Permit .: _ -,.Y
• tf '..„--CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT PERMIT #: PLM2008 -00417
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 10/28/2008
PARCEL: 2S115AD-02900
SITE ADDRESS: 10676 SW TUALATIN DR ZONING: R -4 5
SUBDIVISION: DOVER LANDING LOT: 010 JURISDICTION: TIG
PROJECT: WHITESIDE
Project Description: Backflow for irrigation
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
RANDEL & L WHITESIDE
10676 SW TUALATIN DR Description Date Amount
TIGARD, OR 97224 [PLUMB] Permit Fee 10/28/200€ $36.25
[TAX] 12% State Surch 10/28/200€ $4.35
Phone : 503 -624 -8671 Total $40.60
Contractor:
TEUFEL NURSERY INC .
100 SW MILLER ROAD
PORTLAND, OR 97225 REQUIRED ITEMS AND REPORTS
Contact # : PRI 503-646-1111
FAX 503- 641 -5356
Reg #: LTC 5133
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: / �'�G G7
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.
• t - .
Plumbing Permit Applicatio - ECEflJE 1
Building Fixtures FOR OFFICE USE ONLY
City f Tigard 0 C T 2 $ 211ii? Received �
ty g Date/B :
iv `�� a =�foil" �i
' ermit No,. f 1° Iz g ..'Z,t )L l/ �]
- • 13125 SW Hall Blvd., Tigard, OR 97 •r Plan Review - �'-✓
Phone: 503.639.4171 Fax 598 $ T Y ®F TBGAR �Date/By. Other Permit No.
Inspection Line: 503639 p..4175 - , UILDIAir DIVnSI 'Notified/Method.
I'I Galt D Internet: www.ligardor.gov orwReady/13y ]ur n m ental
��FF yp � y,� %:ytY Supplem ental In formalioa
rt' ;If'i E�li'+lC[7{r�� � � 1 a t 6 '1A mot' , .r. ..'unl lift 1I m / : ; • , t i v ' .Ilfl .�`., •,.. ., v .r . .
t r ` ^,Ifi 5 _ 1'.
'irl rf3iid- rl ' fi a i14 r 1^1 rr 1,,,,.t l ; 1. . I r r.. 1 }'l i t a > tif K,.s ; r
❑ New construction • Demolition For special infornwrion use checklist
Descnption I Qty. I Ea. I Total
51 Addition /alteration/replacement • Other: 1 ll Q1 ��!�t� New I- 2- family dwellings (includes 100 ft. for each utility connection)
N t r 1 It;;l•
y: , x b "t,7 T• IV . 9• 1:'tai• a' r I' Il )11 } 1 G�t�I, t
'' ldl';,:SYf i � ,1't�It iji 1: i ''o •. r i sar ►;. , �.., �r,._.
,!�! ::� •r i -„ "t7�,1 � t�iiN�uSb�'� SFR (l 1 ) bath 1 249 20
Igi I - and 2- family dwelling • Commercial /industrial SFR (2) bath 350 -00
❑ Accessory building • Multi - family
SFR (3) bath 399.00
❑ Master builder Each additional bath/kitchen 45.00
• Other:
:e : brll it'1a t i � . • c• , , , o a -• , � � ,r T Fire sprinkler ( sq. ft.) Page 2
1 .�;SIK; 't.Ig.t Nt k }ll �' .,.. n� ?•,r � 1i ,I '"rI a i ggA (P;Itiil 1 1 Site utlhties
1 Job site address: /0674, 4-20 7 s S r lT r1/4. O; ' I ✓e: I Catch basin or area drain 16.60
City /State/ZIP: T 4 Die ', 7244 Drywell, leach line, or trench drain 16 60
Suite/bldgJapt. no.: Project name: ),,,,clencle_Reviciaince Footing drain (no. linear ft.: Page 2
Manufactured home utilities 110.00
Cross street/directions to job site: / ) 8 +-� ll' Manholes 16.60
Rain drain connector 16.60
I Sanitary sewer (no. linear ft.: _ ) Page 2
Storm sewer (no. linear ft : _) Page 2
Subdivision: I Lot no.: Water service (no. linear ft . ) Page 2
Fixture or item
Tax map/parcel no.: Absorption valve 16.60
,r;,•`11 74 t - e'�;tMgiCP. „r'± i i Nli ultin t Backflowpreventer 1 Page
-T {� Backwater valve 16.60
�G c 1' �+1 / G..7 p - '1 - / .Y 4't�(,l.O�l�'. Clothes washer to
J Dishwasher 16.60
+ A {, '' r�� T T. all i •• i q Drinking ountain 16.60
