Permit C ITY OF TIGARD PLUMBING PERMIT
i DEVELOPMENT SERVICES PERMIT #: PLM2005 -00394
e�Ili - DATE ISSUED: 8/16/2005
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171
PARCEL: 2 S 112 C D - 13100
SITE ADDRESS: 07736 SW CYPRESS LN ZONING: R -
SUBDIVISION: HAMBACH GROVE LOT: 029 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 8/16/2005 $36.25
PORTLAND, OR 97223
[TAX] 8% State Surcha 8/16/2005 $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: :2,Z Permittee Signatur `G, f t ` , p
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.
Rug 1G 05 08:27a Martin Sander 503 -G47 -5151 P -5
1R- (- -. V volt I SF. ll \l.\
Plumbing Permit Applicat1on �j J /
Da a 1 6 O� 3� Per No` �l (7 '" ) 9 `i
City of Tigard i i 1 6 2005
13125 SW Hall Blvd., Tigard, OR 97223' Plan Review Other Permit No.:
Phone: 503.639.4171 Fax: 503.598.1960 An,
'y■y ' „ 1 l Date/By:
24- Hour Inspection Line: 503.639.4I7l OF TIGARD - ='^^' I I Date Ready/By: Jar's: BI See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method: -7 ar Supplemental Information
RI III ntvlr`_ nr %rrr's' .i
TYPE OF WORK . • FEE' SCHEDULE
❑ Demolition For special information use checklist
New construction Description I Qty. ( Ea. I Total
❑ Addition/alteration/replacement ❑ der: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (1) bath 249.20 •
❑ I- and 2- family dwelling ❑
Commercial /industrial SFR (2) bath 350.00
SFR (3) bath 399.00
❑ Accessory building ❑ Multi- family 45.00
Each additional bath/kitchen
❑ Master builder ❑ Other: Fire sprinkler (__ sq. ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities
Job site address: -1 , 1� \+J C_ p 5 C c.c. +'ty Catch basin or area drain 16.60
J
City/State/ZIP: t (J* R q 1 Z Z Drywall, leach line, or trench drain 16.60
i -t ,
Footing drain (no. linear ft.: __,) Page 2
Suite/bldg. /apL no.: l Project name: Ft-a n vvii , k Manufactured home utilities 110.00
Cross street/directions to job site: .
Manholes 16.60
Rain drain connector 16.60
Sanitary sewer (no. linear ft.: ) Page 2
Storm sewer (no. linear ft.: ) Page 2
I Lot no.: Z� Water service (no. linear ft.: �) Page 2
Subdivision: (j, bo�� c., tc�ss
Fixture or item
Tax map /parcel no -: • Absorption valve 16.60
DESCRIPTION OF WORK Backflow preventer Page 2 MSitbo
Backwater valve 16.60
L(i.11 (l � .C.0 A r�- '" J ri:3C1 'o Clothes washer 16.60
Dishwasher 16.60
Drinking fountain 16.60
® PROPERTY OWNER ❑ TENANT
Ejectors/sump 16.60
Name: 1---ee..eNa1 € 1fv1e.5 IL)..kJ . Expansion tank 16.60
C Fixture/sewer cap 16.60
Address: (Z1 F.S S w _&9 IT( �C� , e l l�l E 1 � )
City/State/ZIP: rp•r-- kOi..-,,T A 0 v, `-9 z-Z•j Floor drain/floor sink/hub 16.60
Garbage disposal 16.60
Phone: 6�3) (0 2,0 - • 0 Rb Fax: (S� S9% - gri CO 16.60
Hose bib
tT APPLICANT ❑ CONTACT PERSON Ice maker 16.60
Business name: f--4 a ran &. „fit ate: 171 Y L -? ci S 61'C f- - Interceptor /grease trap 16.60
Contact name: f,„„l 4... Sci fl a..4 ,..� Medical gas (value: $ ) Page 2
Address: (O 0 Primer 16.60
,,,,_,-,e �`1
City/State/ZIP: 0 t -� 0 9 13 _s Roof drain (commercial) . 16.60
y ��� 16
// q Si n k/basi n/ lavatory
Phone: (5°3 ) ` "f 7 - S S 7 Fax :: (cs `� ") 6.7 C� / 7 - / /s 16.60
Tub /shower /shower pan
E -mail: Urinal 16.60
CONTRACTOR Water closet 16.60
Business name: MA, y f - , ce-, ..,,,,&-,--5 6 NJC Water heater 16.60
Address: P ` O , 6 O ).e 3 '-1 Other:
� �y Subtotal
cYY
City/State/ZIP: ND -r( 4' L ai_ ,17 c e ._/ ! /� 3 Minimum permit fee: $72.50
Phone: c5O (o Li •7 - S5 b .) Fax: (5)3) (p LT -. - Gj/ 5 / Residential backflow minimum permit fee: $36.25
CCB Lie.: Plumbing Lic. no.: Plan review (25% of permit fee)
Z State surcharge (8% of permit fee)
Authorized signature: PERMIT FEE 361/15
Print name: ,/14 G . f,�� (5 r , Date � - jG �I� 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 Building Industry Service Board.
CITY OF TIGARD
BUILDING DIVISION PERMIT #: PLM2005.00394
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 8/16/2005
Phone: (503) 639 -4171 %�41��u����,�
Inspection Requests (24 Hrs.): (503) 639 -4175 ��' __..
INSPECTION WORKSHEET FOR DATE: 8/22/2005 TIME: 7:10AM PAGE: 9
SITE ADDRESS: 07736 SW CYPRESS LN CLASS OF WORK:
SUBDIVISION: HAMBACH GROVE LOT #: 029 TYPE OF USE:
PROJECT NAME: HAMBACH GROVE
DESCRIPTION: Baclflow preventer for irrigation.
OWNER: LEGEND HOMES, PHONE #: 503..620 -0000
CONTRACTOR: MARTIN SANDERS GROUNDS MAINTEN PHONE #: 503 - 647 -5567
Inspection Request Scheduled For: Date: 8/22/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
399 Plumbing final 014026-02 503 -647 -55567 N
Corrections/Comments/Instructions:
C.'>;-f „/4-A r j22. / os- - J
El PASS n PARTIAL APPROVAL n CANCEL E NO ACCESS
n FAIL I I CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED
Inspector: Ci NW -- Date: ?I22/j, Phone #: (503) 718-