Permit t
CITY TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT PERMIT #: PLM2007 -00136
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 4/9/2007
PARCEL: 2S102DC -04100
SITE ADDRESS: 09252 SW HILL VIEW ST ZONING: R -4.5
SUBDIVISION: MCDONALD WOODS LOT: 014 JURISDICTION: TIG
PROJECT: MCDONALD WOODS
Project Description: Install residential backflow preventor 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
WESTVIEW CONSTRUCTION
PO BOX 230935 Description Date Amount
TIGARD, OR 97281 [PLUMB] Permit Fee 4/9/2007 $36.25
[TAX] 8% State Surcha 4/9/2007 $2.90
Phone : Total $39.15
Contractor:
TRUSCAPES INC
21600 NW ANBERWOOD DR.
HILLSBORO, OR 97124 REQUIRED ITEMS AND REPORTS
Contact # : PRI 503- 969 -2144
FAX 503 -531 -9216
Reg #: LIC PLUS BACKFL
PLM 7962
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 a •irec e.- tions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued = : Permittee Signature: iC
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.
Plurinbing Permit Application
R eceived y:
City of Tigard 'j 9 D7 J Permit No. / j7 &j/3i6
Y 13125 SW Hall Blvd., Tigard, OR 97223 Plan R
Phone: 503.639.4171 Fax: 503.598.1960 Plan Review Date/By: Other Permit No.:
T I G A R C3 Inspection Line: 503.639.4175 Date Ready/By: J�rjB See ge 2
Internet: www.tigard or.gov Notified/Method: lJ I Supplemental Information
TYPE OF WORK FEE* SCHEDULE
RNNew construction 0 Demolition For special information use checklist
Description I Qty. I Ea. I Total
❑ Addition/alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (1) bath 249.20
I- 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 ❑ Other:
Fire sprinkler ( sq. ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities
Job site address: 9 2 S (' 1k) LL \I ) Catch basin or area drain 16.60
City /State /ZIP: 'T16 ` �(,3� I 3t Cr) 3 Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: I Project name: l Footing drain (no. linear ft.: _) Page 2
Manufactured home utilities 110.00
Cross street/directions to job site:
Manholes 16.60
X Cla u Rain drain connector 16.60
Sanitary sewer (no. linear ft.: _ ) Page 2
Storm sewer (no. linear ft.: ) Page 2
C OON N) i� 0Oa r Water service (no. linear ft.: ) Page 2
Subdivision: 4 1 U V f off ' ill C! J I Lot no.: ' y
Fixture or item
Tax map /parcel no.: Absorption valve 16.60
DESCRIPTION OF WORK Backflow preventer Page 2
Backwater valve 16.60
I / li g A v 4' kw O t9 IC( Clothes washer 16.60
I'� Dishwasher 16.60
A PROPERTY OWNER I ❑ TENANT Drinking fountain 16.60
_ p �,,�/) ( Al jectors /sump 16.60
Name: A 0 v) o Ai uo J J W" C 1 O 11 Expansion tank 16.60
Address: )O - 70(3 ?C- -,2 je) C455" Fixture /sewer cap 16.60
City /State /ZIP: � 4 .- /L � c ,a_____ 9 7.g-/ Floor drain/floor sink/hub 16.60
-
Phone: ( ) Fax: ( ) ! Garbage disposal 16.60
' APPLICANT ❑ CONTACT PERSON Hose bib 16.60
r � e &S / r I �'
Ice maker 16.60
Business name: J Vl.
Interceptor/grease trap 16.60
Contact name: `, 9 E 1•1)‘4K., Medical gas (value: $ ) Page 2
Address: 2,1k N W k' 6 E PA U ®b D. Primer 16.60
City/State /ZIP: ).41 u„1 QgA p r 9'112, Roof drain (commercial) 16.60
Phone: ( '5b,) ` f q _ a , Fax:: ( 13) 5•31-7a)6 Sink/basin/lavatory 16.60
Tub /shower /shower pan 16.60
E -mail:
Urinal 16.60
CONTRACTOR Water closet 16.60
Business name: / Y "' S CO eJ t (.LC Water heater 16.60
Address: Other:
City /State /ZIP: Subtotal
Minimum permit fee: $72.50 / .`
Phone: ( ) Fax: ( ) Residential backflow minimum permit fee: $36.25 i
CCB Lic.: [4 - 7962 Plumbing Lic. no.: Plan review (25% of permit fee)
Authorized signature: 14 State surcharge (8% of permit fee) , • `ZU
TOTAL PERMIT FEE 3f• /C ."--
Print name: 1 - f J ' 1 I t N) N nc., Date: LI ., q,07 This permit application expires if a permit is not obtained within
180 days after it has been accepted as complete.
l
CITY OF TIGARD . - VO-17/667- bb ) 3 (e BUILDING DIVISION PERMIT #:
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED:
Phone: (503) 639 -4171
A R qm�� i#,
Inspection Requests (24 Hrs.): (503) 639 -4175 AL
INSPECTION WORKSHEET FOR DATE: 3 1 t 3/ 0 r TIME: PAGE:
SITE ADDRESS: 1a ' ) a 1/1 V 1 CLASS OF WORK:
SUBDIVISION: LOT #: 1 1 TYPE OF USE:
PROJECT NAME:
DESCRIPTION:
OWNER: PHONE #:
CONTRACTOR: PHONE #:
Inspection Request Scheduled For: Date: Pour Time:
Code # Inspection Description Confirm # Contact # Message
.-a g ' Ot A- -vi AN eDeu-;
Corrections /Comments /Instructions:
6 6 .A C 4- — AC__
___________T- gl-- — 0 ,
i t/ 0 7 6 7
l C
7
7
P r.-1 PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: L /l itV Date: 3 15 / 6 r Phone #: (503) 718-
1