Permit C ITY OF TIGARD PLUMBING PERMIT
DEVELOPMENT SERVICES PERMIT #: PLM2006 - 00254
�� 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 6/2/2006
PARCEL: 2S109DD -07800
SITE ADDRESS: 15615 SW GREENFIELD DR ZONING: R -7
SUBDIVISION: BELLA VISTA LOT: 008 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 NE 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: j j _i_ Permittee Signature: C, Q,
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 Per Appl'r E IVED FOR OFFICE USE ONLY .
City of Tigard JUN 1 200 Received `' - i _ /1 [ ' 4 Pennit Nql M 7 et) ! l/V 5Y
13125 SW Hall Blvd., Tigard, OR 97223 Date/By: n l� D J/v� ` `vw G v v
Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 ti "1 ir .., ,ii ' Date/By: Other Permit No.:
24- Hour Inspection Line: 503.639.4175 CITY �F 3(`( r.4 1 I Y
Internet: www.ci.tigard.or.us BUILDING I -. Y --., D ate ReadyBy: t
D S Page 2 for
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Notified/Method:
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New construction ❑Demolition For special information use checklist.
Description Qty. Ea. Total
❑ Addition/alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
1 1 Vir i - C G60:10, CON01Tr * - a , ...V; -'
... 3 q SFR (1) bath 249.20
a 1- 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:
:,F °. < -:_°., .- _= ,,r �. Fire sprinkler( sq. ft.) Page 2
'
:�,; ' %;',,.. ?� JOB = r`ilu °"� O -Ali �OCAT1OIk1 a A _ ' ,',: 4 . -
<- ^.",,.-._ -x -_° < Site utilities
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Job site address: 1 C&I c 5 ( czeritcot,R. roVe Catch basin or area drain 16.60
City/State /ZIP: 7 a. , O e_ , a aL 4 Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: J �
I Project name: „a \ t Sko•, Footing drain (no. linear ft.: ) Page 2
-
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
l, ` Water service (no. linear ft.: ) Page 2
Subdivision: G e „ 6 Lot no.: g
Tax map /parcel no.: Fixture or item
" x$ ' 3:a .,,_ <; :_ -.., tt < Absorption valve 16.60
N< : - ` ,w - q T1UAFg'rW , ":1
' ac o eventer p 7
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Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
s f r Anti z; ,. mss= ::• :,c -' >; ', =i: „3. ;, ; .:: :<: ,- ... n; .,; a Drinking fountain 16.60
. A ®i PiZOP R S'OWNEi2 t "A. ,:.:, ` = ; ". ''T` 1� , 44 A 0 ` < ,
,. i ,' ^ ' x;,,,,- .:.:<$1:'3 � dks == is ?.. :.K; c. Y�%r' 3, � i= i .., , e .. i m ttw - , � , � f ..ata.�o::' ft �i . i � . .' s�`-'
}� °' E /sump ] 6.60
Name: l:.,i ✓- dji!i °Le. )-1'OYI?P , Expansion tank 16.60
Address: )6'1 2. S AAA/ A.7,116�4� ec ',_ - - 2. 0 1 ,- -) Fixture/sewer cap 16.60
City/State /ZIP: i).e v 7O0 L J Floor drain/floor sink/hub 16.60
Phone: (577 ) L 4 _ ()tj ca ( Fax: (c le -.2_q L,Z Garbage disposal 16.60
,, r �:..ti.,.n €; 16.60
:, , . - . ' �...Pi1'PI..IGJ_ T f- -" x ) " a . D. C-QN :V41E1 S 711;
Ice maker 16.60
Business name:. Li V"(JYf 1 r V yt '5 t 37. , Interceptor /grease trap 16.60
Contact name: At, Gi' .r72 Jv4 .A Medical gas (value: $ ) Page 2
Address: ( 25 -/\/VA( A , 6 . 4 . . „ . • 2 , , , ,) „ (�,- / pit jI� )7- Z oo Primer 16.60
City/State /ZIP: ti Roof drain (commercial) 16.60
Phone: ( ) I Fax:: ( ) Sink/basin/lavatory 16.60
Tub /shower /shower pan 16.60
E-mail:
Urinal 16.60
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>� -���,- x P �_� -�� ,� .j-. a,-.� �,� ^- s'. ^_.`.,. s. ,.*, .._?. at, ;�` m . ..0 Water closet 16.60
Business name: al T ( 4 14i I in r tlAlbf hcl Water heater 16.60
Address:. 2S 05 • S - (k/ . A v 5 t,''.4 L b,t . Other:
Subtotal
City/State /ZIP: 4 la■ k b y 7006
Minimum permit fee: $72.50
Phone: (5L' j ) o e - G65 7 Fax: (50 3 ) 3,7 2, - 95'1 3 Residential backflow minimum permit fee: $36.25
CCB Lie.: 1 q 2 (1 i Plumbing Lic. no.: 3 1/ - 370 pi)) Plan review (25% of permit fee)
7 6 State surcharge (8% of permit fee) 4,2' Authorized signatur ' ?� TOTAL PERMIT FEE 39 fs
Print name: ., � , J `� '
�3Q)1 r , ` '�� ` y� 8 j f � � � Date: � - � -- �j 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.
is\ Building \Permits\PLM- PermitApp.doc 12/03 440-46 16T( I 0 /02 /COM /WEB)
CITY OF TIGARD ' ., - poi / Zs
BUILDING DIVISION PERMIT #. 6
1
13125 SW Hall Blvd., Tigard, OR 97223 ATE ISSUED:
Phone: (503) 639 -4171 k m� ,, ° Npivu�hl)ii tk
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: G(-7„.67o 6 TIME: PAGE:
SITE ADDRESS: t (0 G rQ,Q4, 'Re, l. 8- CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME:
DESCRIPTION:
OWNER: PHONE #:
CONTRACTOR: PHONE #:
Inspection Request Scheduled For: Date: Pour Time:
Code # '" Inspection Descript Confirm # Contact # Message
-2 2q 61 ekk tnN 12 s ' - 11/■-.6 ,( -
Corrections /Comments /Instructions:
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A. PASS n PARTIAL APPROVAL ❑ CANCEL n NO ACCESS
FAIL n CALL FOR INSPECTION I I ADDITIONAL FEES ASSESSED
Inspector: Date: 1 U Phone #: (503) 718- 2Y2l