Permit 4 �
C ITY OF TIGARD PLUMBING PERMIT
,,fly DEVELOPMENT SERVICES PERMIT #: PLM2005 -00395
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 8/16/2005
PARCEL: 2S 112CD -12900
SITE ADDRESS: 07718 SW CYPRESS LN • ZONING: R -12 .
SUBDIVISION: HAMBACH GROVE LOT: 027 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: fZ 013
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.
Flue 16 05 08:28a Martin Sander 503 - 647 - 9151 p.7
Plumbing Permit Application' - FOR OFFI(h: I SE ONI.l
U UL'= \JLCI V �L�
g Dat /B ?16 6S ' m ,90 395
City of Tigard Permit No
13125 SW Hall Blvd., Tigard, OR 97223 a [, Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 U1. 6 �DO ' ,d7 k I. Date.By: Other Permit No.:
24- Hour Inspection Line: 503.639.4175 -AM. • I I � . Date Ready /By: .. tur 6:1 See Page 2 for
Internet: www.ci.tigard.or.us (ITV t 1F TIAb Rl1 Notified/Method: �lU /� Supplemental Information
TYPEEO LWORKDIVISION FEE* SCHEDULE
,New construction 1:1 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 SFR (1) bath 249.20
❑ 1- 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
.1033 SITE INFORMATION AND LOCATION Site utilities
Job site address: --/ '-) ( SW C4 prv ss LGr) f?
Catch basin or area drain 16.60
Ci /State /ZIP: Drywell, leach line, or trench drain 16.60
ty I (�d Z Z Footing drain (no. linear ft.: ) Page 2
Suite/bldg. /apt. no.: l Project name: CL-i'Y1 O C
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.: 7..._-7 Water service (no. linear ft.: ) I Page 2
Subdivision:
R( ry\ bG f,1n ) S S i11 3
Fixture or item
Tax map /parcel no.:
Absorption valve 16.60
DESCRIPTION OF WORK Backflow preventer Page 2
Backwater valve 16.60
r !e ir A Car i r n p n Clothes washer 16.60
vK c i Dishwasher 16.60
g PROPERTY OWNER I ❑ TENANT Drinking fountain 16.60
Ejectors/sump 16.60 •
Name: Le_yL'_eld 1 f `; D_ f . Expansion tank 16.60
Address: 12"1 SS S . ' 3 6 TH fc■*. . SkATE 160 Fixture/sewer cap 16.60
City /State /ZIP: pO ri.- k,,,,,_r? (.4 0 ` - 7 Z-- 3 Floor drain/floor sink/hub 16.60
Phone: (5o3 b 2_0 - K0 go Fax: (6CJ S I g g co Garbage disposal 16.60
In APPLICANT ❑ CONTACT PERSON Hose bib 16.60
S. �+ lee maker 16.60
Business name: f..t 0, �r S n eel - -s s 4'VGUr')c �'(
) S t • Interceptor /grease trap 16.60
Contact name: (L& ex / .t 1 n S 6 n , Medical gas (value: $ ) Page 2 •
Address: 0J 6,-5- 3C:5 " Primer 16.60
City/State/ZIP: Cit C S 9-7 1 3:s Roof drain (commercial) 16.60
y O 'h � / l i � � / Sink/basin /lavatory 16.60
Phone: (503) 6.9 7 - S S 7 [ Fax: : (b 6' L / 7 - 77 pan - -
Tub /shower /shower an 16.60
E-mail: Urinal 16.60
CONTRACTOR Water closet 16.60
Business name: M4 V hi ` 1_N��517 6). roc tri5 Water heater 16.60
Address: e. 0 ‘ 6 p 4:?: ,. Other .
City/State/ZIP: P C 4 ' is , n ,- 1 13 Subtotat
Minimum permit fee: $72.50
Phone: (5Q3 fo .7 - 55 6-1 Fax: ($C)) (, `71 - // S r Residential backflow minimum permit fee: $36.25
CCI Lie.: 5 '•') Le Z Plumbing Lic. no.: Plan review (25% of permit fee)
State surcharge (8% of permit fee)
/I
Authorized signature: �f-- TOTAL PERMIT FEE ), 31, 2 ,1-2.,
Print name: \/ Date: /� [}S This permit applicat expir if a permit is not obtained wi 42 /ice fi � h #.,,, r ' 180 days after it has been accepted as complete.
*Fee methodoloev set by Tri- County Buildine Industry Service Board.
39')5
P
-CITY OF TIGARD
BUILDING DIVISION PERMIT #: PLM200S -00396
13125 SW Hall Blvd., Tigard, OR 97223 4 DATE ISSUED: 8/16/2005
Phone: (503) 639 -4171 /� ^'��1�1 i4% ( #
Inspection Requests (24 Hrs.): (503) 639 -4175 .W■ '"...
INSPECTION WORKSHEET FOR DATE: 9/6/2005 TIME: 7 :06AM PAGE: 2
SITE ADDRESS: 07718 SW CYPRESS LN CLASS OF WORK:
SUBDIVISION: HAMBACH GROVE LOT #: 027 TYPE OF USE:
PROJECT NAME: HAMBACH GROVE
DESCRIPTION: Bacl4lovu 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 014985.04 503 -647 -5567 N
Corrections/Comments/Instructions:
T l-- \7 -) v al .
) - ,
/ ^ 1 r 2 I,
.■., /
l • [PASS 0 PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
1 I FAIL I I CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
o.
Inspector: �� Dat e: /�/ S Phone #: (503) 718-