 -00363 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 8/9/2005 Phone: (503) 639 -4171 !A'24t 01IIT Inspection Requests (24 Hrs.): (503) 639 -4175 INSPECTION WORKSHEET FOR DATE: 8/10/2005 TIME: 7 :05AM PAGE: 83 • SITE ADDRESS: 07934 SW CAROL ANN CT CLASS OF WORK: SUBDIVISION: REBECCA MEADOWS LOT #: 003 TYPE OF USE: PROJECT NAME: REBECCA MEADOWS DESCRIPTION: Installation of bac4Hlow device OWNER: KEYSTONE DEVELOPMENT INC., PHONE #: 503-63 5-4736 CONTRACTOR: NATURESCAPING PHONE #: 503 - 873 -8407 Inspection Request Scheduled For: Date: 8/1012005 Pour Time: Code # Inspection Description Confirm # Contact # Message 399 Plumbing final 013217 -06 503-704-9505 N Corrections /Comments /Instructions: • •• • • PASS . ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS ❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: (TD 11 Date: ? I f / d S- Phone #: (503) 718-