Iligi.l.ftr ? , ' ,; `, � M n 1 ; I �,,��.,,,,� I �tar a� -. �,� ,. t�k r. ki g
and. 1 r Ejectors /sump 16 60
Name: Pa a /1 Loki , Jules /Lip, Expansion tank . 16.60
Address: /o4 li, sto 77, tr .t. , 4:111-p_ Fixture/sewer cap 16.60
City /State/ZIP: 711 area( o _ 47 7 ei Floor drain /floor sink/hub 16.60
r
Phone: (03) rpZ - 341 i F. : ( ) Garbage disposal 16.60
.Ia i.Il,.:f,.:rr,1!.. , ( rfl 1 L Jr, :: .t ',1'I itx_rkii ,o r 04, l • g n ;111 . ,1 hi iP• Hose bib 16.60
,tn' 1ir.A. . " i „.. .7,'„„w.-„ rnierfil rl1� P.l iii .4'1 ,1 liF7t• a`• r'. is t 5 :, d , f^ 1 gA•
c , °A_ t /A�'' y � T r � t . �,�� 1 4I +I uN>l.i� Ice maker 16.60
Business name: 1 � �.( /��tvr' I , T;e. - Interceptor /grease trap 16.60
Contact name: �jyl �Lll.1 ' r Medical gas (value: $ ) Page 2
Address. loo S "W Mille., /, Primer 16.60
City / StaterLIP: PoriLl(,tini , DX, q 2S" Roof drain (contmeretal) 16.60
,
Sink/basin/lavatory 16.60
Phone: (V?) (�`�G6-1 (I I f Fa : : (so?) 4Y1 - c s'
Tub /shower /shower pan 16.60
E -mail: ? - _ , , e p,.,,•t_, Urinal 16.60
,� i•/ ® - � Gdr 1
17:Pk. F 4:51 • q :11 3i li' (L� ,e-�`st� tlei ol A I II`C l;u T Water closet 1660
Business name: 1 -e �t ( v .K , 1 `�/?G- Water heater 1660
Address. /00 St:.e.) e it e4d R �. Other:
Po e- ` / 0 Subtotal
City / State/ZIP: (ggq ��,,, -
1 Minimum permit fee: $72.50 � l
Phone: (03) (P�(, t l 1 Fa : ( ?) 4 41 -4 Residential back minimum permit fee. $36.25 3� -zS r
CCB Lie.: 141 ( P1. bing Lic. no.: S-r.?? Plan review (25% of permit fee)
1 State surcharge (12% of permit fee) 14. i S
Authorized signature: ` iii - TOTAL PERMIT FEE • 140.,46 140.,46 f Print name: ' � tod i Date: / 0J?.6 v 8 This permit application expires if a permit in not obtained within
/ 180 days after it has been accepted as complete.
''Fee methodology set by Tri- County Building Industry Service Board
I. 18uildlnalPermilclPLMF- PermitAPp doc 12/27/76 440- 4616T(10/02tcoM /WEB)
T • d Xdd 13C?13SE13 dH WbOO :O T 8002 82 400
1
CITY OF TIGARD l'
BUILDING DIVISION # PLM'?008OOd1'7
13125 SW Hall Blvd., Tigard, OR 97223 l f f DATE ISSUED: 10/81 � pilg Phone: (503) 639 -4171 �'
Inspection Requests (24 Hrs.): (503) 639-4175 sill
INSPECTION WORKSHEET FOR DATE: 11W2009 TIME: 7 PAGE: 25
SITE ADDRESS: 10676 SW TUALATIN DR CLASS OF WORK:
SUBDIVISION: DOVER LANDING LOT #: 010 TYPE OF USE:
PROJECT NAME: WHITESIDE
DESCRIPTION: Ba:Klobv for irrigation.
OWNER: WHITESIDE, RANDEL & LORI PHONE #: 503-624 8671
CONTRACTOR: TEUFEL NURSERY INC PHONE #: 583-646-1111
Inspection Request Scheduled For: Date: 11812009 Pour Time: E' 6" Th 1
r te ? t v
Code # Inspection Description Confirm # Contact # Mes = • -
399 Plumbing final 079493 -01 503 - 535 -9897
Corrections /Comments/ Instructions:
i r./Sti/fA — I tZ----
,T A ej 4-- A,
,. ci ..... ,,
,,
i PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
V FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: t/ ii Date: I /1 6 C t Phone #: (503) 718- ��
•
Jan 07 09 11:43a Brad %e .925 -9726 p.2
__-_ _ HEATH 23691
BA INC. -
H REbEl V ED
BACKFLOW ASSEMBLY TESTREPORT ❑ REMOVED •
_ 0 REPLACEMENT J N 0 7 20N
. PROPERTY
OWNER: 1,1 / ° "� P </c PHONE:
�� �GIT OF TIGARU
MAILING ADDRESS: /r.' / 7/ � — , 'K i ' %M D NG DIVISION
CITY f ,- .... p -,' STATE ZIP 1 / % .
