Permit CITY OF TIGARD
PLUMBING PERMIT
i DEVELOPMENT SERVICES PERMIT #: PLM2005 -00396
EMI DATE ISSUED: 8/16/2005
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171
PARCEL: 2S112CD 13000
SITE ADDRESS: 07724 SW CYPRESS LN ZONING: R -12
SUBDIVISION: HAMBACH GROVE LOT: 028 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 AVE #100 Description Date • Amount •
•
PORTLAND, OR 97223 [PLUMB] Permit Fee 8/16/2005 $36.25
[TAX] 8% State Surcha 8/16/2005 $2.90
Phone : 503- 620 -8080 Total $39.15
Contractor:
MARTIN SANDERS GROUNDS MAINTEN
PO BOX 307
NORTH PLAINS, OR 97113 REQUIRED ITEMS AND REPORTS
Phone : 503- 647 -5567
Reg #: LIC 5742
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 0001 -0010 through OAR 952 - 0001 -0100. You may obtain copies of
these rules or direct questions to OUNC by calling 503 - 246 -6699 or 1- 800 - 332 -2344.
Issued By: Permittee Signature:
• Call 503 - 639 -4175 by 7:00 a.m. for an inspection that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
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AQe; 16 05 08:10a Martin Sander 503 - 647 -9151 p.2 •
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ltnlbing Permit Appxe�IOn :rill: 0,..,..,,,..-. t sr.: ()N.%
City of Tigard Receive Per N n" �
13125 SW Hall Blvd., Tigard, OR 97223 6 n Plan R y /�t j t 11`n OS �d39
Phone: 503.639.4171 Fax: 503.598.I960 ,qq OG 1 6 200 y Plan cvrew
h i tl.. . Date/By: Other Permit No..:
J„ j„ � lane .
Internet: www.ci.tigard.or,tu CITY OF TIGARD Notifcd/ethd: • - Ilk SSupp Page Inf orma t ion
TYPIU FIE.)1 t!o$KVISION FEE' SCHEDULE
,New construction ❑Demolition For special information use checklist
Description I Qty. I Ea. I Total
❑ Addition/alteration/replacement 0 Other: New 1- 2- family dwellings (includes 100 ft_ for each utility connection
CATEGORY OF CONSTRUCTION SFR (I) bath. 249.20
❑ 1- and 2- family dwelling 0 Commercial /industrial SFR (2) bath 350.00
❑ Accessory building 0 Multi - family SFR (3) bath 399,00
❑ Master builder ❑ Other:
Each additional bath kitchen 45.00
Fire sprinkler ( sq. It.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities
Job site address: '-7 2%1 SW Ci f l 6t Catch basin or area drain 1 6.60
City/ State/ZIP: T f (3d1f a 0 e Z Z Drywell, leach line, or trench drain 16,60
Suite/bldg. /apt- no.: I Project name: i-t 0-ryl V edir‘ Footing drain (no. linear ft,: ) Page 2
Cross street/directions to job site:
Manufactured home utilities 110.00
Manholes 16.60
Rain drain connector 16.60
Sanitary sewer (no. linear ft.: _____) Page 2
Storm sewer (no_ linear ft.: ) Page 2
Subdivision: Nay\ )36 c� L
1 {( i�c1 1 Lot no.: �f Weser service (no. linear ft.: ) Page 2
Tax map /parcel no.: .
_ Fixture or item
Absorption valve 16.60
DESCRIPTION OF WORK Backflow preventer Page 2 poi , , I:
}�( �] Backwater valve 16.60 �
LQr ac0:1t r tJ n ' ° n Clothes washer 16.60
J Dishwasher 16.60
. PROPERTY OWNER ❑ TENANT Drinking fountain 16,60
Ejectors/sump 16.60
Name: ) - e - ' d r - ( Alf a l ) . . ) , / . Expansion tank 16.60
Address: t 2,' S S s -) ,, 1 17 i t' . c Fixture/sewer ca
(j �I(E IL�� cap 16.60
City/State/ZIP: Po -r, k rA D A `: Z-2-3 Floor drain/floor sink/hub 16.60
Phone: (3c3) b 2.o - 5,L> g _ Fax: (.6-4 S9 g - Ice 0O Garbage dispos 16.60
igi APPLICANT ❑ CONTACT PERSON Hose bib 16.60
Ice maker 16.60
Business name: 11..{ a r 1 -i S &, e�� ( Yt JYJ � •S t . Interceptor /grease trap 16.60
p P
Contact name: t1/4A Q f .�-1� S lll/A.0.-I'-> Medical gas (value: $ ) Page 2
Address: O 0 . t�, >� 32,5-7 Primer 16.60
City / State/ZIP:
C ) 0,,-.4-1..\ e/ el Al .7.'-',. 0 / X1 - 7 [ 3-S Roof drain (commercial) 16.60
Phone: (.SU j) Sink/basin/lavatory 16.60
L1 7 - S S v Fax :: (S ) 6''1 7 - { f `S/ Tub /shower /shower pan 16.60
E -mail:
Urinal 16.60
CONTRACTOR Water closet 16.60
Business name: � . ii I/1 5 - 4 .>r ' 6 Water heater 16.60
Address: P . Q . 6 U x ?ice - Other.
City /State/ZIP: CO �t-� 4 C ,_ ;' S , : e ''7 i3 subtotal
1 C i m Minimum permit fee: 572.50
Phone: (509 to -f 7 - S 5 7 Fax: 60:3) eT.- - c / / S / Residential backflow minimum permit fee: 536.25
CCB Lie.: 5-) Z t Plumbing Lie, no_ Plan review (25% of permit fee)
Authorized signature:
State surcharge (8 of permit fee)
�
TOTAL PERMIT FEE - <7 v • 2.5
Print name: 1,=4 // -9-i 4 5 ` ,, . I Date: K «.. 6s 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.
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CITY OF TIGARD t BUILDING DIVISION -' PERMIT #: PLM2006-00396
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 8/15x'2005
Phone: (503) 639 -4171 / aiuou gPIPll0 '
Inspection Requests (24 Hrs.): (503) 639 -4175 'I �..
INSPECTION WORKSHEET FOR DATE: 9/6/2005 TIME: 7:06AM PAGE: 6
SITE ADDRESS: 07724 SW CYPRESS LN CLASS OF WORK:
SUBDIVISION: HAMBACH GROVE LOT #: 028 TYPE OF USE:
PROJECT NAME: HAMBACI-I GROVE
DESCRIPTION: Backflow preventer for irrigation.
OWNER: LEGEND HOMES, PHONE #: 503- 620 -8080
CONTRACTOR: MARTIN SANDERS GROUNDS MAINTEN PHONE #: 503 - 647 ..5567
Inspection Request Scheduled For: Date: 9/6/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
399 Plumbing final 014985 -02 503-647-5567 N
Corrections /Com nts /Instructions: I
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P PASS n PARTIAL APPROVAL n CANCEL I I NO ACCESS
4.
❑ FAIL 1 I CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: 4 c J - Date: / Phone #: (503) 718-