Permit C ITY OF TIGARD PLUMBING PERMIT
PERMIT #: PLM2006 -00249
� DEVE H B ME N 9 r S o ERV 2CES -639 -4171 DATE ISSUED: 6/2/2006
PARCEL: 2 S 109 D D -07 300
SITE ADDRESS: 12790 SW REMBRANDT LN ZONING: R -7
SUBDIVISION: BELLA VISTA LOT: 003 JURISDICTION: TIG
Project Description: Backflow preventer 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
RIVERSIDE HOMES
1925 NE AMBERGLEN PKWY #200 Description Date Amount
BEAVERTON, OR 97006 [PLUMB] Permit Fee 6/2/2006 $36.25
[TAX] 8% State Surcha 6/2/2006 $2.90
Phone : 503- 645 -0986 Total $39.15
Contractor:
STREAMLINE PLUMBING
2505 SW AUGUSTA DR.
ALOHA, OR 97006 REQUIRED ITEMS AND REPORTS
Contact # : FAX 503- 379 -9543
PRI 503- 888 -6657
Reg #: LIC 142111
PLM 34 -370PB
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 By: .!/ Permittee Signature: ,fie.
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.
•
• ' Plumbi Per Application FOR OFFICE USE ONLY
13125 SW Hall Blvd., Tigard, OR 97243`E Date/By: �/�A< 126) PemutNOT v 406 otzZ / /
Plan Review
Phone: 503.639.4171 Fax: 503.598.19601 ` u N I 2006 .)• +I\ Date/By: Other Permit No.:
24- Hour Inspection Line: 503.639.4175 .�^ � ±'_ Date Ready/By: t�s El See Page 2 for
Internet: www.ci.tigard.or.us CITY OF 7IGA a Notified/Method: - 1 .-- 1 fr Supplemental Information
TY{� IVISION FEE* .SCHEDULE
New construction ❑ 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
a 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: 12 qq 0 s VS Re �
�A,A- � Catch basin or area drain 16.60
City/State/ZIP: 71 pa , D e. - n a I) Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: J I Project Hamer „a \t SkN, 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 ft.: ) Page 2
Storm sewer (no. linear ft.: ) Page 2
Subdivision: e " A V `i I Lot no.: Water service (no. linear ft.: ) Page 2
Fixture or item
Tax map /parcel no.: Absorption valve 16.60
DESCRIPTION OF 'WORK . b `
Backflow preventer I Page 2 34 t
Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
Drinking fountain 16.60
❑ PROPERTY OWNER ❑ 'TENANT
1 1 Ejectors /sump 16.60
Name: 12..:1 VeA - r-, l !. 44(TYVI.QS , -'-,')C • Expansion tank 16.60
Address: k il/w kw' A .- ah a j # - ?- D t -- ) Fixture/sewer cap 16.60
�eh
City/ State/ZIP: (4v') pc_ '4-700(c Floor drain /floor sink hub 16.60
Phone: `5 ) tp (4 6 - be. cit, �P Fax: (S'd iv/D -Z9 Li Z Garbage disposal 16.60
❑ APPLICANT ❑ CONTACT PERSON Hose bib 16.60
Ice maker 16.60
Business name: EA V N 1 ( L e H ryl t1 S T' , Y1 - • Interceptor /grease trap 16.60
Contact name: At C.; i)c-yt- r, , , Medical gas (value: $ ) Page 2 /VW Aryl ` `' g
Address: i o 2 Primer 16.60
City/ State/ZIP: Roof drain (commercial) 16.60
Phone: ( ) Fax :: ( ) Sink/basin/lavatory 16.60
Tub /shower /shower pan 16.60
E -mail: Urinal 16.60
CONTRACTOR Water closet 16.60
Business name: .; r pa, oi 1 in c 1:)) v yyl lp; v15 Water heater 16.60
Address: 2S OS . S • W - A u v 4. , br . Other:
City/ State/ZIP: 4 U4 cl O� y 700
Subtotal
Minimum permit fee: $72.50
Phone: (5 OM - 1p 6s 7 Fax: (5b ) 37 2 - 95 3 Residential backflow minimum permit fee: $36.25
CCB Lic.: t Y 2 (I I P lumbing Lic. no.: 3 N - 3'70 p e Plan review (25% of permit fee)
6 State surcharge (8% of permit fee) .Z 9 2
Authorized signatu 6 9 , is
TOTAL PERMIT FEE J �..,
Print name: Z v‘, 8f Date: 2 - e-05-
- Q j This permit application expires if 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.
i:\ Building \Pefmits\PLM- PnmitApp.doc 12103 440-4616T(10 /02/COM/WEB)
CITY OF TIGARD
BUILDING DIVISION PERMIT #: PL-PI Z- CO1V'
•
13125 SW Hall Blvd., Tigard, OR 97223, DATE ISSUED:
Phone: (503) 639- 4171
Inspection Requests (24 Hrs.): (503) 639 -4175 :�'+�
INSPECTION WORKSHEET FOR DATE: TIME: PAGE:
SITE ADDRESS: IZ?90 SIB/ e z- 1 --03e4 ItT CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME:
DESCRIPTION:
OWNER: PHONE #:
CONTRACTOR: PHONE #:
Inspection Request Scheduled For: Date: Pour Time:
Code # Inspection Description Confirm # Contact # Message
ft_uMFSI ^/E1
Corrections /Comments/ Instructions:
•
fy PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
•
Inspector: CH Date: 6' Phone #: (503) 718- Z. 1/'