Permit CITY TIGARD PLUMBING PERMIT
4 All 11°k DEVELOPMENT SERVICES PERMIT #: PLM2006 -00504
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 10!23/2006
PARCEL: 1S134DB-08800
SITE ADDRESS: 11235 SW ELLSON LN ZONING: R -4.5
SUBDIVISION: STONECHASE LOT: 012 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 HY
BEAVERTON, OR 97005 [PLUMB] Permit Fee 10/23/200E $36.25
[TAX] 8% State Surchari 10/23/200E $2.90
Phone : 503 619 - 4668 Total $39.15
Contractor:
MARK BROWN LANDSCAPING
PO BOX 744 REQUIRED ITEMS AND REPORTS
VANCOUVER, WA 98666 -0744
Contact # : FAX 360 - 993 -5993
PRI 503 - 234 -2667
Reg #: LIC 5192
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes
and all other applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is
not started within 180 days of issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law
requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952- 0001 -0010 through OAR 952 - 0001 -0100. You may obtain copies of these rules or direct questions to OUNC by
calling 3- 246 -6699 1- 800 - 332 - 2344 �"
Issued .y: f 'e� �0�t,t- v ,l Permittee Signature ,. , _ ...Ls
Call 503 - 639 -4175 by 7:00 a.m. for an inspection that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
hi 5rae 5 -`08 1 137 `l(
Plumbing Permit Application FOR OFFICE USE ONE1- :.
City of Tigard Received l /�
13125 SW Hall Blvd., Tigard, OR 97223 DateB : Ai 0 ,0" . k.-12 .,•6 No.: ., 0 54.
Plan Review Other Permit No.:
Phone. 503.639.4 i71 Fax: 503.598.1960 /�'ofi.
. l ) e� Date/By:
Hour Inspection Line: 503.639.4175 'S I„ • Date Ready/By: f ' El See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method: /( Supplemental Information
, ::: ,i ti 't "`FEE. UI:$' 'i- :..:,.
TYPE OF WORK•. �,ta�• =: .�:r.,1r _�e`:k �:'ta.. ,.SCHE D
[ 1 ew construction ❑ Demolition For special information use checklist
Description I Qty. l Ea. I Total
❑ Addition/alteration/replacement ❑ Other: New 1 -2- family dwellings (includes 100 ft. for each utility connection)
CATEGORY' OF CONSTRUCTION;cdy;g°,i'.+ a ;;'.;. t ,. SFR (1) bath 249.20
r2 t - 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
;`s'r,r'
JOB SITE INFORMATION AND LOCATION<; : ` ';;°': r
<.:.... , .:•.:. Site utilities
Job site address: 1 1 2_, 35- 0 ( L Catch basin or area drain 16,60
City /State /ZIP: 11 cn a 0 V q 7 ) _( Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: t ) Project name: ne , (! / .e,,,, Footing drain (no. linear ft.: Page 2
Manufactured home utilities 110.00
Cross street/directions to job site: Nor-/h D m7 44,2LL Manholes 16.60
Rain drain connector 16 60 .
Sanitary sewer (no. linear ft.: Page 2
Storm sewer (no. linear ft.: ) Page 2
Subdivision: /) e ( J, aS e-- I Lot no.:
Water service (no. linear ft.: ) Page 2
Fixture or item
Tax map /parcel no.:
Absorption valve 16.60
ORK ;:`` r :
l�
/ DESCRIPTION OF•W :: ;' �;. / ;. ) . : �::'! ��_,..,, :;•. Backflow preventer / Page 2 3 � -� 5
I O D 1.2.E 61 . 1 ,1e. ��JLV f i , % Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
I Drinking fountain 16.60
❑ PROPERTY OWNER
❑ T EN AN T,• :.. :: • ti '/ E jectors /sump 16.60
Name: < r � �
� / �/� L , 7 E xpansion tank 16.60
Address: 5 ,4 ,^ ` V •I Fixture/sewer ca p 16.60
City/State /ZIP: , Ae ‘ r� n t0/( Q y Floor drain/floor sink/hub 16.60
Phone: (..5-C. W N- 4 &b Fax:,(`03)S6,Z_ 9i-/ Garbage disposal 16.60
:,- ; Hose bib 16.60
❑ APPLICANT : •' ::.,; '., _. . ': ❑f CONTACT; PERSON., ;iN :�; 4;
,//jj / // lee maker 16.60
Business name: � f//- l/�I Cl.,6 � 4fite-,5 / �(,C, Intereptor /grease trap 16.60
Contact name: A n (. Medical gas (value: $ ) Page 2
Address: Q 55 )Z21( e v y A / Primer 16.60
City/State /ZIIPL / , i f () (9 ( ` 7c'' 5 Roof drain (commercial) 16.60
Phone: ( O)
` c U I / ' - j ‘,&9 Fax:: U �y� �1lXJ� , J _ p p Sink rY
/basin /lavato 16.60
�
Tub /shower /shower pan 16.60
E -mail: Urinal 16.60
.C ONT RA gO/ :•iA ,; i r'. va; , . ' j Water closet 16.60
Business name: /Y + tt 6 /200)(1 CEi/1/ /4( Water heater 16.60
Address: eo & D / 7 y U Other:
j I'/ 9 ( / 07L/ Subtotal
City/State /ZIP: ■ OW Vl/ /-
� fQ . % Minimum permit fee: $72.50 � /
Phone • f -)?-/-/- 64,7 Fax 3 („0._ t X13 _5yq 3 [p Residential backflow minimum permit fee: $36.25 a
` � t Plan review (25% of permit fee)
CCB Lic.: ���� 7/ � ! � �� - Plumbing Lic. no.: -
` State surcharge (8% of permit fee) _
Authorized signature: ' / 47 . TOTAL PERMIT FEE /5
Print name: ina Y/ C J (�4tJV`' ,-7 -j )/ Date:10 2o- 06, This permit application expires if a permit is not obtained within
�/ C 180 days after it has been accepted as complete.
*Fee methodoloev set by Tri- County Buildine Industry Service Board
CDTY )F TIG, I QLft1-(- 00 ( -6 43 1 1
BUILFIING DIVISION PERMIT #:
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED:
Phone: (503) 639 -4171 h nr�/yp, iii �����e\
-� • I fi
Inspection Requests (24 Hrs.): (503) 639 -4175 y.. __..i,
INSPECTION WORKSHEET FOR • DATE: TIME: PAGE:
SITE ADDRESS: I I 7..:b6 E I, 1„5"\,..) L CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME:
DESCRIPTION:
OWNER: PHONE #:
CONTRACTOR: PHONE #:
Inspection. Request Scheduled For: Date: Pour Time:
Code' # - Inspection Description Confirm # Contact # Message
7)qc1 - ' , fltmin - '1 c8 -1- (!) F 1)‘ _
Corrections/Comments/Instructions: .
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/ PASS PARTIAL APPROVAL I I CANCEL I I NO ACCESS
*•FAIL CALL FOR INSPECTION ADDITIONAL FEES ASSESSED
Inspector: C;44 Date: . 0 0 Phone #: (503) 718-