Permit r
N CITY O TIGARD PLUMBING PERMIT
I DEVELOPMENT SERVICES PERMIT #: PLM2005 -00604
� 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 ----- DATE ISSUED: 10/27/2005
PARCEL: 1 S 135DA -03500
SITE ADDRESS: 11481 SW HALL BLVD ZONING: C -P
SUBDIVISION: LOT: JURISDICTION: TIG
Project Description: Install commercial backflow for irrigation system.
CLASS OF WORK: OTR GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS: 1
OCCUPANCY GRP: B 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
L N PROPERTIES, LLC Description Date Amount
.12725 SW 66TH AVE
PORTLAND, OR 97223 [PLUMB] Permit Fee 10/27/200f $72.50
[TAX] 8% State Surchari 10/27/200E $5.80
Phone : Total $78.30
Contractor:
BEAVERTON PLUMBING INC
13980 SW TUALATIN VALLEY HWY REQUIRED ITEMS AND REPORTS
BEAVERTON, OR 97005
Phone : 503 643 - 7619
Reg #: LIC 128892
PLM 34 - 4PB
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 -000 - 010 • ugh OAR 952 - 0001 -0100. You may obtain copies of these rules or direct questions to OUNC by
calling 03- 246 -669° • 1 -: 0 �i 332 -2344.
Issued y: � , 1 _' �L i . Permittee Signature: k 4-- 4. —`
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.
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Plumbing ferrmit Application . 0FFl('I l: I .\' ' •
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4 J - City of Tigar 1: q c ,B, Date received: // : D� Permit no. , , .. -GZJ ,,e• Sewer permit no Building permit no.:
Address: 13125 SW Hall Blvd, Tigard, OR 97223
City of Tigard Phone: (503) 639 -4171 Projectla 1. no.: Expire date:
(503) 598-1960 OCT •7 2005
Fax: PP p
( ) Date issued: By: Receipt no.:
Land use approval: CITY OF TIGARD Case file no.: Payment type:
:. , n VIS eN
O 1'& 2 family dwelling or accessory Commercial /industrial ❑ Multi- family CI Tenant improvement
CI New construction ❑ Addition/alteration/replacement ❑ Food service ❑ Other:
' 1011' l'I I I ■I'OR\l 's I I0\ ;I l - I..S('III 1)1 I I (for special infort.atinn`use checklist) `
Job address: , kkAg` s' k 'j vAc C)AvA Description Qty. Fee(ea.) Total
Bldg. no.: Suite no.: New 1- and 2- family dwellings only:
Tax map /tax lot /account no.: T G (.._° c (includes 100 ft. for each utility connection)
SFR (1) bath
Lot: 1Block: 'Subdivision: SFR (2) bath
Project name: tArA\ pKa SFR (3) bath
City /county: C'vni -4 I ZIP: Crinck Each additional bath/kitchen
Description and location of work on premises: Site utilities:
. 1-Q.r e'D f Z LPkes..L Catch basin /area drain -
Est, date of completion /inspection: Drywalls /leach line /trench drain
.. __, -- _ , . _ - Footing drain (no. lin. ft.)
' PIT N1'111 i O\ 1"It ∎( 1 Manufactured home utilities
Business name: ■iG'jc y Pt stM*It Manholes
Address: S . tl► '" , ., .. x k - ; I . ` Rain drain connector
City: ` c. ' 1[4., ZIP: 4 0 ,„. Sanitary sewer (no. lin. ft.)
Phone:(, -1 o %q Fax: (ytA3 1LD7,4: -mail: Storm sewer (no. lin. ft.)
CCB no.: 01ZiScct, I Plumb. bus. reg. no: ay, y PC3 Water service (no. lin. 11.)
City/metro lic, no.: Fixture or item:
�--- A - Absorptionvalve
Contractor's representative signature:, _4�, 1 preventer
flow reventer t !��
Print name: T1 - M► -i� , o, Backwater valve
CON I A( ' f Pl' llti( / \' • Basins /lavatory
Name: ' Clothes washer
Address: Dishwasher
Drinking fountain(s)
City: I State: I ZIP: Ejectors /sump
Phone: Fax: E -mail: Expansion tank
Fixture /sewer cap
Name (print): , c . ` ti A J. != Floor drains /floor sinks hub
Mailing address: Garbage disposal
Hose bibb
City: 1State: 'ZIP: Ice maker
Phone: 1 Fax: 1 E -mail: Interceptor /grease trap
Owner installation/residential maintenance only: The actual installation Primer(s)
will be made by me or the maintenance and repair made by my regular Roof drain (commercial)
employee on the property I own as per ORS Chapter 447. Sink(s), basin(s), lays(s)
Owner's signature: Date: Sump
Tubs /shower /shower pan
Name: Urinal
Address: Water closet
• Water heater
City: 1 State: 'ZIP: Other:
Phone: 1 Fax: 1E-mail: Total
Not all jurisdictions accept credit cards, please call jurisdiction for more information. Minimum fee $ Wa
Notice: This permit application
U Visa U MasterCard Plan review (at %) $
expires if a permit is not obtained]
Credit card number: Ex tr/ within 180 days after it has been State surcharge (8 %) $ e
p TOTAL $ `dig. 30
Name of cardholder as shown on credit card accep as complete.
$
Cardholder signature Amount
440-46l6 (6/00 /COM)
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CITY OF TIGARD
,
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BUILDING DIVISION. - ' " I PERMIT #: PLIVI2006-00E;04 \ I
13125 SW Hall Blvd., Tigard, OR 97223 . ' DATE ISSUED: 10/27/20Ik
Phone: (503) 639-4171 Amoinvil \l'il ON
Inspection Requests (24 Hrs.): (503) 639-4175 zdij.11. ,
INSPECTION WORKSHEET FOR DATE: TIME: PAGE:
SITE ADDRESS: 11481 SW HALL BLVD CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: L N PROPERTIES
DESCRIPTION: itali COmm.14..ciai bri:rillovy.for irrigation sysritirrk . ..,,,
OWNER: L N PROPERTIES, LI..C, . ,„ PHONE #: ----
CONTRACTOR: BEAVERTON PLUMBING INC PHONE #: 50.643-7619
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Inspection Request Scheduled For: Date: 10/31/2006 Pour Time:
• Code # Inspection Description , - ' Confirm # Contact # Message
326 RP/backflow prevent& 019769-0• Eia3.6 ¥
Corrections/Comments/Instructions: S
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St_l_PASS I I PARTIAL APPROVAL n CANCEL El NO ACCESS
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I FAIL I CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED
Inspector: l'i " L." Date:I / Phone #: (503) 718-
/ 7 •