Permit a - CITY OF 1 IG
PLUMBING PERMIT
° COMMUNITY DEVELOPMENT PERMIT #: PLM2007 -00419
T I G A R D DATE ISSUED: 9/14/2007
13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 PARCEL: 2S110DD - 90571
SITE ADDRESS: 10840 SW MEADOWBROOK DR 57 ZONING: R -
SUBDIVISION: SUMMERFIELD BROOKSIDE CONDO LOT: 057 JURISDICTION: TIG .
PROJECT: SUMMERFIELD BROOKSIDE CONDOS
Project Description: Remove and replace backflow device. (Located in planting bed in front of 10840 SW
Meadowbrook, unit #57)
CLASS OF WORK: OTR GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: MF 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
SUMMERFIELD BROOKSIDE CONDOS
2105 SE NINTH AVE Description Date Amount
PORTLAND, OR 97214 [PLUMB] Permit Fee 9/14/2007 $72.50
[TAX] 8% State Surchart 9/14/2007 $5.80
Phone : 233 - 0300 Total $78.30
Contractor: •
WILLAMETTE LANDSCAPE SERVICES, INC.
18480 SW PACIFIC DR •
TUALATIN, OR 97062 REQUIRED ITEMS AND REPORTS
Contact # : PRI 503- 625 -9600
FAX 503- 625 -9714
Reg #: LIC 6949
•
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 rul- - : : orth in OAR 952- 0001 -0010 through OAR 952 -0001 -0100. You may obtain copies of these rules or direct questions to OUNC
by ca . g 503.246.66• ° • r 1.800.332.2344.
Iss • ed By: 4....INA: � I _ Permittee Sin iu z flini
1
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.
V Sep. 13. 2007 1:49PM WILLAMETTE LANDSCAPE SERVICES No. 0481 P. 2/3
(
Plumbing Permit Applic . ' i n
City of Tigard R�
` EV
Daiemy; p Ili •, t / /� Q 7 PennitNo.: 7��//7
13125 SW Hall Blvd., Tiga ' Plan Review
e Phone: 503.639.4171 Fax: 503.598.1960 Other Permit No.:
S� 1
Inspection Line: 503.639.4175 p 3 2007
Dale/By: tRe
T I ; A is F) 1 e7 Dale Ready/By: real El See Page 2 for
Internet: www.tigard•or.gov / _3` p Notifed/Method: Supptemenlat forme Iion
• TYPE ti ', of 1�.j • - :. • . FEE!.'SMEP OLE . . • .
•
El New construction . �; For special information use checklist.
e '.31� �l De p j I Qty. I Ea. -
I natal
X74, Addition/alteration/replacement • Other: New I- 2- family dwellings (includes 100 ft. for each utility connection)
CATEGORY OP CONISTRIICTION = SFR (1) bath 249.20
El I- and 2- family dwelling El Commercial/industrial , SPIt (2) bath 350.00
El Accessory building ,Multi- family SPR (3) bath 399.00
Each additional balh/kitehen 45.00
❑ Master builder El Other:
Fire sprinkler sq. ft.) Page 2
. JOB SITE INFORhIAT100.#1D LOCATION
��- • • • Site utilities
Job site address: 0 3 c g,,,..) 1 4J' e , Q k e _ Catch basin or area drain 16.60
City /State/ZIP: "C c4AP A l OR e( 1 Tai-I Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no. 57 Project name- Footing drain (no. linear ft.: ) Page 2
Cross etreet/directions to job site: - H € b , i .E , 7.. Manufactured home utilities 110.00
Manholes 16.60
Rain drain connector 16.60
toe,.) 1 :.►1ae ' is : . _ _ _, a Sanitary sewer (no. linear ft.: ) Page 2
lVU►.c� Woe.. S''15 }ct''^'� Storm sewer (no. linear ft.: ) Page 2
Subdivision: I Lot no.; Water service (no, linear ft.: ) Page 2
n 9a221.)
