Permit JP
• i 'CITY OF TIGARD PLUMBING PERMIT
uri I " DEVELOPMENT SERVICES PERMIT #: P -00235
��i DATE ISSUED: 5/26/20026/200 4
x ' -- " 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
/cR 8'S -� PARCEL: 2S102CB -00100
SITE ADDRESS: 12850 SW GRANT ST
SUBDIVISION: NORTH TIGARDVILLE ADDITION ZONING: R -12
BLOCK: LOT: 041 JURISDICTION: TIG
CLASS OF WORK: OTR GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS: 1
OCCUPANCY GRP: 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
Remarks: Backflow preventer.
FEES
Owner:
Description Date Amount
TIGARD - TUALATIN SCHOOL DISTRICT #23
6960 SW SANDBURG RD [PLUMB] Permit Fee 5/26/2004 $72.50
TIGARD, OR 97223 [TAX] 8% State Surchan 5/26/2004 $5.80
Total $78.30
Phone:
Contractor:
CEDAR LANDSCAPE
14145 SW GALBREATH DRIVE
SHERWOOD, OR 97140 REQUIRED INSPECTIONS
Phone : 625 - 3700 Final Inspection
Reg #: LIC 5843
PLM ALL PHASES & BA
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.
Issued By: ,Gix.. 4,,i,40 Permittee Signature: �,, ' ,/� � 6T
Call (503) 639 -4175 by 7 :00 P.M. for an inspection needed the next business day
Ma,t: J4 11:54a S Cedar Landscape 5036258623 p.
Plumbing Permit Apo itY \� . .. ,.
,. .. V �® EOR. OE USE ONLY ,.
City of Tigard Received 5' y/L�
13125 SW Hall Blvd., Tigard, OR 97223 Datc /Ay Pe,mrt Na r� a �S
Phone 503 639 4171 Fax 503 598 1960 MAY 2 5 200 :. -�_, a k Plan Revie ° ®6
24- Hour Inspection Line 503 639 4175 l I 'I'I Date/By. Other Permit No
Internet www ci tigard or us C ITY 3Y \ OF TIG r "" �'i cam ' Date Ready/By 1 is p See Page 2 for
Notified/Method �/�
I /Uf Supplemental Inforrnahmr
TY "P tt i' �j
FEE* SCHEDULE
❑ New construction ❑ Demolition For special information use checklist
® Addition /alteration /replacement Er Other: Description Qty. I Ea ( Total
New 1- 2- fancily dwellings (includes 100 ft for each utility connection)
CATEGORY OF CONSTRUCTION SFR (1) bath I i
1 249.20
❑ I- and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 350 00
❑ Accessory building ❑ Multi - family SFR (3) bath 399 00
❑Master builder Each additional bath/kitchen 45 00
® Other: � c s s L
Fire sprinkler ( sq It ) Page 2
JOB SITE INFORMATION AND LOCATION
Site utilities
Job site address: 1,,`2.( —?�-• J.L.,„) (.; -„�, , r 5 l A28.5:5— Catch basin or area drain
16 60
City /State /ZIP: 7 6ri -.Y_) t)/Z 9 7 zZ41 Drywell, leach line, or trench drain 16 60
Suite /bldg. /apt, no C F �t✓J E /C,� a Footing drain (no linear ft. ) Page 2
: I Project name:
n r r-t
Cross street/directions to job site: A6� Manulhetured home utilities 110 00
L�l ��� r i Manholes 16 60
j=-r c.v. S '4.) i-- /; In t./7- Rain
drain connector 16 60
Sanitary sewer (no linear ft ) Page 2
Storm sewer (no linear ft ) Page 2
Water service (no linear Fr ) Page 2
Subdivision. I Lot no.:
Tax map /parcel no.: fixture or item
Absorption valve 16 60
DESCRIPTION OF WORK
Backllow preventer / P® ye. y0
Backwater valve
. 1- f1't:ei>47 -fili, 34-c /5 (� ✓re/�v `r- Clothes washer 16 60
i Dishwasher 16 60
❑ PROPERTY OWNER ` ❑ TENANT Drinking fountain
16.60
Name:
Ejet ors!swnp 16 60
Expansion tank 16 60
Address:
Fixture /sewer cap 16 60
City/State/ZIP: Floor drain /floor sink /hub 16.60
Phone: ( ) Fax: ( ) Garbage disposal 16,60
❑ APPLICANT 0 CONTACT PERSON Hose bib 16.60
Business name:
Ice maker 16 60
Interecptorigrease Trap 16.60
Contact name.
Medical gas (value $ ) Page 2
Address: Primer 16 60
CttyiStatc /LIP: Roof drain (commercial) 16 60
Phone: ( ) Fax:: ( ) Sink /basin /lavatory 16 60
E-mail: Tub /shower /shower pan 16 60
Urinal 16 60
CONTRACTOR
Water closet 16 60
Business name' (>'L;D , 4'4,-. 4se e s - --i[ Water heater 16.60
Address: H/ys Jlu 64(# rc4y4 D2 Oilier
City /State /ZIP: SC'J c-e� 1)1� q 7/ , Subtotal
� ?f�l
Phone: (S7 lip A Fax: U
-
jj) Z t Minimum permit fee S72 50 --7
3 700 (5 3) 6, 6 Z z Residential backllow minimum permit Fee $36.25 Z .S
CCB Lie.' 5 Plumbing Lie. no.: Plan review (25;4, of permit fee)
Authorized signature '7Z` Stale surcharge (8% of permit fee) S, o
, TOTAL PERMIT FEE 76,3c)
B-ev ../k/.. /
Print name. c e .. ,SS N" /✓ Date: LS -e y This permit application es. pi res ifa permit is not obtained within
1811 days after it has been accepted as comp /ere.
*Fee methodology set by Tn- County Building Industry Service Board
i dnuddure'A'enmrs:PLA1 -Perms App doe 12'U3 440- 46101'(10;22'COAVN'E8)