Permit 4 1111 CITY O TIGARD PLUMBING PERMIT
el As DEVELOPMENT SERVICES PERMIT #: PLM2006 -00498
41�- `� 13125 S W Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 10/23/2006
PARCEL: 1S134DB-08900
SITE ADDRESS: 11279 SW ELLSON LN ZONING: R -4.5
SUBDIVISION: STONECHASE LOT: 013 JURISDICTION: TIG
Project Description: Residential backflow 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
GERRITZ BIGGI CUSTOM HOMES Description Date Amount
9550 SW BEAVERTON HILLSDALE HW
BEAVERTON, OR 97005 [PLUMB] Permit Fee 10/23/200€ $36.25
[TAX] 8% State Surcharl 10/23/200€ $2.90
Phone : 503 619 - 4668 Total $39.15
Contractor:
MARK BROWN LANDSCAPING
PO BOX 744 REQUIRED ITEMS AND REPORTS
VANCOUVER, WA 98666 -0744
Contact # : FAX 360 - 993 -5993
PRI 503- 234 -2667
Reg #: LIC 5192
Th is 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 50 - 246 -6699 0 8 0- 332 -2344. -------
Issued B ` C (J Q�/l1� jQ Permittee Signa urn_ ,�
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.
. rn >1 2O 5- Obyl �Y
Plumbing Permit Application . - FOR OFFICE IiSE ONI •
City of Tigard Eew"1 /, //'' 13125 SW HaBlvd., Tigard, OR 97223 ' (!/ 2
Phone: 503.639.4171 Fax: 503.598.1960 �/xntnEh;l,l Date/By: Other Permit No.:
24- Hour Inspection Line: 503.639.4175 , ■ �. ''I Ii Date Ready/By: f""': ® See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method: _ 0 Supplemental Information
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TYPE OF - WORK. i� �< .e K, ,�:�i;;:�` ...a..FE�, sS(HEDLJI.�_�r� �,
..i �?,� - .�C!''.- dzfi., ,:',L., `r c2a,' ?' ,�f., <:}.;.:'- .57i =c :, .n _� .. .. . .. - ... .
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For special information use checklist
E 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 ;:., :'a „;;j;;;' :: ,: 's ?' SFR (1) bath 249.20
B I - and 2 - family dwelling ❑ Commercial/industrial SFR (2) bath 350.00
❑ Accessory building ❑ Multi- family SFR (3) bath 399.00
Each additional bath/kitchen 45.00
❑ Master builder ❑ Other:
Fire sprinkler ( sq. ft.) Page 2
JOB SITE INFORMATION AND LOCATION` 'i,:,.:,..:•..,.,,-. Site utilities
Job site address: + I ,) 11 , I. F 56h Lin Catch basin or area drain 16.60
City /State /ZIP: ' C Cr/d) / C'( a ,� (-I Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: Project name: $ n( h .e..., Footing drain (no. linear ft.: ) Page 2
Manufactured home utilities 110.00
Cross street/directions to job site: /'/nr -//? L D 0. Q-/ Manholes 16.60
Rain drain connector 16.60
Sanitary sewer (no. linear ft.: , ) Page 2
Storm sewer (no. linear ft.: ) Page 2
Subdivision: , , oe e has e-- I Lot no.: Water service (no. linear ft.: , ) Page 2
Fixture or item
Tax map /parcel no.: Absorption valve 16.60
2 ..DESCRIPTION OF' WORK': w: ..., . , A :. 4,,: ;;.:.: „,', : .
/� Backflow preventer / Page 2 .3 ,, '
// 0 D Il2 G'��c1 . /u w PlevC / Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
Drinking fountain 16.60
❑ P OWNER • . i ' ❑ .
E /sump 16.60
Name: ( � �/) f LLI. Expansion tank 16.60
Address: j ,_ . .? (. �'e n .7/! , / { - I. Fixturelsewer cap 16.60
City/State /ZIP: , �(\r, .1 o 9700.5 y Floor drain/floor sink/hub 16.60
Phone: (5-0 JY- Fax: J( l 3 j 6,.. 91 Garbage disposal 16.60
❑ APPLICANT ` / ❑; CONTACT=.�PERSON :hy ;'; Hose bib 16.60
�JJjj n Ice maker 16.60
Business name: r t l/7 // � 7 /f/ 1 5 , / , ■ , Interceptor /grease trap 16.60
Contact name: n � e / Medical gas (value: $ ) Page 2
Address: 5 G� v - er i A /�5 y Primer 16.60
City/State /ZIIPP r 7( / f f) 97 ' 719.5 / Roof drain (commercial) 16.60
16.60
1 y� �) p Sink/basin/lavato
Phone:60 /3) 6 / _ i 6 & b Fax:: (50,5 b _,gio0 � ry
Tub /shower /shower pan 16.60
E -mail:
Urinal 16.60
.. _ 2 ,CON ,)
TRAgOtt .,, . ,.. ` =1G% ? ;!.r; " .. :. Water closet 16.60
Business name: Iyl n �- A P . )(j / 4nA ,a,„./., Water heater 16.60
Address: OVA 8 � 0 � / .7 y t_/ Other:
City /State /ZIP: ■ VN /J n to �- (A 96y 4, 4, _Q 7L/L� Subtotal
{ M inimum permit fee: $72.50 . I S
Phone:. V3 - � ) 1,4,7 Fax: 3 4,0._ g 9 3 _5 3 Residential backflow minimum permit fee: $36.25 ,.., '
CCB Lic.: � Plumbing Lic. no.: Plan review (25% of permit fee)
Ilk JJ L -7� State surcharge (8% of permit fee) ,. 9D ..... _
Authorized signature: / ��/��
- TOTAL PERMIT FEE 9J
Print name: mu Y/L i e� / Date: f 0 (�1 -0� This permit application expires if a permit is not obtained within
Ti. 180 days after It has been accepted as complete.
*Fee methodoloev set by Tri- County Buildine Industry Service Board.
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PERMIT #:
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13125 SW Hall Blvd., Tigard,. OR 9,72 DATE ISSUED
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Phone: (503) 6394171 r' : - ° l'f*,
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Inspection Requests (24 Hrs.): ri ..
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INSPECTION WORKSHEET FOW ''..DAZ? rrO I TIME: PAGE:
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SITE ADDRESS: t .1 '2.- 6 - -
SeY:': „, LASS OF WORK:
SUBDIVISION: ',":'-='..; ,, ,, . ,-..-- ' ; LOT #: , TYPE OF USE
PROJECT NAME:
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DESCRIPTION:
OWNER 14.4.
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VP !., , -7.4, -7 '0, PHONE #:
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CONTRACTOR: PHONE #:
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Inspection Request Scheduled For: ; Date*, ' -:- Pour Time
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Code # Inspection Description Confirm ._# -' ''''Contact # Message
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Corrections/Comments/Instructions: , s, 7tc,:fr
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FA PASS PARTIAL APPROVAL I CANCEL NO ACCESS
1 FAIL I CALL FOR INSPECTION 7 ADDITIONAL FEES ASSESSED
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Inspector: C4 -- Date: Phone #: (503) 718- ,Z4(