fixture or item
Tax map /parcel no.: /d D- Absorption valve 16.60
. BESCR1PTION OF WORK. • • .. • - _ -_ Beckflocv preventer 1 Dal
I.OVUE 0 O
T E O�Me� Ye. • t ea.tt - k t ', t ., ,. r, 1_ , !-_•• Backwater valve 16.60
iek1Gc3 i Dr ".4gel it,� vO:M (,,�],Qw1•:vAc, Iry Z H -rv I1v� E Clothes washer 16.60
ir
ta1G `q} id ? �. `� J Dishwasher 16.60
i .. Drinking fountain 16.60
• -1 •. •, • iii P ROPERTY OWNER • I .• _� •TIE:NA .
Ejectors/sump 16.60
Name: Doti\ve ;. ncaiwr C of "-y %MAVineye.v) , -N Expansion tank 16,60
Addres :;t c N .� _ Fixture/sewer cap 16,60
City /State/ZIP: pi t criti e .1011 `I Floor drain/floor sink/hub 16.60
Phone: (•a•3 ) a3. _ a3oa I Fax: ( ) Garbage disposal - 16.60
• . Hose bib 16.60
• '.W AIPPLICANT • • .0 Cijiim T 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
Phone: ( ) I Fax: : ( )
Sink/basin/lavatory 16.60
Tub/shower /shower pan 16.60
E-mail; Urinal 16.60
..' •t CONTRACTOR , •
• Water closet 16.60
Businessname: g Q I,eltMitjPrefP ntlltl :C.. 114r Water heater 16.60
Address; qrq%) S GS Pe.(z4tc Or Other:
Subtotal
City/State/Z1?: l tee. I,,t ltn (}try c,t.. `nab ;�
1 � � Minimum permit fee: $72.50
Phone: (%403)6a5 ., q (0 Loo pax' 6 0 - 5 ) 6, -- c N Residential bacldlow minimum permit fee: $36.25 7a • 50
COI Lie.: L4 (5 # 6 Li C Plumbing Lic. no.: Plan review (25% of permit fee)
State surcharge (8% of permit tee) s
Authorized signature:
.. ,��
L L a TOTAL PERMIT FEE
Print name: J6- e , „v Date:Bc1 I 1 10 7 This permit application expires if a permit is not obtained within
( 180 days after It has been accepted as complete.
*Pee methodology set by Tri -County Building Industry Service Board.
I:\Bd lding'Pennit5PiM- PermicApp4oe 06/26106 440- 4616T(I0/Or/COM/WEB)
CITY OF TIGARD - •
BUILDING DIVISION PERMIT #: PLM2007 -00419
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 3/14/2007
Phone: (503) 639 -4171 #141it
Inspection Requests (24 Hrs.): (503) 639 -4175 ..
INSPECTION WORKSHEET FOR DATE: 11/6/2007 TIME: 7:00AM PAGE: 66
SITE ADDRESS: 10840 SW MEADOVUBROOK DR 57 CLASS OF WORK:
SUBDIVISION: SUMMERFIELD BROOKSIDE CONDO LOT #: QJ7 TYPE OF USE:
PROJECT NAME: SUMMERFIELD BROOKSIDE CONDOS
DESCRIPTION: Remove and replace backflow device. (Located in planting bed in front of 10840 SW Meadowbrook,
unit #is57)
OWNER: SUMMERFIELD BROOKSIDE CONDOS, PHONE #: 2330300
CONTRACTOR: WLLAMETTE LANDSCAPE SERVICES, INC. PHONE #: 503 -625 -9600
8
Inspection Request Scheduled For: Date: 11/6/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
399 Plumbing final 059051 -01 503.572 -842.7 Y
Corrections /Comments /Instructions:
DP t. /∎<
C otet. 94,t)
•
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: 11 Date: I I i C. 10) Phone #: (503) 718-