Permit mob
C ITY OF TIGARD PLUMBING PERMIT
DEVELOPMENT SERVICES PERMIT #: PLM2006 - 00054
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 1/31/2006
PARCEL: 2S109AD
SITE ADDRESS: 12895 SW TAKENA CT ZONING: R -
SUBDIVISION: ARBOR SUMMIT NO. 2 LOT: 038 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
WEST HILLS DEVELOPMENT Description Date Amount
15500 SW JAY ST
BEAVERTON, OR 97006 [PLUMB] Permit Fee 1/31/2006 $36.25 •
[TAX] 8% State Surcha 1/31/2006 $2.90
Phone : 503- 641 -7342 Total $39.15
Contractor:
TRADEMARK LANDSCAPES, INC.
PO BOX 2410
OREGON CITY, OR 97045 REQUIRED ITEMS AND REPORTS
Contact # : PRI 503 -504 -2013
Reg #: PLM 6796
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:
� \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.
11 TUE 11:19 All FAX NO. P. 07
•
RECEIVED
Plumbing_Pe>rmit J A, Ui31 ion FOR OFFICE USE ONLY
Ci J7aIV 2006 Received f / - J� �1`'\. Q6 van
Date /By, Permit N ..
131 SW of Ti Hall and Blvd., Tigard, OR 97223 Pinn Review
Phone: 503.6394.171 fax; sD t�B�le3� TIGAR �, ., ; il Dale/By; Giber Permit No.:
24- Hour Inspection Line; 50B13PL 1f G DMS10N Dole Ready /dy: iuriu: Sec Page 2 fur
Internet: www.ci.rigard,ar,uS Notified /Method: -r 1Er Supplemental Information
TYPE OF WORK ' • FEE'' SCHEDULE
® New construction ❑ Demolition � Fo r s ecial information use checklist.
Description J Oty. [ En. 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
• I- and 2- family dwelling D Commercial /industrial SFR (2) bath 350,00
❑ Accessory building In Multi-family SFR (3) bath 399,00
Each additional bath/kitchen 45.00
❑ Master builder ❑ Other: - -
Fir: sprinkler ( sq. tt.) Page 2
. JOB SITE INFORMATION AND LOCATION Site utilities
Job site address: 1 z g415~ $W Mk • Catch basin or area drain 16.60
City /State/ZIP: TI GAgh. 0Z 9 7 224' Drywell, leach line, or trench drain 16.60
Suite/bldg./apt. Project name: Footing drain (no. linear ft.: , ) Page 2
• Manufactured home utilities 110.00
Cross street/directions to - job site: Manhole -
16.60
Rain drain connector 16.60
Sanitary sewer (no. linear ft.: ) Page 2
- r--..
• Storm sewer (no. linear ft.: ) Page 2
Subdivision: Arbor Summit Lot no.: /Q ` Water service (no. linear ft.: ) 6 Page 2 _-
_. ■ U Fixture or item
Tax map /parcel no.; Absorption valve 16.60
DESCRIPTION 'OF WORK.. Buckflow prcventer Page 2
• NEW CONSTUCTION - Backwater valve _ 16,60
Clothes washer 16.60 •
Dishwasher 16.60
• Drinking fountain 16.60
'• ® .PROP.GRTY OWNER: 0, TENANT Ejectors/sump 16.60
Name: West Hills Development Expansion tank 16,60
Address: 1 5500 SW Jay ST. Fixture/sewer cap 16.60
City /State /ZIP: Beaverton, OR 97006 Floor drain/floor sink/hub 16.60
Phone: (5113)64] -7342 Fax: (503)641 -7661 Garbage disposal 16.60
Hose bib . 16,60
' '® APPLICANT ® CONTACT PERSON,. Ice maker I6.60
Business name: Same As Owner. _ Interceptor /greusc trap 16.60
Contact name: "KAC tz. L/J I E& _ Medical gas (value: I ) Page 2
Address: (5t c ,gyp 1/ ) Printer 16.60 •
City /State /ZIP:
- Roof drain (commercial) 16.60
Sink/basin/lavatory 16.60
Phone; (503 ) 64] -7342 Fax: ; ( )
I I C '` G Tub /shower /shower pan 16.60
E-mail; K L-k(•1 E KC Vkf 5; N I U,SDEVELI:)PA 4 Go at Urinal 16,60
. CONTRACTOR Water closet 16,60
Business name: `1 R G ,1& A., Ri L NDSGPcpE Water heater 16.60 • Address: • PO 60>:. 2. 1 -l-1 0 Other:
c Subtotal
City /State /ZIP:' b(.?C(10N1 G('1,O g7O�.J Minimum permit fee: $72.50
Phone: (503) t C5O4— 20 i 3 1 Fax: Residential backflow minimum permit fee: 536,25
i [ 3 3 EX 1 3 i f $ - . ,'°` Plan review (25% of permit fee)
COB Li c,: .. / rrkT'�� /if `:7`1r�C
State surcharge (8% of permit fee)
-
Authorized signature. f TOTAL PERMIT FEE
Print name: f. r ',WE. / J l I Date: j f / CIA, This permit application expires if a permit is not obtained within
li ] days after it has been accepted as complete.
*Fee methodology set by Tri- County Building Industry Service Board.
iAB wilding TormitAll- M- PrrrnilApp.e0c WU] 440.4616T( ID/07/COM/WEB)
CITY OF TIGARD
BUILDING DIVISION PERMIT #: 2- 006- 000S
13125 SW Hall Blvd., Tigard, OR 97223 • DATE ISSUED:,
Phone: (503) 639 -4171 • �avpatlp
Inspection, Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: TIME: PAGE:
SITE ADDRESS: (Zd l S.- 1' 14KL�V4— 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 •
P -v ft-l�li..ftv‘ 14'1--
Corrections /Comments / Instructions:
•
•
.. -
Li PASS eg P° RT : APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL P5 AL OR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: - '/41■ Date: 52— ' Phone #: (503) 718-
, 1