Permit •
CITY OF TIGARD
PLUMBING PERMIT
COMMUNITY DEVELOPMENT PERMIT #: PLM2007 - 00253
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 6/19/2007
PARCEL: 1S134DB-07300
SITE ADDRESS: 11100 SW NORTH DAKOTA ST ZONING: R -4.5
SUBDIVISION: TORLAND ESTATES LOT: 011 JURISDICTION: TIG
PROJECT: TORLAND
Project Description: Install 4 zones irrigation (1) backflow preventer.
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
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Owner: FEES
TORLAND, MARY HANSON Description Date Amount
11100 SW NORTH DAKOTA
TIGARD, OR 97223 [PLUMB] Permit Fee 6/19/2007 $36.25
[TAX] 8% State Surcha 6/19/2007 $2.90
Phone : Total $39.15
Contractor:
URBAN LANDSCAPE
14845 SW MURRAY SCHOLLS DR.
SUITE 110 PMB #420 REQUIRED ITEMS AND REPORTS
BEAVERTON, OR 97007
Contact # : PR1 503 - 313 -0115 •
Reg #: PLM LCB 8445
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 or 1.800.332.2344. ,
Issued B % // Permittee Signature: J4 A L /,
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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Plut>tib><ns� Permit Aunl�cat�o>
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City of Tigard n a Lo ) 6 ) Sid Permit No.: pal Zc -002,5
13125 SW Hall Blvd., Tigard, OR 97223 U N 1 9 2007
• Phone: 503.639.4171 Fax 503.598.1 Other Permit No.:
1 I G n It D Inspection Lane: 503.639.4175 � Y OF TIGAI;ID Other
ReadyBy. H See Page 2 for
Internet: www.tigard- or.gov BUILDING DIVISION Notified/Method: �(1 Supplemental Information
TYPE OF WORK FEE* SCHEDULE
❑ New construction ❑ Demolition For spectral information use checklist
Description I Qty. I Ea. I Total
❑ Addition/alteration/replacement 1 Other A! 1 New 1- 2- family dwellings (includes 100 fL for each utility connection)
CATEGORY OF CONSTRUCTION SFR (1) bath 249.20
�1- and 2- family dwelling ❑ Commercial/industrial SFR (2) bath 350.00
( b 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: / )/00 (,J - 01 r , k e) -... Catch basin or area drain 16.60
City/State/ZIP: I , a r o 5,79.1 Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: V P roject name: Off/ 0. Lec Footing drain (no. linear ft: _) Page 2
/ Manufactured home utilities 110.00
Cross street/directions to job site:
Manholes 16.60
Rain drain connector 16.60
Sanitary sewer (no. linear R: _) Page 2
Storm sewer (no. linear ft: _) Page 2
Subdivision: I Lot no.: Water service (no. linear R: _) Page 2 <t.
Fixture or item
Tax map /parcel no.:
Absorption valve 16.60
DESCRIPTION OF WORK Backflow preventer / Page 2
-s ,I 1 1 -7.9-n s T r , Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
pt,LROPERTY OWNER I ❑ TENANT fountain 16.60
Ejectors/sump 16.60
Name: 7Th1 �B1��G Expansion tank 16.60
Address: / / / 0 J A ✓ l` • I), k® 'Y Fixture /sewer cap 16.60
City/ State/ZIP: --i- ' A , r ®' q n / Floor drain/floor sink/hub 16.60
Phone: C - ,vG (o35 Fax: ( ) Garbage disposal 16.60
APPLICANT ❑ CONTACT PERSON Hose bib 16.60
Ice maker 16.60
Business name: � lr jo 4 c) � c r°.__ R W Interceptor /grease trap 16.60
Contact name:
,
Contact q g Si) t `- Medical gas (value: $ ) Page 2
Address: l S sU ) infl✓�ci - S /1 /3 Pi`. -2�, d /) Primer
( commercial ) 16.60
City/State/ZIP: �.a tJ�rO 0 R q 79� Roof _
(.. 3 0 / � ( ) Sink/basin/lavatory 16.60
Phone: ) a , I ` Fax Tub/shower /shower pan 16.60
E -mail: Urinal 16.60
CONTRACTOR Water closet 16.60
Business name: 0 ,,,r) `� �� /}��' / Water heater 16.60 t
Address: 5 /,/)9 e v 7 er:
Subtotal
City/ State/ZIP:
Minimum permit fee: $72.50 e2 f . 7
Phone: ( ) Fax: ( ) Residential backflow minimum permit fee: $36.25 J !�
CCB Lic.: Plumbing Lic. no.: / 8 y Plan review (25% of permit fee)
Authorized signature: ' I ,f 1 9/ I , _ State surcharge (8% of permit fee) 2 .90
LI, , , TOTAL PERMIT FEE , 2� . I 5
Print name: U WIL- . t Date: ffiff% This permit application expires K a permit is not obtained within
180 days after it has been accepted as complete.
*Fee methodology set by Tri -County Building Industry Service Board.
CITY OF TIGARD
BUILDING DIVISION .. .. '' PERMIT #: PLM2007 -00253
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 6/19/2007
Phone: (503) 639 -4171 Ak
Inspection Requests (24 Hrs.): (503) 639 -4175 A F 'I �..
INSPECTION WORKSHEET FOR DATE: 6/22/2007 TIME: 7:03AM PAGE: 75
SITE ADDRESS: 11100 SW NORTH DAKOTA ST CLASS OF WORK:
SUBDIVISION: TORLAND ESTATES LOT #: 011 TYPE OF USE:
PROJECT NAME: TORLAND
DESCRIPTION: Install 4 zones irrigation (1) backflow preventer.
OWNER: TORLAND, MARY HANSON, PHONE #:
CONTRACTOR: URBAN LANDSCAPE PHONE #: 503- 313-0115
Inspection Request Scheduled For: Date: 6/22/2007 Pour Time 0 S
Code # Inspection Description Confirm # Contact # Message 4 1
399 Plumbing final 050728 -01 503-313-0115 Y :
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C i tons /Comments /Instructions:
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' VA PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
1!Ai a ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: ` 1 v v Date: (P1 f) / Phone #: (503) 718- 2-22
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