Permit CITY TIGARD PLUMBING PERMIT
kiar � DEVELOPMENT SERVICES PERMIT #: PLM2005 - 00127
` 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 3/28/2005
PARCEL: 1S133CD-12700
SITE ADDRESS: 11764 SW TALLWOOD DR ZONING: R - 25
SUBDIVISION: PEBBLECREEK LOT: 020 JURISDICTION: TIG
Project Description: Backflow device.
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
NEWBERRY, JACK L
11764 SW TALLWOOD DR Description Date Amount
TIGARD, OR 97223 [PLUMB] Permit Fee 3/28/2005 $36.25
[TAX] 8% State Surcha 3/28/2005 $2.90
Phone : Total $39.15
Contractor:
DOWN TO EARTH IRRIGATION
13075 SW PACIFIC HWY
TIGARD, OR 97223 REQUIRED ITEMS AND REPORTS
Phone : 503- 684 -3500 •
Reg #: LIC 8169
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: ..% 2 . Permittee Signature: (a r
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.
FROM : FAX NO. : Jun. 10 2002 11:34AM P1
la taittaing 112 LA LULA CO Plumbing Permit : ., -. , .- - - FOR, U js ONLY �. .. , .
Ptah
Received - �� �� �� n ,—
City Tigard 2 8 20 paint N o,. ` /
MA l3atc/Sy `L p �7 �1./ � ` ' � �� /. ��
131 SW Hall Blvd., Tigard, OR 97123 P, iN < r
Phone: 503.639.4171 Fax 503.598.1960 4' e \ Date/13y: vow Other Permit No.:
24 Ilpur Inspection Line : 503-639 -4175 CITY OF TIC' '� e ,
Internet: www.ci.iigard.or.us p� ,..11., ' A' 1 Date Ready /By: ram Et See Page 2 for
�' 1 ;LOING B%' ' • ° Notilled/Method: "r I v- Supplemental Information
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New construction 0 Demolition For special information rise checklist
Description ILCIMMIZION Total
• is • 4 dition/alttrtition/replacement ❑ Other:
New 1 - 2 dwellings (includes 100 ft for each utility connection)
? 1 ,' - .' i, a 0 4, 4 Q1• : n a� s ... 17 pp r t "f 'Y' 20 `;;„`;;r SFR (1) bath 249.20
4 1- and 2- family dwelling 0 Commercial/mdustrial SFR (2) bath 3$0.00
❑ Accessory building 0 Multi-family SFR (3) bath 399.00
Each additional bath/kitclbath/kitchen 45.00
0 Master builder 0 Other:
ZE I r Fire sprinkler ( sq. ft.) Page 2
, Site unit
' to t➢ s ;y o a sr 6® a �
Job site address. " a ir1o4• I e Catch basin or area drain I6.60
City /State/ZIP: 4.. .sr p Drywcil, leach line, or trench drain 16.60
Suite/bldg. /apt no.: Project name: Foaling 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 R.: ) Page 2
Subdivision Lot no.: Water service (no. linear ft_: ) Page 2
Fixture or item
Tax map/parcel no -:
„., Y r rte R . _ .. Absorption valve 16.60
t' w �, . > � o ` " , ® I. � `� � . ; . u a ' s! - Baeldlow preventer -, Page 2
I mo: a ,M _ 7 Backwater valve II 16.60
Clothes washer 16.60
Dishwasher IIII 16.60
.i�� ' .` a p. ^ y. t a sct , .'r, Drinking fountain 16 -60
� P 411 �W <:. yam V to Nectors/sump 16.60 IIII
Name: �a Expansion tank 16.60
Address: y , Fixtutr/scwer cap 16.60
City /State/ZIP: 11 CA' C I 771Z 3 Floor chain/floor sink/hub 16.60
Phone: 1,I) � Garbage . 6 2, Fax: ( ) Hose disposal _ 60
16. 16.
S y �'p '1 �.i qq,, illilx,. -. . 1 ... ,V' Sloe biV l Ra '2t X _ d; , .� E Ck, F S„
xr .� r' �x�.: 1 . R: Ice maker NE 16.60
Business flame: . `. .,, :t[. Interceptor /grease asp 16.60
Contact name: 4 Medical gas (value: S ___ __ _) Page 2 -
Address: /3(...4. � A-) ;I Primer 16.60 IIIIIIII
City/State ZIP: . - .._... / (commercial) Roof drain (commercial) 16.60 —
Pboruc : ) ■ Fax: : t Sink/basin/lavatory 16.60
�' ' l `" h Tub /shower /shower pan 16.60
13-mail:
Urinal 16.60
ni 2 i s4' +� ;ii: f � .,'
, , 3 0 •
. . r , _' .r 4 4+ � �%r
3 � C � :p F e •..�ip ;<�c �•�
. a a.:.� � ;i ' `' 2. . Vie'' - S . s , • ° • �a.h'i' % ' S i ( q I Water closet 16.5D •
Business name: oiL'�l�A. ti. Mr .., Water heater ME 16 -60
Address: .. 4-7 . ).. -, I' ,!. Other:
City /State/ZIP: r--... q r T Subtotal Min
3) Minimum permit fee: $72.50
Phone: ( ' Pax: (��) (3 kesidential bacic1low minimum permit fee: $36.25
Cal L.ic.: P „� _ _ , _ . Plan review (25% of permit fee) MIN
Authorized signature: �i State surcharge (8% of permit f'ee)
—. -' TOTAL PERMIT FEE
Prxu name: �^ Date Th
_ yea permit application s=prees if a permit is not obt•� � d within
— 180 days atter it has been accepted as complete_
*Fee methodology set by Tri- County Building Industry Service Board.
