Permit CITY OF TIGARD
PLUMBING PERMIT
,L
IliI DEVELOPMENT SERVICES
PERMIT #: PLM2006 -00280
- ,:_ DATE ISSUED: 6/2/2006
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 PARCEL: 2S109DD - 10500
SITE ADDRESS: 12740 SW DA VINCI LN ZONING: R -7
SUBDIVISION: BELLA VISTA LOT: 035 JURISDICTION: TIG
Project Description: Backflow preventer for irrigation.
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
RIVERSIDE HOMES, INC.
1925 NW AMBERGLEN PKWY. #200 Description Date Amount
BEAVERTON, OR 97006 [PLUMB] Permit Fee 6/2/2006 $36.25
[TAX] 8% State Surcha 6/2/2006 $2.90
Phone : 503- 645 -0986 Total $39.15
Contractor:
STREAMLINE PLUMBING
2505 SW AUGUSTA DR.
ALOHA, OR 97006 REQUIRED ITEMS AND REPORTS
Contact # : FAX 503- 379 -9543
PRI 503- 888 -6657
Reg #: LIC 142111
PLM 34 -370PB
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: 7 2 Permittee Signature: F ■ ,. c •
1
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.
,
Plumbing Permit Applicatici i FOR ROFFI use ONLY
' City of Tigard Rp�CEIVE' DateBy - -0 1 1 Permit No.' \46„: ry 0 , °,
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 AI 1 2. / "4w' ,P I + Date /By: Other Permit No.:
P ��
24 Hour Inspection Line: 503.639.4175 ' `' l )
Jur
Notified/Method: Supplemental Information
��Y QF TIGAR+ �('r o 6on
Date a See Pe
Internet: www.ci.tigard.or.us Suppleme a
z e�:
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For special information use checklist
X New construction ID Demolition
Description Qty. Ea. Total
❑ Addition/alteration/replacement ❑ Other: New 1-2-family dwellings (includes 100 ft. for each utility connection)
11 CA F3GORY .OFCO . S'TR Cif?I Ne, - � "- SFR (1) bath
a.. 6 � S 249._0
a 1- and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 350.00
❑ Accessory building ❑ Multi - family SFR (3) bath 399.00
I:: Master builder Each additional bath/kitchen 45.00
❑ Other
�1 V ', OB i(i`E 1NRORMATION AND LOCATTt3N x : � i yi<(,1 ;�, .» Site utilities r ( sq. ft.) Page 2
s. ft. Pae
Job site address: p > ' ;® flN lk,, %At i i1va. Catch basin or area drain 16.60
City/State /ZIP: "-` Q eA ��l lll �n D . Q, Pi4 Drywell, leach line, or trench drain 16.60
Suite /bldg. /apt. no.: J � a I Project name: „a \l‘ Ski, Footing drain (no. linear ft.: ) Page 2
Manufactured home utilities 110.00
Cross street/directions to job site:
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.: S
e \ \a \I 6 , y < Water service (no. linear ft.: ) Page 2
Fixture or item
Tax map /parcel no.:
sorption valve
Ab orptt 16.60
`.y °' , i P;Tii{?I� oa O
V WTLK v, .» g
'�'.'`. i•jv"�- , ", . &t> 1 .. .F. , .6 ` • 1> , °,l�" Si .ems
.�: °�, � =�- ,r y�- ��:;, -,� :�"�;a,..= � <...a,���.��,. .- ' „;,,-r. �.�it, .. Backflow � Page 2 3(„,„
Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