ASSEMBLY
ADDRESS: r
STREET
❑R.P.B.A..121 ❑ R.P.D.A ❑ D.C.D.A. Q P.V.B.A. Q S.V.B A. Q A.V.B. O AIR GAP
SIZE: I 1/>X 191 MAKE: . /14 '- i MODEL: >) t -
WATER SERIAL 77 / c
PURVEYOR: ....-2----
' 7/ / J N UMBER: • ) U 2 C% 9 S
ASSEMBLY (/ •- f '
LOCATION: ,Z3 9
' �) 1 / r ` V
.
I
REDUCED PRESSURE ASSEMBLY P.V.A. B. / S.V.B.A INITIAL 1'E�ST \ (.
r1 CHECK D9 1:£E� !AMC AIR CHECK PASSE ILfl
PRESS OROP l CHECK NI y INLET FAILED ❑
INITIAL RELIEF VALVE OPEN AT: PRESS DROP •
.
• OPENED AT (B) FIGHT , DATE: • C
MIN 2 PSID !LEAKED ❑ PSI D r r x
RESULTS BUFFER CHECK N2
PSI 0 PSID • O
p �
RELIEF VALVE !TIGHT , E I / ( DID NOT FAILED SYSTEM 0
PASS 0 FAIL ❑ LEAK ❑ MD OPEN ❑ ❑ PSI 00
COMMENTS .O
REPAIRS
AND /OR
PARTS O 0
REDUCED PRESSURE ASSEMBLY: . __ .„.„..... , P.V.B.A./S.V.B A. AFTER REPAIRS
PI CHECK '�'E'V:K. •
PRESS DROP (A) CHECK NI DATE: ` ,
TEST RELIEF ! OPENED AT PRESS DROP V
AFTER OPENED (B) TIGHT ❑ PSID
REPAIRS BUFFER CHECK N2
A - B=
hanll m TIGHT ❑ P 510 PSID PSID PASSED ❑
IN COMPLETING AND SUBMITTING THIS TEST REPORT. THE TESTER CERTIFIES THAT THE
ASSEMBLY HAS BEEN TESTED AND MAINTAINED IN ACCORDANCE WTiH ALL APPLICABLE
RULES AND REGULATIONS OF THE W1lTER SYSTEM. AND STATE REGULATIONS
GAUGE CALIBRATION DATE - 7 Pr /' DE TECTOR METER READING
' 4:------ -'7 -- - 3275
TESTER SIGNATURE CER
David B Heath 20039 /3.
TESTERS NAME PRIP fEO PO Box 1565 Sherwood OR 97140 (5031 625-8553
8 553
TESTERS ADDAE59 • Head ■ ��
Backflow c. PHONE
COMPANY NAME
ID, E
SRVICE RESTORED
REPORT RECEIVED Br (REPRESENTATIVE OF OWNER) !)
i WHITE - Water System Copy PINK • Customer Copy YELLOW -Tester Copy k
•
•
F7 . -
CITY OF TIGARD .. , .
BUILDING DIVISION '' PERMIT #: PLM2008 -00 417
13125 SW Hall Blvd., Tigard, OR 97223 4 �' �,BATE ISSUED: .10/28/2008
Phone: (503) 639 -4171 ��i h ∎ ff��
Inspection Requests (24 Hrs.): (503) 639 -4175 "���
INSPECTION WORKSHEET FOR DATE: 12/18/2008 TIME: 7:01AM PAGE: •i1
SITE ADDRESS: 10676 SW TUALATIN DR CLASS OF WORK:
SUBDIVISION: DOVER LANDING LOT #: Q10 TYPE OF USE:
PROJECT NAME: Min ESIDE
DESCRIPTION: E3arkfloui for irrigation.
OWNER: WHITESIDE, RANDEL & LORI PHONE #: 503-6248671
CONTRACTOR: TEUFEL NURSERY INC PHONE #: 5Q3646 -111 I
Inspection Request Scheduled For: Date: 12118/2008 Pour Time: f-'"
Code # Inspection Description Confirm # Contact # Mes g
39 Misc. inspection 079094 -01 503 - 616.1111 Y
Corrections /Co ments /Instr ions:
G A dt- Ae-ur-i1Q lAAAS6--tik \)1/4-)
(;,,
) u ,— D V1 0 622 o. 'k/
403.1:; D'40 - iq — - 1(1/0 4e1 if<1-2L-i5
/11661 c)..Th
(A t :Le
4
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
Vg,,FAIL CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: AA'
0 D' V" V Date: � �I � I D Phone #: (503) 718-