Permit t„.'"
,'. CITY OF TIGARD PLUMBING PERMIT
li DEVELOPMENT SERVICES PERMIT #: PLM2006 - 00252
- 'I 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 6/2/2006
PARCEL: 2S109DD - 07600
SITE ADDRESS: 15655 SW GREENFIELD DR ZONING: R - 7
SUBDIVISION: BELLA VISTA LOT: 006 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
RIVERSIDE HOMES, INC.
1925 NW AMBERGLEN PKWY #200 Description Date Amount
BEAVERTON, OR 97006 [PLUMB] Permit Fee 6/2/2006 $36.25
[TAX] 8% State Surcha 6/2/2006 $2.90
Phone : 503- 645 -0986 Total $39.15
Contractor:
STREAMLINE PLUMBING
2505 SW AUGUSTA DR.
ALOHA, OR 97006 REQUIRED ITEMS AND REPORTS
Contact # : FAX 503- 379 -9543
PRI 503- 888 -6657
Reg #: LIC 142111
PLM 34 -370PB
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.
l/, r
Issued By: Permittee Signature: _ _p \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.
.. .
Plumbin P A� 1 .D , . . FOR OFFICE USE ONLY
' -' City of Tigard r t Received
6 i Permit
c Plan Review
P No.: 1 „ /I ( /
� `
13125 SW Hall Blvd., Tigard, OR 97223 U w '1 l `.06 Date/By: ^ Q )
Phone: 503.639.4171 Fax 503.598.1966 1V
1 4� Date/By: Other Permit No.:
24- Hour Inspection Line: 503.639.4175 T1GARD ��/ /
�� ISI �,, �•,•, � • Date Ready /By: 111 0 See Page 2 for
Internet: www.ci.tigard.or.us CITY INfa pIV Notified/Method: / 5 l 5- Supplemental Information
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New construction ❑Demolition For special information use checklist.
Description Qty. Ea. 1 Total
❑ Addition/alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
� °.` ��; .. 1J 7115:11'W �.�'€ :&q .rte �az�;va�a``sir; -;= �' - -
.... 0 :':'01''1,
CATk;GORY? OFD .GUI�ISTI2UC`ITO , N ':, ^,., _ : v "_ S ( • FR 1) bath 249.20
[t 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 ❑ Site utilities
Other:
...,:_ Fire sprinkler ( sq. ft) Page 2
- ., ",_.,- dos i E \r1 9P,; -k olv 1L9t A - 9 .1, m
t � °�� "_ ��,e�=,r"�> � � ���
Job site address: >f S (p; S 5 W L.ceeNCnt.(pt r rive Catch basin or area drain 16.60
City/State /ZIP: 7, p a �+1 O
, i D e. , a )L Drywell, leach line, or trench drain 16.60
Suite/bldg./apt. no.: J �` I • Project name ,1\ q , 50,, Footing drain (no. linear ft.: ) Page 2
Manufactured home utilities 1 10.00
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. Subdivision: -- Lela Y f I Lot no.: Water service (no. linear ft.: ) Page 2
Fixture or item
Tax map /parcel no.:
.:. ,rte. ::r,;.: ,if .�: e,:.a a zs :" K:: 5v „,,,,„,,,,,,,, „ Absorption valve 16.60
1 „ , ' ,.. 1 ,fie DE$CRIPTIUN I? WORK., :; ,
h.a � _ 4_ =� �a s uY , F „, ,,,,„ ,� ,,-.�� - - f ? - ' , ,., ate; x-,, . _ Backflow preventer II Page 2 34, 2 .,.. 1-1
Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
mi=x: , t D g ountam 16.60
r, .R,a A T ::: �rs - otivriER:: hon,t I it lvA i 3 -
,� ,.> , -_ : �,�r .. •, .. < � � ,.e�a� x:.. f3 �:• .�. x,.��a3, ..� . :dt..,.
,� �,>,. "Y.>rz,� �.� <_ - -" . � -�. -., .. ` , _: =.,� . � Ejectors/sump ] 6.60
Name: 2,i V �ri rte. 4)0 -LP? _, YxG • Expansion tank 16.60
Address: ! e l 2 5 / t,/w i , ) , . 6 t . j o „ _ pr A 11- - c r Fixture/sewer cap 16.60
City/State /ZIP: P et v , 4.� v ( .� 71 o() L J Floor drain/floor sink/hub 16.60
Phone: (5-1/3 ) tl q_c - t) (p Fax: (CL ) i 0 - 2_q Li Z
Garbage disposal 16.60
:,. ',_:. ®, AI' IG , Hose bib 16.60
COI�`TrA PERSON; € , : s,,
; ,.- .3 - , pron>n �� . =�Li� �'E• ..,:.. ; ,r>~., a',.;,;i aasa< >: „--- , <�,F� Ice maker a'
'_ _,,. °3 rc 16.60
Business name: p .... ,- ; 1 ,.,,,,,,.., i 1 ,.,,,,,,.., i () F-i-1, r., 7,1)6_ Interceptor /grease trap 16.60
Contact name: At (_- c -Z - A4 - ", , A Medical gas (value: $ ) Page 2
Address: j G( Z j JVW y1 �, J { 1 , p i . L)1 f 7 0 Primer 16.60
City/State /ZIP: Roof drain (commercial) 16.60
Phone: Sink/basin/lavatory 16.60
( ) Fax:: ( )
Tub /shower /shower pan 16.60
E -mail: Urinal 16.60
a: a ';• - a- a ( ;u" .q
- '1 _ £ C,.... ' CT> _ v, Water closet
16.60
Business name: 3' f r pmt y t I 1 ' 4 ) c r, t i fib( v5 Water heater 16.60
Address: 2 S 05 • S • t:.) . A v ( 4-c_ b(. Other:
ty ` 02 '' Subtotal
Ci /State /ZIP: s q Ye p
_ Minimum permit fee: $72.50
Phone: (5 ) ow, - b 6s 7 Fax: (SC/ ) .?,7 Z - 95 Li 3 Residential backflow minimum permit fee: $36.25
CCB Lie.: /12 H ( Plumbing Lic. no.: 3 1 1 - 3-0 .p13 Plan review (25% of permit fee)
Authorized signature ...7 . G 64,( State surcharge (8% of permit fee) 9,r, TOTAL PERMIT FEE 3f jS
Print name: � `'
3o y12�'h�l � � j r � � ( Date: � - g -- Q J 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.
i:\ Building \Permits \PLM- PermitApp.doc 12/03 440- 46t6T(t0 /02 /COM/WEB)