Permit •
- Er CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT PERMIT #: PLM2008 -00105
T lca D • ` . DATE ISSUED: 3/12/2008
. 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 PARCEL: 1S125DC-09200
SITE ADDRESS: 07258 SW SHADY PL ZONING: R -4.5
SUBDIVISION: ASH CREEK ESTATES LOT: 025 JURISDICTION: TIG
PROJECT: ASH CREEK ESTATES
Project Description: Installing backflow preventer.
CLASS OF WORK: ALT 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
WINDWOOD CONSTRUCTION INC
12655 SW NORTH DAKOTA Description Date Amount
TIGARD, OR 97223 [PLUMB] Permit Fee 3/13/2008 $36.25
[TAX] 12 %,.State Surch 3/1'3/2008 $4.35
Phone : 503- 780 -4375 • Total $40.60
Contractor:
BURNESS LANDSCAPE
9330 SW LEHMAN ST
TIGARD, OR 97223 REQUIRED ITEMS AND REPORTS
Contact # : PRI 503- 432 -8525
FAX 503 -432 -8525 •
Reg #: PLM 13007
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.
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Issued By: Permittee Signature:
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Call 503.639.4175 by 7:00 a.m. for an inspection that business day.
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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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Plumbing Permit Application
. Building Fixtures � �O
-City of Tigard C.J° Received ' Permit No.:
a 1' 13125 SW Hall Blvd., Tigard, OR 9 2 eAa% Date/By: ? j I ( J � L!' / � y � i % � 1 �
0 P 503.639.417,1 Fax: 503.598.1960 P Plan Review i S Gt Vd l e
A � 1 Plan Review Other Permit No.:
r i v n t; o Inspection Line: 503.639.4175 ` G NW° `, to Ready/By: • ions: ® See Page 2 for
Internet: www.tigard -or.gov 4 o f I\ , , •fied/Method: Supplemental Information
TYPE OF WORK CAI vAG,V FEE* SCHEDULE
construction ❑ Dion For s cial in ormation use checklist
Description Qty. Ea. 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
® 1- and 2- family dwelling ❑ Commercial industrial SFR (2) bath 350.00
❑ Accessory building ❑ Multi - family SFR (3) bath 399.00
❑ Master builder ❑Other: Each additional bath/kitchen 45.00
Fire sprinkler ( sq. ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities
Job site address: 7258 SW Shady Place Catch basin or area drain 16.60
City/ State/ZIP: Tigard, OR, 97223 Drywell, leach line, or trench drain 16.60
Footing drain (no. linear ft.: ) Page 2
Suite/bldg. /apt. no.: I Project name: ,QG �, �(,{ -}.�� _
`� Manufactured home utilities 110.00
Cross street/directions to job site: sw 74 Place
Manholes 16.60
Rain drain connector 16.60
Sanitary sewer (no. linear ft.: ) Page 2
' Storm sewer (no. linear ft.: ) _Page 2
Subdivision: Ash Creek; Windwood Homes I Lot no.: 25 Water service (no. linear ft.: ) Page 2
Fixture or item -
Tax map/parcel no.: Absorption valve 16.60
DESCRIPTION OF WORK Backflow preventer 1 Page 2 36.25
landscape irrigation Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
® PROPERTY OWNER 1 ❑ TENANT Drinking fountain - 16.60
Ejectors/sump 16.60
Name: Windwood Homes Expansion tank 16.60
Address: Fixture/sewer cap 16.60
City/ State/ZIP: Floor drain/floor sink/hub 16.60
Phone: ( ) Fax: ( ) Garbage disposal 16.60
® APPLICANT ❑ CONTACT PERSON Hose bib 16.60
Ice maker 16.60
Business name: Burness L/S • -
Interceptor /grease trap 16.60
Contact name: Tom Burness Medical gas (value: $ ) Page 2
Address: 9330 SW Lehman St Primer 16.60
City/State/ZIP: Tigard, OR 97223 Roof drain (commercial) 16.60
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Phone: (503) 432 -8525 I Fax: : (503) 432 -8525 Sink/basin/lavatory 16.60
Tub /shower /shower pan 16.60
E -mail: Urinal 16.60
CONTRACTOR Water closet 16.60
Business name: see above Water heater 16.60
Address: Other:
City/State /ZIP: Subtotal
Minimum permit fee: $72.50 36.25
Phone: ( ) Fax:
( ) . Residential backflow minimum permit fee: $36.25
CCB Lie.: 13007 Plumbing Lic. no.: Plan review (25% of permit fee)
State surcharge (12% of permit fee) . 4.35
Authorized signature: TOTAL PERMIT FEE 40.60
Print name: n rn , //,,, p4,4_ Date: 3 .f2. oa This permit application expires if a permit is not obtained within
180 days after it has been accepted as complete. _
•Fee methodnlnov get by Tr-County Rnildino Indnetry Service Roard
CITY OF TIGARD
BUILDING DIVISION PERMIT #: PLM2008- 00105
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 3/12/2008
Phone: (503) 639-4171
Requests (24 Hrs.): (503) 639 -4175 .. ' ° --
INSPECTION WORKSHEET FOR DATE: 7/10/2008 TIME: 7:00AM PAGE:
SITE ADDRESS: 07258 SW SHADY PL CLASS OF WORK:
SUBDIVISION: ASH CREEK ESTATES LOT #: 025 TYPE OF USE:
PROJECT NAME: ASH CREEK ESTATES
DESCRIPTION: Installing backflow presenter.
OWNER: WNDWOOD CONSTRUCTION INC, PHONE #: 503-780 -4375
CONTRACTOR: BURNESS LANDSCAPE PHONE #: 503.432 -8525
Inspection Request Scheduled For: Date: 7/10/2008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
399 Plumbing final 072455-02 503 - 860.1203 N
Corrections /Comments /Instructions:
1-e
Care
X PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: �"�'►���- Date: '7 Phone #: (503) 718-