Permit .
CITY OF TIGARD
PLUMBING PERMIT
' :. COMMUNITY DEVELOPMENT PERMIT #: PLM2008 -00104
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 3/12/2008
PARCEL: 1 S 125DC -09100
SITE ADDRESS: 07230 SW SHADY PL ZONING: R -4.5
• SUBDIVISION: ASH CREEK ESTATES LOT: 024 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 •
VERDE ASH CREEK LLC.
P.O BOX 1188 Description Date Amount
LAKE OSWEGO, OR 97035 [PLUMB] Permit Fee 3/13/2008 $36.25
[TAX] 12% State Surch 3/13/2008 $4.35 •
Phone : Total $40.60
Contractor:
BURNESS LANDSCAPE
9330 SW LEHMAN ST
TIGARD, 97223 REQUIRED ITEMS AND REPORTS ,
Contact # : PRI 503- 432 -8525
FAX 503- 432 -8525
Reg #: PLM 13007
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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
r these'rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued.By Permittee Signature: .. Se,„
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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PI . bin Permit Application _
s± as 7- v cS ?cS
Bui1 lllg Fixtures RECEINIE FOR ()F1-1( 'E. 1'SI 1_)N1.1
City of Tigard 8 Rece Permit / //
11111 a 13125 SW Hall Blvd., Tigard, OR 97223 MAR 1 2 7 DateBy: ived /Vo /3 rmit N P(/� ?IAA- co �() �(
C Plan Review
Ph 503.639.4171 Fax: 503.598.1960 D Other Permit No.: ^T
Line: 503.639.4175 '1{Y QF TIG`'A�F+t D ateBy: S /? (1(Jfj
Inspection
"F t G A R D Internet: Line: 03.63 ov GI ISlo a Ready/By: rarie: la See Page 2 for
g g gl f ILDII` 011"
Notified/Method: Supplemental Information
TYPE OF WORK FEE* SCHEDULE
ew construction ❑ Demolition For special information use checklist.
Description . j 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
® 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: 7230 sw shady Place Catch basin or area drain 16.60
City/State/ZIP: Tigard, OR, 97223 Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: I Project name: (rid( tS S Footing drain (no: linear ft.: _) Page 2
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 Estates I Lot no.: 24 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
. • Backwater valve 16.60
Clothes washer 16.60
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Dishwasher '16.60
❑ PROPERTY OWNER I ❑ TENANT Drinking fountain 16.60
Ejectors /sump 16.60
Name: Eke-ell 7` 7 6'ee- . � Expansion tank I • I 16.60 I -
/ v
Address: ed x / ( F - Fixture /sewer cap ' 16.60
City / S ta t e/ZIP: i.(/6 C, _ t'[a ,. _ V R I ?() 3$ 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 •
Phonc: (503) 432-8525 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: Burness Landscape ; Water he ate r . 16.60
% mss miss G� I .
Address: 9330 SW Lehman St Other: I -
Ci /State /ZIP: Tigard, OR 97223 Subtotal
ty
Minimum permit fee: $72.50 36.25
Phone: (503) 432 -8525 Fax: (503) 432 -8525 Residential baekflow minimum permit fee: $36.25
CCB Lie.: 13007 013 i us( Plumbing Lic. no.: - • - . Plan review (25% of permit fee)
' State surcharge (12% of permit fee) 4.35
Authorized signature:
/ / '- TOTAL PERMIT FEE 40.60
I Print name: o yr ' Date: 3 . / aroll' - ( This permit application expires if a permit is not obtained within
ISO days after it has been accepted as complete.
*Fee methodology set by Tri- Cntmty Rnildinp Induct Service Rnard
.1
MY OF TIGARD � '' p(,/v1200Q -ootoy
r= UAL®ANG L!OV0SII • ' N PERMIT #: tf�,T,f ?C _ntr;tf l
13125 r SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 1')/ 14/2007
Phone: (503) 639
Inspection Requests,(24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 4/24/20()8 TIME: 7 :01AM PAGE: 4
SITE ADDRESS: 0723() SW SHADY PL. CLASS OF WORK:
. SUBDIVISION: ASH CREEK EST ATES LOT #: 024 TYPE OF USE:
PROJECT NAME: ASH CREEK ESTATES
DESCRIPTION: SF
OWNER: VERDE ASH CREEK LLC, PHONE #: t;03- 650.2421
CONTRACTOR: VERDE HOMES INC: PHONE #: 603-650-2421
Inspection Request Scheduled For: Date: 4124 /2008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
3f. Plumbing fir ! 060059 -01 503-650-2421 Y
Corrections /Comments /Instructions:
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PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑•.FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: (J ' .i_✓' Date: L/ 12)- (0 Phone #: (503) 718-