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Permit PI 1 C ITY OF TIGARD PLUMBING PERMIT DEVELOPMENT SERVICES PERMIT #: PLM2005 -00355 ' SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 8/8/2005 PARCEL: 2S 105BC -03800 SITE ADDRESS: 12999 SW TEAROSE WAY ZONING: R -25 SUBDIVISION: BULL MOUNTAIN MEADOWS NO.3 LOT: 172 JURISDICTION: URB Project Description: Irrigation backflow preventer. 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 MIKE JANTLE Description Date Amount 12999 SW TEAROSE WAY TIGARD, OR 97223 [UPLUMB] Permit Fee 8/8/2005 $36.25 [UTAX] 8% State Surch< 8/8/2005 $2.90 Phone : 503 -524 -4841 Total $39.15 Contractor: OWNER REQUIRED ITEMS AND REPORTS Phone : Reg #: 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 -66 or 1- 800 - 332 -2344. i Issued By: ` _ _, AOP _ Permittee Signature: ,r / a 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. Plumbing Permit AP,v1ic .tion \ / / / / 'FOR OFFICE t .Si ONLY U U L,� = . V = R e, en•td 1� .. City of Tigard Date /By: ' t ', � O_. Femur No 11_4, / _00355.- 13125 SW Hall Blvd., Tigard, OR 97223 Flan Revie - r1 i C C r Permit No . Phone: 503.639.4171 Fax: 503.598.196N, -, ki 8 tut -0 %h,a+l,lr i Dade/By: : 24- Hour Inspection Line: 503.639.4175 .. tt51 I I Date Ready /By: \ ? Bse 2 for Internet: www.ci,tigard.or.us Notified/Method: pplemental information sn U u _ I i i. : rvi1v * LE TYPE O M t - . . For special Information use checklist. III New construction 17J Demolition Description I Qty. I Ea. I Total . 0Addition/alteration/replacement ❑ Other: New I- 2-family dwellings (includes 100 It. for each utility connection) CATEGORY OF CONSTRUCTION • SFR (I) bath 249.20 /f1- and 2- family dwelling ❑ Commercial/industrial SFR (2) bath 350.00 CI Accessory building Multi-family SFR (3) bath 399.00 ❑ Multi -famil Each additional bath/kitchen 45.00 ❑ Master builder ❑ Other: Fire sprinkler ( sq. ft.) Page 2 JOB SITE INFORMATION AND LOCATION Site utilities Job site address: / Z C1 Cj1 5 Tew v(9S e, it/t9)1 Catch basin or area drain 16.60 City/State/ZIP: T7 14 2 9 Qgr ,✓ ,97z2-,5 Drywell, leach line, or trench drain 16.60 Suite/bldg./apt. no.: I Pro ect name: Footing drain (no. linear ft.: ) Page 2 /_ Manufactured home utilities 110.00 Cross street/directions to job site: /loo J.:-.1=- Manholes 16.60 P eIdP"VnaJS - ruin 5., r,FiA 60 )bu '1' Rain drain connector 16.60 %MCC g (sr X iy h o h 1E4 /os E c Te� ,�, e + S v.`ro Sanitary sewer (no. linear ft.: Page 2 1 7 _J /0 .0 .,14., 5 'T�q1 S�fcy g h# . yo `- re 9 ,'h r4 &-'4y. - Storm sewer (no. linear 6: ) Page 2 1 (/ / Water service (nu. linear ft.: ) Page 2 Subdivision: of no.: Fixture or item Tax map /parcel no.: Absorption valve 16.60 DESCRIPTION OF 'WORK • Backflow preventer / Page 2 b / Backwater valve 16_60 '1n� 5!�l�G�- >/ ` �"" ' � lad �1�. � r ✓ et 4 , P-- `�i >44vo , Clothes washer _ 16.60 J� A� p� Dishwasher 16.60 Drinking fountain 16.60 16.60 PROPERTY OWNER I ❑ TENANT Ejectors/sump Name: I Kg JAit1TT . Expansion tank 16.60 Address: /Z C 4 9 ,5uJ TL.,4 g W All Fixture/sewer cap 16.60 C / t City/ State/ZIP: - 7 - 7 0 L � 67,sr/ 97 22,1 Floor drain/floor sink/hub 16.60 Phone: (5,3 ) 524- - / ¢ B y ) Fax: (5j Z23 --- 3-872- Garbage disposal 16.60 Hose bib 16.60 0 APPLICANT ❑ CONTACT PERSON Ice maker 16.60 Business name: ,t) /A Interceptor /grease trap 16.60 Contact name: / / L / 1 A.J 7Zj Medical gas (value: $ ) Page 2 . Address: / 2 9 9 9 Sw T4a ) Gv,®y Primer 16.60 City/State/ZIP: -7,6 ag 97z,23 Roof drain (commercial) 16.60 7L Sink/basin/lavatory 16.60 Phone: (5s3 ) 5 4 _ 46344 Fax: : (.5 ) ZZ g Tub/shower /shower pan 16 -60 E -mail: Urinal 16.60 CONTRACTOR Water closet 16.60 N.. Business name: Water heater 16.60 Address: ■ Other: City/ State/Z1P: Subtotal Minimum permit fee: $72.50 Phone: ( ) Fax: ( ) Residential backtlow minimum permit fee: $36.25 CCB Lic.: Plumbing Lic. no.: Plan review (25% of permit fee) State surcharge (8% of permit fee) Authorized signature: j ,' TOTAL PERMIT FEE 3) , is Print name: M //C Date: g /7 / © This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. *Fcc methodology set by Tri- County Building Industry Service Board. 2 ' d 2 LBS -E2Z EOS sates auid mu e22:60 SO B0 5nd CITY OF TIGARD BUILDING DIVISION PERMIT #: PLM2005 -00355 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 8/8/2005 Phone: (503) 639 -4171 Inspection Requests (24 Hrs.): (503) 639 -4175 ' � INSPECTION WORKSHEET FOR DATE: 10/11/2005 TIME: 7,:08AM PAGE: 96 SITE ADDRESS: 12999 SW TEAROSE WAY CLASS OF WORK: SUBDIVISION: BULL MOUNTAIN MEADOWS NO.3 LOT #: 172 TYPE OF USE: PROJECT NAME: JANTLE DESCRIPTION: Irrigation baclflow preventer. OWNER: JANTLE, MIKE PHONE #: 503 - 524 - 4841 CONTRACTOR: OWNER PHONE #: Inspection Request Scheduled For: Date: 10/11/2005 Pour Time: Code # Inspection Description Confirm # Contact # Message 399 Plumbing final 017814 -02 503 - 524 -4841 N Corrections /Comments /Instructions: PASS I PARTIAL APPROVAL ❑ CANCEL I NO ACCESS FAIL I I CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED Inspector: Date: 6 Phone #: (503) 718-