Permit CITY TIGARD PLUMBING PERMIT
�i DEVELOPMENT SERVICES PERMIT #: PLM2005 -00434
�i�I DATE ISSUED: 9/6/2005
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171
PARCEL: 2S 112C D -12800
SITE ADDRESS: 07706 SW CYPRESS LN ZONING: R -12
SUBDIVISION: HAMBACH GROVE LOT: 026 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
LEGEND HOMES
12755 SW 69TH Description Date Amount •
SUITE 100 [PLUMB] Permit Fee • 9/6/2005 $36.25
PORTLAND, OR 97223 [TAX] 8% State Surcha 9/6/2005 $2.90
Phone : 503- 620 -8080 Total $39.15
•
• Contractor: •
MARTIN SANDERS GROUNDS MAINTEN
PO BOX 307
NORTH PLAINS, OR 97113 REQUIRED ITEMS AND REPORTS
Phone : 503- 647 -5567
Reg #: LIC 5742
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: ":P, 1 ,4 . c f Permittee Signature: -L O
Call 503 - 639 -4175 by 7:00 a.m. for an inspection that business day. e
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.
Sep 06 05 08:08a Martin Sander 503 -647 -9151 p. 3
A 1 NED � r.`g 1`1111 ()I'1'I( 1. t 11. (1\ IA
it 1`s pU11- -- n. .
'luml�xn� Perm ,.. . -170 t
y u ��n d ° Permit No
:ity of'� Tigard 0 R rAPS D,,,,
d OR 97223 Alan Review Other Permit Nn.:
3125 SW ! -tall Blvd., Tigard, ;ax.;[y - . 1 Date/B }: it Pa 2 for
none: 503.639.4171 Fax: 503.598.19 .� �� I:1We ReadyBy: , to see Pare 2 Information Hour www_ inspection a r d. o 503.639.41 F 1 ' "N'+ Notified/Metha
r.1TY nAt SCHEDULE
For r - U' FEE* SCKED
-•
TYPE �vF1L F or special infornralron use check/W.
Demolition Ea. Total
New construction ilescri •lion
New i- ].-family dwellings (includes 100 0. for each utility connection)
❑ Other: New Addition/alteration/replac SFR (1) bash
CATEGORY OF CONSTRUCTION SFR (2) bath 350.00
Commcrzinl�ndustrial SFR (3) bath 399.00
1- and 2- family dwelling g
Accessory 45.00
buildin Q Multi- family Each additional bath/kitchen 0 Other_ _._ Fire sprinkler ( sq. IL)
Page 2
Master builder
JOB SITE INFORMATION AND LOCATION Site utilities 16.60
Catch basin or an = drain
b she address 16.60
Drywall, leach line, or trench drain
�i Z F ootin drain (no. linear ft.: i) = Page 2 MOM
ty /Statc/ZiP: j CU(a g
Project name: } 4 - a .� Manufactured home utilities 110.00
tile/bldg./apt. no.: )
v
ss street/directions
Manholes cct/dircctions to job Site: 16.60
' Rain drain connector . •
Sanitary sewer (no. linear ft.:.____) _
Storm sewer (no. linear ft.: ) _
Page 2 11111N1111 Water service (no. linear n.: 1 Page 2
(( Lot no.:
tbdivision: (j_ b - l ,�} S 1 A Fixture or item
ax map /parcel no.: _ Absorption valve
16.60
Backtlnw pm-venter Page 2 A + • \1'7
• DESCRIPTION OF WORK 16.60
Baelcwater valve
Clothes washes 111111111 16.60 1
A el C i / I Dishwasher 16.60
i Drinking fountain 16.60 111111 16.60
®. PROPERTY OWNER Q TENANT Ejcciats/sump
16.60
', Expansion tank
lame: 1_,.e • c � ,_ _ 16.60
' J . Fixture/sewer rap
cddt�ss: t -- I `- .0L.) T Floor drain/floor sink/huh 11.1 16.60
:ay/State/Ziff': �'p c r D `-i LZ 16.60
Garbage disposal
g a p� 16.60
'hone; tr 2-0 . a :, 1 Fax: (6 ` C - Hose bib
ArrucANTr
Q CONTACT PERSON
ice maker 16.60
3 , C))' 16.60
3usincss name: _� L - S � I lntcrccptod trap l �'1 � � y a pp Page 2
�Gi /- 0,0.,l•- Medical gas (value: $ )
'antact name: j,,_,•1 e ,-, A-- 16
Primer
lddress: l ' t�
- _ 3C> p q Roof drain (commercial) 16.60 Ab
O t'�� ' I-7 i 3.:S 16
'h (�I {1.r klr \ �_� / Sink /basin/lavatory
t5. L7 7 - WS/ S/ Tub/shower/shower pan 16.60 u
'hone: (5 ) � '� - S s Fax:: ( 16.60
-mail: Urinal
CONTRACTOR closet 16.60
16.60
M l � � f ) Water heater __
business name: L'v! � /' 11 r� . C �� ,j't�'� C � Other: address: p . 0 , 6 c) k. ,-� Subtotal �-../? 'I - 1 1 - Minimum peirttitfee: 572.50
:l ane: teTLfP: pY Y(n E Gc- ,tit 5 C J� t
- D) (0 -7
,`9 � S , Residential backtlow minimum p it fee: 53625
hone: (50� to `'r 7 - :55 6 � Fax: V ' Plait review (25 %ofpcmiit fee)
:CB Lie.: r} Z Plumbing Lie. no.: State surcharge (8% of permit fee)
- QS TOTAL PERMIT FEE , - 7
rint n me signature: ,/1. _AN : �''i rmit a lication e xpires if a permit is not obtained within
• Date: This permit PP
tint name' 1.4.41 a 7'1'1 z-: - 180 days after it has been accepted as complete.
*Fec methodoloev set 1w Tri- County Building industry Service Boani