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Permit CITY TIGARD PLUMBING PERMIT DEVELOPMENT SERVICES PERMIT #: P 10/23/2006 -00500 AX. � ,�� 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 10/23/20 PARCEL: 1 S 134DB -08600 SITE ADDRESS: 11175 SW ELLSON LN ZONING: R -4.5 SUBDIVISION: STONECHASE LOT: 010 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 Surchan 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 5 '36-6699 -4 -8 ,0- 332 -2344. I`` _fl I • ssued P J�l ( 'mow �a Permittee Signature:— 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. fili ; oo 9 .) ) f Plumbing Permit Application FOR OFFICE USE ON.1 City of Tigard RPl°e°'yed /0 2©i Permit No.: / 13125 SW Hall Blvd., Tigard, OR 97223 a n Re Re C �Y�G�tt �67 Plan Review Phone: 503.639.4171 Fax: 503.598.1960 Ali' l lei l Date/By: Other Permit No.: 24- Hour Inspection Line: 503.639.4175 • I Date Ready/By: Ire/ ®See Page 21 for Internet: www.ci.tigard.or.us " " Notified/Method: Ire /� Supplementa . ;'.:ask - .<;s�: '''FEE., �ULE� �ti:�:::• . .TYPE OF WORK;v.. .�:t 1.(;, • _ �:, , .r`�,�a`xl�;;- ��td.'��a.. ,t5tr1D 3E E ew construction ❑ Demolition For special information use checklist 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;, > ii,k"ra? SFR (I) bath 249.20 and 2- family dwelling ❑ Commercial/industrial SFR (2) bath 350.00 ' ❑ Accessory building El 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`::'`r ;2,i .'j'`' :':.: . a Site utilities Job site address: + , ) 6) I Son L41 Catch basin or area drain 16.60 City /State /ZIP: r fi ft (9. 0(1). Li Drywell, leach line, or trench drain 16.60 Suite/bldg. /apt. no.: °� Project name: n( h„ .ei Footing drain (no. linear ft.: Page 2 Manufactured home utilities 110.00 Cross street/directions to job site: NOrte ,1)01(04_, 9- /2,. / Manholes 16.60 Rain drain connector 16.60 Sanitary sewer (no. linear ft.: ) Page 2 Storm sewer (no. linear ft.: ) Page 2 Subdivision: l /it< h a s � � Lot no.: Water service (no. linear ft.: ) Page 2 Fixture or item Tax map /parcel no.: Absorption valve 16.60 , DESCRIPTION OF WOR K',...;.,. •.;'.. ^;: r :.:a;:;i.:� .;;;• r; it t ' . .. . ...;,: t•. �: .�,';��..: �;.r Backflow preventer i Page 2 3 A' 5 l4 0 D zgiei &A-nor) .l *_((/ epot d 1.- e itev .. Backwater valve 16.60 Clothes washer 16.60 Dishwasher 16.60 Drinking fountain 16.60 ❑ PROPERTY OWNER I ' ❑., TENANT..: / Ejectors /sump 16.60 Name: (e �r LLI. Expansion tank 16.60 Address: a c ( ,V (( :7 n . 1 "l� <� , ! y Fixture/sewer cap 16.60 City /State /ZIP: , - i n oe 97005 y Floor drain/floor sink/hub 16.60 - Phone: (.._6-9 ,/ /_ Fa / x: ,/ / ?j Garbage disposal � �l -'7U/IG'� fit` ���SfJ/� -/�p� osal 16.60 g P Hose bib 16.60 ❑ APPLICANT. ' r 0 « : i, . / ACT =PERSON / Ice maker 16.60 Business name: rr (A41.4_11// , . ? � � 5 ' , ,/ e Interceptor /grease trap 16.60 Contact name: , n (. e Medical gas (value: $ ) Page 2 Address: 455' ) ve 4/A y Primer 16.60 City /State /ZIP - dye , ( n c9k vv 709.5 / Roof drain (commercial) 16.60 Phone: O& 1� / 6` i / - ` b& (� Fax:: � 6 'A®A p y Sink rY /basin/lavat 16.60 d Tub /shower /shower pan 16.60 E -mail: Urinal 16.60 : RA '. ; s ; U ; :.:.., • . ; ; . . n:. CONT� O �- ., y � ~. ,..' . �:% _. .. Water closet 16.60 Business name: / lL e /4/ i 1/ /2.0 Water heater 16.60 Address: ,0 , (), 7 y L Other: y� , t,() Subtotal City /State /ZIP: �� / l ' l/�'!�' `1 '4 /� ; © 7 II L � Minimum permit fee: $72.50 / » P hone:• 503 61,27 Fax: w._ g 93 _sqq 3 Residential backflow minimum permit fee: $36.25 l Q - CCB Lie.: 44(2_,..3:61f ,e • I Plumbing Lic. no.: Plan review (25% of permit fee) State surcharge (8% of permit fee) / .90 Authorized signature: ' Orf.,/�� 7.i., ( /5- TOTAL PERMIT FEE Print name: in y/ C i 1 Date: Date:/ 0201 - 06, 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. CITY OF TIGARD `` P1� uyb6, 0 U '5 ®d BUILDING DIVISION PERMIT #: 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: Phone: (503) 639-4171 Requests (24 Hrs.): (503) 639 -4175 ' ' -_.• INSPECTION WORKSHEET FOR DATE: TIME: PAGE: SITE ADDRESS: (1 I tI I c' WI" 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 2A6 ,lwlivvioitgns ri)ocS Corrections /Comments /Instructions: • 4 n C'• 9 , M PASS ❑ PARTIAL APPROVAL CANCEL ❑ NO ACCESS ❑ FAIL n CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: Date: /1 Phone #: (503) 718- T6"/