Permit CITY TIGARD PLUMBING PERMIT
.,' DEVELOPMENT SERVICES PERMIT #: PLM2005 -00001
' 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 1/3/2005
SITE ADDRESS: 09763 SW LANDAU PL PARCEL: 1S125CD -06600
SUBDIVISION: LANDAU WOODS ZONING: R -4.5
BLOCK: LOT: 003 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, residential.
FEES
Owner:
Description Date Amount
BULL, PATRICIA RENEE
9763 SW LANDAU PLACE [PLUMB] Permit Fee 1/3/2005 $36.25
TIGARD, OR 97223 [TAX] 8% State Surcharl 1/3/2005 $2.90
Total $39.15
Phone : 503 452 - 8483
Contractor:
JOY CREEK NURSERY
20300 NW WATSON RD.
SCAPPOOSE, OR 97056 REQUIRED INSPECTIONS
P RP /Backflow Preventer
Phone : 503 549 1414
Final Inspection
Reg #: PLM 6774
LIC ALL PHASE + BAC
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 18.0 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 Permittee Signature:
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the A bu - • :y
12123/2004 08:20 FAX 5035981960 CITY OF TIGARD t. II 001
RECEIV: .1) ,
PlAffib121tf: Permit Application . :ird,or.us FOR USE O NLY - •
City of Tigard I 20 D".".;, /- ?,- 05 s�j PemhtNo�� _ 0000 / 13125 SW Hall Blvd., Tigard, Oft 97723 P tan Review
Phone: 503.639.4171 Fax: 503.598.1960 ti „9�y },i . - :
CIT T�
IT .- Ctt,ei PermitNo.:
24- Hour Inspection Line: 503.639.4175 . . 7 j .=.
IZead 7w
tnternct: www,Ci.ti ' •� a; ® see Page 2 for
$ e .sa f L+'; 1 ethod: 7/' Supplemental Information
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❑ New aonstt'uc5prt [] Demolition
For special information use checkti 4
Description � Qty. 1 Ea. Toed
Q Addition/alteration/replacement ® Oth 2 dwellings (includes ft. connection)
I 1 - each ,...LI,...w. I� .." �� ' i! ., ,. It1. 1 i.:; '1' "rl:�:i;'l'.•j;;', .... R {i for c 2492 T
'�' r• New 2 - famil d 'n i 100 f utility c 'an
kJ ;I 5F ) bath 4
k74 1 - and 2 - family dwelling 0 Commercial/industrial SFR (2) bath . 350.00
Q Accessory building - j] Multi - family
SFR (3) bath 399.00 ,
Master builder 0 Other: _ . Each additional batl lleitchon 45.00 '
O rut sprinkler ( sq. It) Page 2 •
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, i . , . . _ ' , ,. .. Site
^ . .ne utilities
Job site add ress: q - 6 23 S W LAN Y> l Q. L Ac F Catch basin or area drain 16.60
City/State/ZTP: J (, A2A f - q 1--2. 3 Drywell. leach line, or trench drain 16.60
Suite/bldg./apt. no.: Project name: Footing drain (no_ linear ft.: ) Page 2
Manufactured home utilities t 10.00
Cross street/directions to job site: Take �S l.f' / � � )
Manholes 16.60 •
L.c r of a tt.. Ti k.ri'1 on I.,Gu c Q'•l -C- Pic4ce. Rain drain connector 16.60
-T { Sanitary sewer (no, linear ft.: ) Page 2
Storm sewer (no, linear ft.: _) Page 2
n
t
W service (no. linear ti. __) i Pagc 2 -_
Subdivision: Lot no.: ..-- .-...1
Tax map/parcel no.: Fixture or item
.. ''''.1:;:'..::: Absorption valve 16.60
,:, :;iD.!SC Jt$'O'R! VY `i 2