) ».; .,;, -. 4.rs •• , Drinking fountain 16.60
i.,:: `. :?X ®`.1'11`0 ..:G11�...,, Vf,,.Y \1....14- i:�2: 0 . 1 '� ,.',�`; ,.. ®:S -' a41, 1 H :''! X•
te a_
. ^. zq ., ; ,, g - vvnv6,aye,:»aH z, <.: _ „� ,�; 'i'�'3'�u�' k'x,k>. . _a .....xt> a2,�.^s> .r•, „ ",.•. 16.60
t
b ,
..:., = . t -' , ,_ Ej ectors / sump
Name: I :ii V-+°�Y " Gl,� )40Y1?F� , Expansion tank 16.60
Address: )6 1 Z 5 Af j'ipia,), ff , G O Fixture/sewer cap 16.60
W � - e - Le," ,
City/State /ZIP: ,D 7
i _e V 100 t Floor drain/floor sink/hub 16.60
Phone: (5 ) La q_c - b - 3 L Fax: (c ) 6 ‘ 0 - 2-q t.1.2-
Garbage disposal 16.60
:�;•: �~�;.: ;.��'. :��,. »`.vim: �.�� • `.,:�„�.,.�'i r � >:' >.�z,,•za�a-: =• Hose bib 16.60
- '' ' .. '''''' ''' IC AN'r °; .. 33..., w �r. _® GL) „1�iNl ACJti� 1 R St31'''''M w '`' '
' : �'' ` sue `' ' Ice maker 16.60
Business name: b 1 ,,,,, f)+ a, R7 / -, ..l r em Interceptor /grease trap 16.60
Contact name: At Lt vC=� c Medical gas (value: $ ) Page 2
Address: ( C 2 6 Ai w 1 '� / tj p� il itF zoo 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
4,1 r; 1l.,,t rAf 4, W 1,� , - 4 ; . 6, e m ._�.�.,r Water closet 16.60
Business name: ■751-V poi,i,rj I t VI c ii v j t $15 Water heater 16.60
Address: 2 5 p5 .s • U/ . ti-, (�� _ p(, Other:
ty 0 1. 7006 Subtotal
Ci /State /ZIP: u,, �
Minimum permit fee: $72.50
Phone: (5 ) e - c, 6s 7 Fax: (56 3 ) .?,`1,' a - 95 -Li 3 Residential backflow minimum permit fee: $36.25
CCB Lic.: / q 2 (I i Plumbing Lic. no.: 3 1-f - 3`70 / e, Plan review (25% of permit fee)
�! 6 rJ ��� State surcharge (8% of permit fee) a ��
Authorized signatur TOTAL PERMIT FEE 39 fs
Print name: , 3rn',,' n4 h 8 r I i Date: </ - e _. O 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.
i:\ Buildrng \Permits\PLM- PennitApp.doc 12/03 440-461 6T( I 0 /02 /COM /WEB)
CITY OF TIGARD
BUILDING DIVISION PERMIT #: PLM2006-00280
I • 13125 SW Hall Blvd., Tigard, OR 97223 A tt DATE ISSUED: 6/2/2006
Phone: (503) 639-4171 kilopylllt 41"
Inspection Requests (24 Hrs.): (503) 639-4175 -.4.4 t.L.
INSPECTION WORKSHEET FOR DATE: 6/7/2006 TIME: 7:06AM PAGE: 101
SITE ADDRESS: 12740 SW DA VINCI LN CLASS OF WORK:
SUBDIVISION: BELLA VISTA LOT #: 035 TYPE OF USE:
PROJECT NAME: BELLA VISTA
DESCRIPTION: Backflovv preventer for irrigation.
OWNER: RIVERSIDE HOMES, INC., PHONE #: 503-645.0966
CONTRACTOR: STREAMLINE PLUMBING PHONE #: 503-888-6657
Inspection Request Scheduled For: Date: 617/2006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
399 Plumbing final 031234-04 503-572-4708 N
Corrections/Comments/Instructions:
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o ti-PA-ss- El PARTIAL APPROVAL Li CANCEL El NO ACCESS
fl FAIL pi CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED
Inspector: \///1 CA_ Date: (9- ( ) / 4. Phone #: (503) 718- 2 ,( 2. (f