Permit CITY OF TIGARD
PLUMBING PERMIT
� r DEVELOPMENT SERVICES PERMIT #: PLM2005 -00030
VIII 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 1/26/2005
SITE ADDRESS: 09720 SW LAKE SIDE DR PARCEL: 2S111CA -04300
SUBDIVISION: SUMMERFIELD NO.12 ZONING: R -7
BLOCK: LOT: 663 JURISDICTION: TIG
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
Remarks: Backflow preventer.
FEES
Owner:
Description Date Amount
PRUETT, FLOYD W TRUSTEE
PRUETT, MARGARET C TRUSTEE [PLUMB] Permit Fee 1/26/2005 $36.25
9720 SW LAKESIDE DR [TAX] 8% State Surchan 1/26/2005 $2.90
TIGARD, OR 97224 Total $39.15
Phone:
Contractor:
SIGNATURE LANDSCAPE
PO BOX 304
TUALATIN, OR 97062 REQUIRED INSPECTIONS
P RP /Backflow Preventer
Phone : 503 673 0252
Final Inspection
Reg #: PLM 6195LCB
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.
Issued By: r�� Permittee Signature:
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed e next business day
ti
.`
Plumbing Permit Ap I ; ; ti 'VEDA FOR OFFICE USE ONLY
City of Tigard Received /
JAN 19 2005. DateBy: / � O 6�
3,2,...51....... Permit No.: � j j . O
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 /4^r4 ( Date/By: Other Permit No.:
24- Hour Inspection Line: 503.639.4175 J
Internet: www.ci.tigard.or.us CITY OF TIGA " ="' "" D ate R ea d y B y: H See Page 2 for
Notified/Method: 1 Supplemental I nformation
.
FEE* SCHEDULE
❑ New construction ❑ Demolition For special information use checklist.
Description 1 Qty. I Ea. I Total
VIL ❑ Other: New 1 - 2 - family dwellings (includes 100 ft. for each utility connection)
' CATEGORY OF CONSTRUCTION SFR (1) bath 249.20
❑ 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: Fire sprinkler ( sq. ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities
Job site address: ' a 0 G,k !1;:e S rd e a Catch basin or area drain 16.60
City/State/ZIP: -1-tI ` �•Ad 0�2����3 Drywell, leach line, or trench drain 16.60
� "
Suite/bldg. /apt. no.: `J I Project name: Footing drain (no. linear ft.: ) Page 2
street/directions to job site: q G 7i Manufactured home utilities 110.00
Cross street/directions 0 A ,S e. c):11 4t , Manholes 16.60
Rain drain connector 16.60
Sanitary sewer (no. linear ft.: ) Page 2
Storm sewer (no. linear ft.: ) Page 2
Son: '� / / I Lot no.: Water service (no. linear ft.: ) Page 2
ubdivisi
- SLt u�►m�f
ar cel no.: Fixture or item
Tax map /p
Absorption valve 16.60'
DESCRIPTION OF WORK Backflow preventer I Page 2 3 2 t
/
- I C{ - , • ••/) /li' O.S / '�P. �` +C j 'Ct /' it � °U +Cpe A Backwater valve • ' 16.60
cl p ji-4 Gr -44) V 0 atii le (") Pr �/l/ 4.r' X ar. 74- '(o.., Clothes washer 16.60
�l// v PA,.. 0 Dishwasher 16.60
Y 9 Drinking fountain 16.60
5/PROPERTY, OWNER I ❑ TENANT
//
5 PROPERTY, 16.60
Name: Fly d 4' t!,' -6 f Expansion tank 16.60
Address: -7 'Z 0 G _ e . e iar Fixture /sewer cap 16.60
City/State/ZIP: ''f%r/ a d �� 7 ,.3 Floor drain/floor sink/hub 16.60
z
Phone: ( y . r F ax: ( ) Garbage disposal 16.60
�`aL� Hose bib 16.60
,❑ APPLICANT ❑ CONTACT PERSON
Ice maker 16.60
Business name:
Interceptor /grease trap 16.60
Contact name: Medical gas (value: $ ) Page 2
Address: Primer 16.60
City/State/ZIP: Roof drain (commercial) 16.60
Sink/basin/lavatory 16.60
Phone:
( ) I Fax:: ( )
Tub /shower /shower pan 16.60
E -mail: Urinal 16.60
CONTRACTOR Water closet 16.60
Business name: nam /
- � cm � E7/`O`S' cafe Water heater 16.60
Address: _ t c%: AK 3 Off, Other:
City/State /ZIP: p d , U (' Z
Subtotal
7-44A j ! Minimum permit fee: $72.50
Phone: 02;1 ) 6 •7 e 2 ✓c-2 Fax: 927) 67 6 jyz Residential backflow minimum permit fee: $36.25 tv 36 2 r
CCB Lic '3 ` g
Plumbin Lic. no.: • - Plan review (25% of permit fee)
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i
Authorized signature: State surcharge (8% of permit fee)
.1 rL B AFL. TOTAL PERMIT FEE .r I L . ) i
Print name: / y - O 41 ... _ t7.M I c i--t Dater / 7 0-- This permit application expires if a permit is not obtained within
✓✓ 180 days after it has been accepted as complete.
*Fee methodoloev set by Tri- County Buildine Industry Service Board.
CITY OF TIGARD 24 -Hour ..
BUILDING Inspection Line: (503) 639 -4175 MST
INSPECTION DIVISION Business Line: (503) 639 - 4171
BUP •
Received Date Requested 2 AM PM BUP _
Location q7 go 1_ I e 5-i's Suite MEC
Contact Person Ph
( ) /3 - 0,95 — . 1 , .S— 0o03,
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation ELC
Access: - -
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Fire Sp 4--. Fire Sprinkler � � �� — _—', - ��
Fire Alarm �� . / K �a/�
Susp'd Ceiling tr.
Roof
Other:' J
Final — V k------
T FAIL
eam
Under Slab 0
Rough -In (2.
Water Service
S
/
anitary Sewer # ! J - d `/'
Rain Drains J � '
Catch Basin / Manhole
Storm Drain
Shower Pan
O ,, ,. ll
.ieri i �l�
0
Fi / _ ,�// J
FAIL 1 1/ � /
HA AL , , .. vv I��' 4
Post & Beam 1
Rough -In
Gas Line
Smoke Dampers (� '
Final •
PASS PART FAIL
ELECTRICAL ` :,''
Service
Rough -In
UG /Slab
Low Voltage
Fire Alarm
Final 0 Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE - ❑ Please call for reinspection RE: E Unable to inspect - no access
Fire Supply Line
ADA 6 //�/� /
Approach /Sidewalk Date (( Inspector ! (�� Ext
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL