Permit •
CITY OF TIGARD
PLUMBING PERMIT
DEVELOPMENT SERVICES PERMIT #: PLM2006 - 00287
DATE ISSUED: 6/2/2006
13125 SW Hall Blvd., Tigard, OR 97223 503 -639 -4171 PARCEL: 2S109DD - 11200
SITE ADDRESS: 12736 SW REMBRANDT LN • ZONING: R - 7
SUBDIVISION: BELLA VISTA LOT: 042 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 INC Description Date Amount
1925 NW AMBERGLEN PKWY #200
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: ,SQL e\-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.
• Plumbi Per mit Applicati0 ` en FOR OFFICE USE ONLY
City of Tigard G� V G Received ../.- e mt
Pit N .. ‘‘•,,,
13125 SW Hall Blvd., Tigard, OR 9723 Dat �� d,
Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 ‘1 1 20� 1l I' Date/By: Other Pe No.:
24- Hour Inspection Line: 503.639.4175 r. _ Date Ready/By:
-tilt See Page 2 for
Internet: www.ci.tigard.ous art_ RDIGA,- ,v,S,• R•I I Notified/Method: Su
J Supplemental laformetion
TYPEO
QF FEE* SCHEDULE
For special information use checklist
X New construction ❑ Demolition
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
51 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: 1 2 73 L s w Dom, L PA rA t4 l_a) ti C Catch basin or area drain 16.60
City/ State/ZIP: --'�`, p J a , O �, � ;' -I Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: Project rtame: 11a 4.,%-1/4-0,,, 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: l) e`1 \ F 0\ I Lot no.: (4 L Water service (no. linear ft.: ) Page 2
Fixture or item
Tax map /parcel no.: Absorption valve 16.60
DESCRIPTION OF WORK y r
Backflow preventer I Page 2 34
•
Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
❑ PROPERTY OWNER I ❑ TENANT Drinking fountain 16.60
66 Ejectors /sump 16.60
Name: }� .:I vizr (�i., i e_ !4(7YVl.PS , Ti-)C • Expansion tank 16.60
Address: ) 5 Af k J .. � _ L i it 7 D f) Fixture/sewer cap 16.60
City/State/ZIP: V pc_ 4 /00 Floor drain/floor sink/hub 16.60
(j�j) ii - -(;, $ (F (s )) lo�V 4 Z Garbage disposal 16.60
Phone: Fax:
❑ APPLICANT ❑ CONTACT PERSON Hose bib 16.60
Ice maker 16.60
Business name: ILI 1(,0,,,,,SI a H oyvte S i _r-1G Interceptor /grease trap 16.60
Contact name: .,`CG (_' 9 c.. yr. C , A Medical gas (value: $ ) Page 2
Address: ( C 2 5 jvw Ali & J I 1 / p`. . J AP 700 Primer 16.60
City/ State/ZIP: Roof drain (commercial) 16.60
Phone: ( ) Faz :: ( ) Sink/basin/lavatory 16.60
Tub /shower /shower pan 16.60
E -mail: Urinal 16.60
CONTRACTOR Water closet 16.60
Business name: 3+ if poc,01 I ill c 01 V vti b( ✓IS Water heater 16.60
Address: 2 S DS . S • LA./ • A Lis L1S4- _ bf • Other:
City/State/ZIP: 4 U4 el 01 6) 700(0 Subtotal
Minimum permit fee: $72.50
Phone: (5 ) g IR - b 6S 7 Fax: (503 ) 37 2. - 95y 3 Residential backflow minimum permit fee: $36.25
CCB Lic.: 1112 ( t Plumbing Lic. no.: 3 N - 370 p 6 Plan review (25% of permit fee)
/J- G State surcharge (8% of permit fee) .Z 92
Authorized signature t 614,/s TOTAL PERMIT FEE 3f iS
• Print name: 30n h $ f l I I Date: 2 - g -- 05- 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.
is\ Building \ Permits \PLM- PamitApp.doc 12/03 4404616T(10 /02/COM/WEB)
CITY OF TIc ARD
BUILDING DIVISION PE R MIT #: PLM2006 -00287
13125 SW Hall Blvd., Tigard, OR 97223 DATE IS 6/2/2006
Phone: (503) 639-4171
Requests (24 Hrs.): (503) 639 -4175 11-
INSPECTION WORKSHEET FOR DATE: 6/7/2006 TIME: 7:06AM PAGE: 103
SITE ADDRESS: 12736 SW REMBRANDT LN CLASS OF WORK:
SUBDIVISION: BELLA VISTA LOT #: 042 TYPE OF USE:
PROJECT NAME: BELLA VISTA
DESCRIPTION: Backflow preventer for irrigation.
OWNER: RIVERSIDE HOMES INC, PHONE #: 503- 645-098G
CONTRACTOR: STREAMLINE PLUMBING PHONE #: 503.808 -6657
Inspection Request Scheduled For: Date: 6/7 /2006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
399 Plumbing final 031234 -02 503 - 572 -4708 N
Corrections /Comments /Instructions:
St
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: ��� v Date: 10(7 d `"" Phone #: (503) 718- 2-1(2