... :..:.. .. : . 1i',...... ,. ,�,•, .� f : :::''�..: Pages
'.`.::;: ::;: �. � • ' ; L .:. 5 . � �'.: , . ' � ; ` s.:!I Hackilow preventer
c5i Ct G(.h` (7 oc j1.J ci (t--4 Lo ipL
re_' i1-L Backwater valve 16,64 ,
o �,'1 L � 1 Clothes washer 16.60
l/ Dishwasher 16.60
' n w .` '„ .i ( Prinking fountain 16.60
• tti '1 41 ; JR ' •:'i'':'.' ! j :,.; ',1 : ,:; „ :,!I Iii,
..• .. .......... ... �tl- .I�T 1 rs urrtp 1660
F /s
Name: - ( Expansion tank 16.60
Address: 1-/ed 50 LCe )C Ce(u- rl eeG ei Fixture/sewer cap 16,60
City /State /ZIP: t a rd. , p e 7 a a 3 Floor drain /floor sink /hub 16.60
Phone: (�3) 4 ‘31-1-g.3 Fax: ( ) Garbage disposal 16,60
:q: I i . ,; , 1 iI! ;ip. i., i , f : • •••• . Bose bib 16.60
ill'1!3:l :
: iClr ;; l k l:. 'ri lgi:! R'' . ®..• -Cu a''1*i :!A 4$il•'!!''' ..:
li ifTY"r : Tt R;' Lh, I!: , r I: I: lee maker 16.60
Business name: G(ee K �t/l f r�5 P_r�� interceptor /grease trap 36.60
4 Contact name- R aeon . LOL d z e C Medical gas (value: $ ) Paso 2
E Address: 7-03(1) ,4)) llikon see Primer 16.60
City /State /ZIP: 3ccuppo J 02, 9 to Lo Roof drain (commercial) ..+
Phone: (,5Q3) 5 4'3' 4 i Fax: : (5 ) 513 - [Qcf33 Sink/basin/lavatory 16.60
Tub/shower /shower pan 1 6.60
E -mail:
Urinal 16.60
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Business name :S 3 b y Ju - ee.L l- ), j /s}- ei__er C.c L `�-( ) •Qts Water heater 16.60
Address: a a2. -ct. Other:
• 5c_ &pp Did, Gf -c€" Co. : 72.0
G't /StatrJZ]P: �,� r Minimum perm f ee: 572.50 /
Phone: (5 5 ) U • - L} - 4. 4 Fast: ( ) 04 - (-0 3- Residential backflow minimum permit fee: $36.25 3(0. dZ 5
CGl3 Lic-: LOP to - 9 LI f.Z/Ai 06- ,Plumbing 7Lic- n4. ' 5-1`37-- Plan review (25% of permit fee)
7 S tate surcharge (8% of permit fee) ..• 90
Authorized signature:
te e: Eo ivir i_ Ll 1 TOTAL PERMIT FEE .j' I `7
Flint nano: ` a A • • _ LL ( _ Date: i 2 D This permit application expires if a permit is not obtained withtn
- -
180.days.af ter -it- has•been.accepted -as- complete.
• "Fee methodology set by Tri- County Building lndastry Service Board.
i:\ BuitdinenIlniulPLM -t'trmlIAtro400 t ✓ea 440-461 CiT(10/02./COMAVEB)
CITY OF TIGARD
BUILDING DIVISION PERMIT #:gym aao S 2'�cvpo 1
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED:
Phone: (503) 639 -4171 . °i rmnlN�ij � l
Inspection Requests (24 Hrs.): (503) 639 -4175 �
INSPECTION WORKSHEET FOR DATE: 3 - TIME: PAGE:
SITE ADDRESS: q 76 f2-- CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME:
DESCRIPTION:
OWNER: ` PHONE #:
CONTRACTOR: PHONE #: S(.{3 -- (4 7 e"
Inspection Request Scheduled For: Date: Pour Time:
Code # Inspection Description Confirm # Contact # Message
3a- 56t - /
Corrections /Comments /Instructions:
(9/ 941I . ' ,,,,,,---,-;.,:._
_ _P ASS_ n_PARTIAL_AP_P_ROVAL Q- CANCEL n- NO- ACCESS—
FAIL CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED
Inspector: % Date: //77P Phone #: (503) 718 -