is tar gnu- \Pt-atF -r pp.ana 12/03 440- 461,170OM /COM/Wm
CITY OF TIGARD • _ ,
BUILDING DIVISION PERMIT #: PI_IM'l 0()=:,.00127
13125 SW Hall Blvd., Tigard, OR 97223 .. DATE ISSUED: •,r;tj; }t)tj?;
Phone: (503) 639 -4171 4 111flit i l� In spection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 1()/200E TIME: 7:04AM PAGE: 73
SITE ADDRESS: 11764 SW TALLWOOD DR CLASS OF WORK:
SUBDIVISION: PEI3BLECREEK LOT #: 020 TYPE OF USE:
PROJECT NAME: NF
DESCRIPTION: Ba :kflow device. REINSEATED FOR FINAL INSPECTION FOR A PERIOD OF 30 DAYS.
OWNER: NEWBERRY, JACK I., PHONE #:
CONTRACTOR: DOWN TO EARTH IRRIGATION PHONE #: 603-68 43500
Inspection Request Scheduled For: Date: 2t10/2006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
399 Plumbing final 026621 -04 503-68 N
orrections /Comments /Instructions:
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,, j. :'ASS I I PARTIAL APPROVAL n CANCEL I I NO ACCESS
*`- U CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED
V A ; (A1(.. Inspector: D ate: L 0/ D Phone #: (503) 718 -
CITY TIGARD PLUMBING PERMIT
DEVELOPMENT SERVICES PERMIT #: PLM2005 -00127
tL��>♦�� DATE ISSUED: 3/28/2005
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171
PARCEL: 1 S133CD- 12700
SITE ADDRESS: 11764 SW TALLWOOD DR ZONING: R -25
SUBDIVISION: PEBBLECREEK LOT: 020 JURISDICTION: TIG
Project Description: Backflow device.
•
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
NEWBERRY, JACK L
11764 SW TALLWOOD DR Description Date Amount
TIGARD, OR 97223 [PLUMB] Permit Fee 3/28/2005 $36.25
[TAX] 8% State Surcha 3/28/2005 $2.90
Phone : Total $39.15
Contractor:
DOWN TO EARTH IRRIGATION
13075 SW PACIFIC HWY
TIGARD, OR 97223 REQUIRED ITEMS AND REPORTS
Phone : 503- 684 -3500
11111111
3 Reg #: LIC 8169 , ,
8
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.
Inspections Required for: PLM2005 -00127
✓ Code Inspection Description PASS Date By ✓ Code Inspection Description PASS Date By
BUP - Building Permit ELC - Electrical Permit
405 Excavation 105 Underground /slab cover
410 Fill 110 Temporary electrical service
415 Grading 115 Electrical service /reconnect
205 Footing 120 Electrical rough -in
805 MFG- Stricture grading /footing 125 Wall cover I
'1
210 Foundation walls 130 Ceiling cover I
215 Footing drain 135 Low voltage
220 Slab 140 Sign installation
310 Crawl drain 145 A/C or heating unit circuit
225 Post/beam structural 150 Hot tub /spa /pool
230 Underfloor insulation 195 Misc. inspection:
235 Shear walls /anchors 199 Electrical final
240 Exterior sheathing
245 Firewall
250 _ Roof nailing _ ELR - Restricted Energy Permit ___
255 Wtr proofing basement walls _ 135 Low voltage
260 _Tilt -up panel ( 195 Misc. inspection:
265 Masonry 199 Electrical final j
270 Reinforcing steel (rebar)
273 Framing
810 MFG Stricture set-up
MEC - Mechanical Permit
280 Insulation 605 Post/beam mechanical
_285 Drywall nailing 610 Gas line
287 Suspended ceiling 615 Mechanical rough -in
295 Misc. inspection: 620 Hydronic piping
899 MFG - Structure final 625 _ Duct work
498 Grading final 630 Fire damper _ j
299 Final inspection 635 Smoke detector shutdown __
640 Exhaust hood J
695 Misc. inspection:
m •
699 Mechanical final I I _
j
BUP - Fire Protection System Perm it
905 Sprinkler underfloor /slab PLM - Plumbing Permit
.4 910 Sprinkler rough -in _ 305 Plumbing underslab
9] 5 Fire alarm rough -in
6-. 310 Crawl drain
920 Suppression trip test 315 Post/beam plumbing
s 4 . 995 Misc. inspection: 320 Plumbin: rough -in
998 Alarm final X 325 RP/backflow preventer
999 Sprinkler final 330 Water service
335 Rain drain
340 Storm drain
11: . -' SIT - Site Work Permit 505 Sanitary sewer _
405 Excavation 345 Culvert/catch basin
410 Fill 350 Septic tank
415 Grading 395 Misc. inspection:
205 Footing X 399 Plumbing final
210 Foundation walls
1 215 Footing drain
4, -420 Sprinkler supply lines SWR - Sewer Permit
495 Misc. inspection: 505 Sanitary sewer
498 Grading final • 595 Misc. inspection: _
499 Final inspection 599 Final inspection
I: \Building \IVR \InspCard- AOP.doc 02/02/2005