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Permit • CITY TIGARD PLUMBING PERMIT DEVELOPMENT SERVICES PERMIT #: PLM2005-00361 DATE ISSUED: 8/9/2005 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 PARCEL: 28112 C D -14500 SITE ADDRESS: 07925 SW CAROL ANN CT ZONING: R -12 SUBDIVISION: REBECCA MEADOWS LOT: 002 JURISDICTION: TIG Project Description: 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: L,^i� �'� Permittee Signature: 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 E Plumbing Permit Applicatt_ony 0 `" W F OR OF , ONLY City ofTigard ry n !! e P ermitNo.: 13125 SW Hall Blvd., Tigard, OR 97223 Pt 0 9 LO` '� ' � 1� ao3�C l Phone: 503.639.4171 Fax: 503.598.1960 //yvillle i 1' A. Date /By: Other Permit No.: 24- Hour Inspection Line: 503.639.4175 cm( OF TIC•^ - ^^ - -- Internet: www.ci.tigard.or.us ., -+ Date Ready/By: J "/s 0 See page 2 for .., n nlVllUtN Noti fied/Method 4l & Supplemental Information r � • . TYPE OF � WORK • FEE* • SCHEDULE • [ 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 (I) bath 249.20 ❑ I- and 2 -family dwelling ❑ Commercial /industrial SFR (2) bath 350.00 ❑ Accessory building ❑ Multi- family SFR (3) bath 399.00 El 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: 71,2 5 5 44 1 674 .EG%G- / 1 / v, 77 Catch basin or area drain 16.60 City /State /ZIP: c rq. ,cjn • Drywell, leach line, or trench drain 16.60 Suite/bldg./apt. no.: I Project name: n Footing drain (no. linear ft.: ) Page 2 Manufactured home utilities 110.00 Cross street /directions to job site: }h� Manholes 16.60 /� " /7 'v e Rain drain connector 16.60 Sanitary sewer (no. linear ft.: ) Page 2 Storm sewer (no. linear ft.: ) Page 2 Subdivision: i.-_--8&--'GG„¢ /N.�i4' 3 7.1c^ I Lot no.: i,, ,,,. 415" Water service (no. linear ft.: ) Page 2 Fixture or item • Tax map /parcel no.: Absorption valve 16.60 • DES OF WO Backflow preventer / Page 2 - Backwater valve • 16.60 Clothes washer 16.60 Dishwasher 16.60 PROPERTY •OWNER, " . - Drinking fountain 16.60 ❑ TENANT Ejectors /sump 16.60 Name: i - - r / S'lex , F i)atl _c3 f f Expansion tank 16.60 Address: 1,6? .92y 976- Fixture /sewer cap 16.60 City /State /ZIP: 0.5 _ 7 ©,c--- q703./ Floor drain/floor sink/hub 16.60 Phone: (5 ) 70 4 ._ ��j Fax: Garbage disposal 16.60 f Cam` >> G��? 7'y` Hose bib 16.60 ..: APPLICANT 0 CONTACT; PERSON ',i 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: ( ) Fax:: ( ) Sink/basin/lavatory 16.60 Tub /shower /shower pan 16.60 E -mail: Urinal 16.60 .. ' CONTRACTOR Water closet 16.60 Business name sJ-TG° zi SC- ..I P,, - ✓ � Water heater 16.60 Address: //62 l ca G.% .1 /l/ /fie' c / AD Other: /� Subtotal City /State /ZIP: /t .I -4- EJ !0 3 _ ! Minimum permit fee: $72.5 Phone: („52 ) 073__ gizt7 Fax: ( ) Residential backflow minimum permit fee: $36.25 CCB Lic.: °� ,➢ Plumbing Lic. no.: 70.75 Plan review (25% of permit fee) State surcharge (8% of permit fee) Authorized signature: TOTAL PERMIT FEE Print name: /-E / 7 L BCt/e/> Date: _ 9 ._ 615 This permit application expires if a permit is not obtained within ! / / 1 180 days after it has been accepted as complete. *Fee methodology set by Tri- County Building Industry Service Board. i:\ Building Wermits\PLMF -PermitApp.doc 06/05 440- 4616T(10/02 /COM/WEB) CITY OF TIGARD BUILDING DIVISION I. PERMIT #: PLM200S-00361 13125 SW Hall Blvd., Tigard, OR 97223 A-, DATE ISSUED: 8/9/2005 Phone: (503) 639-4171 Inspection Requests (24 Hrs.): (503) 639-4175 INSPECTION WORKSHEET FOR DATE: 8/10/2006 TIME: 7 PAGE: 85 SITE ADDRESS: 07925 SW CAROL ANN GT CLASS OF WORK: SUBDIVISION: REBECCA MEADOWS LOT #: 002 TYPE OF USE: PROJECT NAME: REBECCA MEADOWS • DESCRIPTION: Backflow device. OWNER: KEYSTONE DEVELOPMENT INC, PHONE #: 503-635-4736 CONTRACTOR: NATURESCAPING PHONE #: 503-873.8407 Inspection Request Scheduled For: Date: 8/10/2005 Pour Time: Code # Inspection Description Confirm # Contact # Message 399 Plumbing final 013217-0 503-704-9505 . N Corrections/Comments/Instructions: C4..rt • Egi PASS El PARTIAL APPROVAL CANCEL II NO ACCESS El FAIL El CALL FOR INSPECTION I] ADDITIONAL FEES ASSESSED Inspector: CP Date: 'R) /6 j OS% Phone #: (503) 718-