Permit AA, CITY OF TIGARD PLUMBING PERMIT
DEVELOPMENT SERVICES
PE
DEVELOPMENT PLM2006 -00253
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 6/2/2006
PARCEL: 2S109DD -07700
SITE ADDRESS: 15635 SW GREENFIELD DR ZONING: R -7
SUBDIVISION: BELLA VISTA LOT: 007 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.
Issued By: — � 2 T1, 2E f��� Permittee Signature: ' g -,u c , o
` �
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.
Plumbing Permit A • 1' t� EN
V ED . .
. ,_ FOR OFFICE USE ONLY
City of Tigard / �l � Permit N.
13125 SW Hall Blvd., Tigard, OR 97223 ,JU 1 200', Date/By: / � � / lJ) �M� /� 1 aQ 45-5
Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 / . + Date /By: Other Permit No.:
24- Hour Inspection Line: 503.639.4175 CITY OF TIG ` a , ' 1(
Internet: www.ci.tigard.or.us G DI
...4.4,- ���. Date Ready /By: )arms: 10 See Page 2 for
BUILDING c I / Supplemental
aam�.z�.: -. - , � . .rte... s: <_ . -� f,«� a . ,��;�- M_�.:;:.. < =�-.x.,.< . gsx „,:� . V Information
Notified/Method: ormation
. €, . <; _ .'b' -.fir :'.•�.. ,
EE:: F H F
E7 WQRK: tEE SG Di7I;E
: ..._ , -..a.a ., ._<. - ..�d�.�t:��t- :He-.:y'a��. -: ��P �.__.r -. 'i �.,_. Aa•- . bt...� �._.u .._-- _���e`as -, ,. :>3 >s -.. ,... .- 'y`i�' �. _ �_.�F- a ^ <<::. .�.cn -. .v.��'.� � _:.:. -- �y�f�'il; , : z�- _ x
New construction ❑ Demolition For special information use checklist
Description I Qty. Ea. I Total
❑ Addition/alteration/replacement ❑ Other: New 1 - 2- family dwellings (includes 100 ft. for each utility connection)
yy V , , ` ` - -s-' ;, y°:' •t::: s :. .� A"., f "#t -x,;. : s ,.-- ..'.<:-;,.,KY,q, 1, _..x a-� x `
-y �
CATPIGOR]"QF CONSTRiail N '' 0 �` ` 1 i
rta• SFR (1) bath 249.20
.�'= a.::,,:,_. _ _. , x:aa - �,tt�•` _s;a;�%a;n -�.. �.z .:c3a. >.=.' aF: c ,,�
N 1- and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 350.00
El Accessory building ❑ Multi - family SFR (3) bath 399.00
1=1 Master builder Each additional bath/kitchen 45.00
❑ Other:
,v :... x:.K�s s.; ,,.,.:.. Fire sprinkler ( sq. ft.) Page 2
a ; _ ,. , :IU Ii a i tir 1NFORItiiATi R AND LOC iii6i '`r "'x ,. � ,;: :Ana
3;
i' <t .r ` -..� ',.. 'mi7 ti ff u_Z__.z -s 6a,.;r;� °,.A:;° .:.��, ,7 �,,, _ -mJ ^_`t�r. . 4a/,,, ' S ut
Job site address: I S63 7 S W (r rces-4 y `�' 1 a f i,e Catch basin or area drain 16.60
City/State /ZIP: 71/4 p ay.�+{ «..r. �
De. , a � L.` Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: J it Project name: ,1 \tt 5 ci„, 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
Subdivision: eA\ \f I Lot no.: Water service (no. linear ft.: ) Page 2
Fixture or item
Tax map /parcel no.:
Absorption valve 16.60
,, ! €, . rc a_ i, - - „ :: _:; D ESCR I PT?IQN F WORT{ � .4 �. _ ; ! I C =-r : ,; ;. '.,,,. „,
F.. ,,;:e, , , Y.<, . - .:... ., - /I ° B ac kfl ow preventer p Page 2 , ( t
Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
.. .., Y, _ .;- ;,r- a Drinking fountain 16.60
y .R., .RUPERTi'�•�O ER:. '.'t,: 4 �i �fyj,;�.r a., q ♦:MT g,,,,.u.`_Il': %. ;:
i
:�.,... .. - - , p - -, ~��;�.�,. < ':.�:E Ejectors /sump 16.60
Name: V.�iYSI rle.. tiUl'1.4.PS Y /'?e.: • Expansion tank 16.60
Address: !Gt 5 ,V(4/ k ii t yi _ A .- zi + e „,_ f y-V,,y� if o 6) Fixture/sewercap 16.60
City/State /ZIP: be� V .�. y. q 100 L Floor drain/floor sink/hub 16.60
Phone: 673) C , �c - (.) to Fax: (s 6 ) ( 0 -- Zcl 4-12- Garbage disposal 16.60
,,,,,,,,,„„ ',y' " „,. ;r, , ,, ;,t. ti * , a ; t ` .� p,, r .f . r ;: Hose bib 16.60
. .; . C : = PERS ^..�x « ..
