Permit !Fla .‘,
d ` CITY OF TIGARD
PLUMBING PERMIT
' I I DEVELOPMENT SERVICES PERMIT #: PLM2006 -00495
III 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 10!23/2006
PARCEL: 1S134DB-09100
SITE ADDRESS: 11240 SW ELLSON LN ZONING: R -4.5
SUBDIVISION: STONECHASE LOT: 015 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 $39.15
Contractor:
MARK BROWN LANDSCAPING
PO BOX 744 REQUIRED ITEMS AND REPORTS
VANCOUVER, WA 98666 -0744
Contact # : FAX 360 - 993 -5993
PRI 503- 234 -2667
Reg #: LIC 5192
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes
and all other applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is
not started within 180 days of issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law
requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 - 0001 -0010 through OAR 952 - 0001 -0100. You may obtain copies of these rules or direct questions to OUNC by
calling 503 or 1- 00- 332 -2344.
Issued k > "Ca ;vtA I Permittee Signatufej 747
Call 503 - 639 -4175 by 7:00 a.m. for an inspection that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
1146T •7tos = 00 9 lo
P lum b ing Permit Application i. F014 oFFlCI. USE °NIA' .,• -.
City of Tigard Received Date/By: Iu ` �' 6� ,0 Permit No.: / a,-- iii ,
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 �/�Mn.NM:$ )y: I' < a Date/By: Other Permit No..
24- Hour Inspection Line: 503.639.4175 ■ 1 J. + Date r
Internet: www.ci.ti ard.or.us - - ^� Notified/Method: l Supplemental 1 II upplemeuSee Pent f
g al Information
for
_.TYPE OF WORK 5 4; ',ia 0 ti +r,Erii: :n. 4F! :." ;.a0i• "c. ...Z FE4:**D1j#4 :,:- ::-
C For special information use checklist
Description j Qty. Ea. Total
Addition/alteration/replacement 0 Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
CATEGORY SFR (1) bath 249.20
[3 and 2-family dwelling 0 CommerciaUindustrial SFR (2) bath 350.00
SFR (3) bath 399.00
0 Accessory building 0 Multi-family
Each additional bath/kitchen 45.00
■ Master builder ■ Other:
Fire sprinkler ( sq. ft.) Page 2
' SITE INFORMATION Site utilities
address: Job site A Catch basin or area drain 16.60
City /State /ZIP: i at • .� L Drywell, leach line, or trench drain 16.60
. �- , Footing drain (no. linear ft.: ) Page 2
A .
Manufactured home utilities 110.00
street/directions Cross to job /a if ' q J
�- Manholes 16.60
Rain drain connector 16.60
Sanitary sewer (no. linear ft.: ) Page 2
Storm sewer (no. linear ft.: ) Page 2
Subdivision: ne e _ as e-- I Lot no.:
Water service (no. linear ft.: ) Page 2
Fixture or item
Tax map /parcel no.: Absorption valve 16.60
DESCRIPTION OF'
/ WORK' K : :_.t,;,; >;. :50 : Backflow preventer i Page 2
; :.c; 5
'..3 :: :;1 ;: . ;;c:: ; '
A- 0 D 1_24 61 1-774 r .6_et ( jeP ow /• e n M Backwater valve 16.60
Clothes washer 16.60
•
Dishwasher 16.60
Drinking fountain 16.60
❑ PROPERTY OWNER • . I . • (, . ... ❑, ,' TENANT..: J ,. .,,,,.. ; / . , ' , Ejectors /sump 16.60 • Name: ( r / .k 4 6 t l / , / S Lt(-- - Expansion tank 16.60
Address: J ,) 0 a t / L ; • ..h.. I _ Fixture/sewer cap 16.60
City/State/ZIP: , 4 • I t� . n 0/ 970Q5 Floor drain/floor sink/hub 16.60
Phone: n i 4 /- / Fax: a` Z0 Garbage disposal 16.60
❑ : _ :' CONTACT'PERSON; ' ",�',;
Hose bib 16.60
APPLICANT: :," ,.•.;;•; .
:. PYE,:a2..:;
(r �n Ice maker 16.60
Business name: �' . tl // / . A. I si j ' '5 interceptor /grease trap 16.60
Contact name: n ` - - Medical gas (value: $ ) Page 2
Address: I ) " 1i1 A - I ' . rod st I ■ #� i go Primer 16.60
City/State/ZIP , /� , . ( /) ` 7c9 Roof drain (commercial) 16.60
Ci
'c 1 � /' J/ / Cl ) p Sink/basin/lavato 16.60
Phone:5D� (2/ f T(I2 ((� d Fax:: (550 _ ?QO� ` ry
Tub /shower /shower pan 16.60
E -mail:
Urinal 16.60
CONTRARTO)R .;;;i °. - 'r: 'ry ' `
;';', : ".>^ =: ' ..... . . Water closet 16.60
Business name: / �.9/ Water heater 16.60
Address: ea: 18�O,�X, 7 LJ L/ Other:
r-lJ w W� 7 or j 0 `0 7 � L Subtotal
City /State /ZIP: o r,* /•
, _ �S / Minimum permit fee: $72.50 f L �
Phone: • 03 ,2 tO4,7 Fax: 3 (00.-9 93.59 3 Residential backflow minimum permit fee: $36.25 (i, . c7
CCB Lic.: �Z,�] Plumbing Lic. no.:
+L f� K Plan review (25% of permit fee)
State surcharge (8% of permit fee) , y0
Authorized signature: / � / r ./.e. TOTAL PERMIT FEE 1t / 5
Print name: )' 13� Date: fo a0 -06 This permit application expires if a permit is not obtained within
/ 180 days after it has been accepted as complete.
*Fee methodoloev set by Tri- County Buildine Industry Service Board
MY OF T O:- i ® 064 .....---
:WILDING IBVOSOON PERMIT #:
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED:
Phone: (503) 639 -4171 /a A 1pli @� l �A�
Inspection Requests (24 Hrs:): (503) 639 -4175 L...
INSPECTION WORKSHEET FOR DATE: TIME: PAGE:
SITE ADDRESS: l 1 2- d l l,<417 '' L1 \[ • CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME:
DESCRIPTION:
OWNER: PHONE #:
CONTRACTOR: PHONE #:
".t[41„' 0!1 -
Inspection Request Scheduled For: ,Y; Date: Pour Time:
Code # Inspection Description ; Confirm # Contact # Message
«- ii i pLvvii . c..8 >,,
Corrections /Comments /Instructions: .
•. "2 �'� '�•'. .«:151. _ ;`, - A'.',..,:--,
' Al : - <. •
.!
T PASS n PARTIAL APPROVAL n CANCEL n NO ACCESS
• FAIL I I CALL FOR INSPECTION I I ADDITIONAL FEES ASSESSED
Inspector: - Date: 0 Phone #: (503) 718- _•