Permit CITY TIGARD PLUMBING PERMIT
DEVELOPMENT SERVICES PERMIT #: PLM2006 -00281
DATE ISSUED: 6/2/2006
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171
PARCEL: 2S109DD -10600
SITE ADDRESS: 12762 SW DA VINCI LN ZONING: R -7
SUBDIVISION: BELLA VISTA LOT: 036 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: � � Permittee Signature: _ Q
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 A s it, � ' VED = - - - - .. - -- - - - - - -- -
',jut_ FOR OFFICE USE ONL �J� /+�� `
1 Received 3 S W Tigard N 1 Z OO6 Date /By: -/ `(!6 ix..../ PennitNo [�F'7�
3125 W Hall Blvd., Tigard. OR 97223 JU Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 Air Other Permit No.:
24- Hour Inspection Line: 503.639.4175 CITY OF TIGAR " � DateBy:
Internet: www.ci.tigard.or.us BUILDING DIVIS c-710;# ''I Date Ready/By: Jul' Sr Supplemental See Page 2 for
Notified Method: l l Supplemental Information
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y j New construction ❑ Demolition For special information use checklist.
Description Qty. Ea. Total
❑ Addition/alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
�°�,:.'�" > i.!!' , ' , Ag P. O CUIYST t , : R OPT ?'; 3; ` /' SFR (1) bath 249.20
N and dwelling • . • SFR (2) bath • 350.00
E Accessory SFR (3) bath 399.00
Each additional bath/kitchen 45.00
0 Master builder D Other:
Fire sprinkler ( sq. ft.) Page 2
1 I Site utilities
Job site address: 1 "-° Catch basin or area drain 16.60
City/State /ZIP: 71 Ja j p e on a a Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: J Project name: \\ • s 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: e" V I Lot no.: Water service (no. linear ft.: ) Page 2 art
Fixture or item
Tax map /parcel no.:
,. _ s <, :3 - ", :, -: s ., Absorption valve 16.60
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t e
. - a., a,�> :�,� _ .. � � >�,. ',���,��;� ..__ � _> z ,��� �( • r, T . Backflow pr
Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
r, . iiiirt a t;,: iT . i �z ;xa, ,- _.,., > ",<,. isfi .,,,, : e x Drinking fountain 661
3: ; PRt?I'ER `<j:::,> ° z tia i'':.
°z x��=?'::;. .,��,��,�;�� -�_,. _r ��.n�az�,>s�:, �.. r�z�_�` <v��i� ,.�.�.. a ?c,,,..3,� - ...,. , Ejectors /sump 661
Name: }�l � -t-
K. ✓- Pi1` C %(.2_ �'�J?'12CC�a � - t`r7e:. • Expansion tank 16.60
Address: C ? S /l/,v 4 - 11- --) Fixture/sewer cap 16.60
City/State /ZIP: he 4 p.0 i) q 100 (, Floor drain/floor sink/hub 16.60
Phone: (57? ) t i); c _ b Cz to Fax: (cc/ le v -2_q Li Z Garbage disposal 16.60
,- _ ,,.,.-«• • :z =r Tzowst.viti ;:l;.:,.,. ; -. "f ;:,, . :. ;, :.e L, ,, : H ose bib
� � eW; iVii tgi> .. M` I: TR 1 F 17 :1 4 a ffi x ., ,iiira A GT :I r- m ) 16.60
'. °`' :.." `'' ; Ice maker 661
Business name: Li V f i ()Le Hryi, , e �'Y Interceptor /grease trap 16.60
Contact name: . L G. &L r , l ,t Medical gas (value: S ) r
Address: f "1 2 S Aiw A i) 2 - . / P`• ik. J )T 7 O(,) Primer 661
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
,- �, ', z, � "" ,/ :.<.� _ ;.5Z A* , =>x �;.,,, „ �• . :: ;ti
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° �?` `'`" "� F� ���:;�,,;;��. , x W. °, m>.;��= Water closet 16.60
Business name: ai-sr (um y l I i VI C pl ■ vvi b( ✓15 Water heater 16.60
Address: 2 s D5 • S • 1,c1 - A u j D-4 - b(. Other:
Subtotal
City/State /ZIP: 1ti 02 700 tJ
Minimum permit fee: 572.5 0
Phone: (5 ) OM - G 6S 7 Fax: (S p3 ) 3,t; 2. - 9 cj 4 3 Residential backflow minimum permit fee: 836.25
CCB Lic.: ( y 2 (I ( Plumbing Lic. no.: 3 I-( - 370 1 e, Plan review (25% of permit fee)
� G State surcharge (8% of permit fee) � Authorized signatur e TOTAL PERMIT FEE 39 -
Print name: ,..3 A. irk 8 l ( ` I Date: :2. - g -- 05 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:\Building \Permits \PLM- PermnApp.doc 12/03 440- 4616T(10/02/COM /WEB)