`�` � � � � � Ice maker 16.60
Business name: L ,/,p irZi rie. H-rnte `-� ;
�'
A-1., 1'iG Interceptor /grease trap 16.60
Contact name: - 1. , C4 Sc�Z ✓vL� Medical gas (value: $ ) Page 2
Address: [ ( 2 j AAA/ ) �'1 )0.--_ ` , P 1 J 7°0 Primer 16.60
City/State /ZIP: ' Roof drain (commercial) 16.60
Sink/basin/lavatory 16.60
Phone: ( ) J Fax:: ( )
Tub /shower /shower pan 16.60
E -mail: Urinal 16.60
` ,,, r te= w, : pa 3 , � :x. � - - I
;. '.. -i': :' .f OIYTR�A ,TWA'g ` ,,, ?< . ". a ;1,9. n z'
���,., s�,° .f � -� x ,, r. =� * -� ; Water closet 16.60
Business name: J`j-v I I c_ l(V yl b; YI5 Water heater 16.60
Address: ''S D5 . S . w' . -A u �-,
j - - V► ` • Other:
City/State /ZIP: 4 tC , O v. 7006 Subtotal
Minimum permit fee: $72.50
Phone: (5't ) OQ, - Co 6s 7 Fax: (SD ) �7 M. - 95`1 3 Residential backflow minimum permit fee: $36.25
CCB Lie.: j Y 2 (( ( Plumbing Lic. no.: 3 Li - 37o )) 6 Plan review (25% of permit fee)
Authorized signature�� G� State surcharge (8% of permit fee) • m
TOTAL PERMIT FEE 3 /.5-
Print name: 3 v 8 ft I ( Date:: - e -. 075 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 -4616T(10 /02 /COM/WEB)
CITY OF TIGARD
BUILDING DIVISION PERMIT #: PUN/12006-00253 13125 SW Hall Blvd., Tigard, OR 97223 / DATE ISSUED: 617J2006
Phone: (503) 639 -4171 zwip 1 )(j*
Inspection Requests (24 Hrs.): (503) 639 -4175 _. __..
INSPECTION WORKSHEET FOR DATE: 9/13/2007 TI i • .01AM PAGE: 63
SITE ADDRESS: 15635 SW GREENFIELD DR CLASS OF WORK:
SUBDIVISION: BELLA VISTA LOT #: 007 TYPE OF USE:
PROJECT NAME: BELLA VISTA
DESCRIPTION: Bac:kflow preventer for irrigation. 9/4/2007 Reinstated for (30) days for final inspection.
OWNER: RIVERSIDE HOMES, INC., PHONE #: 503-645-0996
CONTRACTOR: STREAMLINE PLUMBING PHONE #: 503 -8086 -6667
Inspection Request Scheduled For: Date: 9/13/2007 fevr` Pour Time: tN
Code # Inspection Description , Confirm # Contact # Mz-:sag=
399 Plumbing final 056545 -01 971 - 246 -1996 Y f � S ` n
Corrections /Comments /Instructions: W� 'Z f.
1,
(
(: j' C/.- I
, 7.„,
k ykss PARTIAL APPROVAL ❑ CANCEL NO ACCESS
FAIL ❑ CALL FOR INSPECTION I ADDITIONAL FEES ASSESSED
IX Inspector: - Date: 01 1 0 Phone #: (503) 718 - 2 Sf Z '