Permit CITY TIGARD PLUMBING PERMIT
rl� DEVELOPMENT SERVICES PERMIT #: PLM2%05 -00450
e 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 9/9/2005
PARCEL: 2S 103DC -03400
SITE ADDRESS: 11255 SW VIEWMOUNT.CT ZONING: R -4.5
SUBDIVISION: VIEWMOUNT LOT: 022 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
GEOFF & ROS BIRKEMEIER Description Date Amount
11255 SW VIEWMOUNT CT
TIGARD, OR 97223 [PLUMB] Permit Fee 9/9/2005 $36.25
[TAX] 8% State Surchan 9/9/2005 $2.90
Phone : 503 639 - 1509 Total $39.15
Contractor:
SIGNATURE LANDSCAPE
PO BOX 304 REQUIRED ITEMS AND REPORTS
TUALATIN, OR 97062
Phone : 503- 673 -0252
Reg #: PLM 6195LCB
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: A - L44—
Call 503 - 639 -4175 by 7:00 a.m. for an inspection tha usiness 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 Application . , FOR oPli( 1, I SI: o \:I.\
City of Tigard i•: ECE �'A E F D eB y 1)-9 i a C Permit NS? \ /4� a (/)`J
13125 SW Hall Blvd., Tigard, OR 9r2 A,. Plan Review
Phone: 503 639.4171 Fax: 503.598.1960 /tot, i ' Other Permit No
f,, .�:: Date/By
24 Hour Inspection Line: 503.639.4175SEp 0 9 20 - • ' I I , Date Ready/By iWO See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method: '7 ® Supplemental Information
.Pr MultGARD FEE* SCHEDULE
t t • ' Fors al information use checklist
❑ New construction BUILDIN `' r - - o ition �° f
G , [ � Description Qty. I Ea. Total
❑ Addition/alteration/replacement $ Other: gas I�/ow New 1 - 2 - family dwellings (includes 100 ft. for each utility connection)
' CATEGORY OF CONSTRUCTION SFR (I) bath 249.20
Sit 1- and 2- family dwelling ❑ Commercial/industrial SFR (2) bath 350.00
❑ Accessory building ❑ Multi- family SFR (3) bath 399.00
Each additional bath/kttchen 45.00
❑ Master builder ❑ Other:
Fire sprinkler ( sq. ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities
• Job site address: 1 245 3 U r Pry /14 Oil .6. c, a - Catch basin or area drain 16.60
City/State /ZIP: T e t,- J Q k. 972-2-.1 Drywell, leach line, or trench dram 16.60
Suite/bldg. /apt. no.: J I Project name: Footing drain (no. linear ft.: ) Page 2
Manufactured home utilities 110.00
Cross street/directions to job site: S' I !y .6_ Manholes 16.60
Rain drain connector 16.60
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
no.: • Fixture or item
Tax map/parcel
6SSr ����0�t -GPs �� ®c Absorption valve 16.60
DESCRIPTION OF WORK Backflow preventer I Page 2
)t ( . - . 'r - P tee. i' . P. _ Orly . Backwater valve 16.60
Clothes washer 16.60
r(// Dishwasher 16.60
PROPERTY OWNER I ❑ TENANT Drinking fountain 16.60
�//�• �J P
Name:
Ejectors/sump 16.60
�o't� " X OSe ,f7; • JFPAI a lei' Expansion tank 16.60
Address: , j L . ,r • -t- Fixture/sewer cap 16.60
City/State /ZIP: �v a� / - 2 . 7 _ 3 Floor drain/floor sink/hub 16.60
c Garbage disposal 16.60
Phone: (�jj3) c �_ /5--0 7 Fax: ( ) _
' ' ❑ APPLICANT' • . ❑ CONTACT PERSON Hose bib 16.60
Ice maker 16.60
Business name:
Interceptor /grease trap 16.60
Contact name: Medical gas (value $ ) Page 2
Address: Primer 16.60
City/State/ZIP: Roof drain (commercial) 16.60
Phone: ( ) I Fax: : ( ) Sink/basin/lavatory 16.60
Tub /shower /shower pan 16.60
E -mail:
Urinal 16.60
. CONTRACTOR Water closet 16.60
Business name S 4 '�a/c LA'AGd. �' -e Water heater 16 60
Address: A o . doX 20V Other:
City/ State/ZIP: T4 4 �04'r^ 4 -- 7(0C Z Subtotal
Minimum permit fee $72.50
Phone: (03) c? 3 Q - :2_ Fax: (7D?) 67.' 0 / y2, Residential backflow minimum permit fee. $36.25 3(• Z S
CCB Lic.: Plumbing Lic. no.: ■ Plan review (25% of permit fee)
State surcharge (8% of permit fee) 9.90
Authorized signature: k , _ i TOTAL PERMIT FEE 39 /S-
Print name: (5 R y ■
, 7 if et Date: 9 Q 0 This permit application expires if a permit is not obtained within
180 days after it has been accepted as complete.
*Fee methodoloev set by Tri- County Buildine Industry Service Board
CITY OF TIGARD . `"
BUILDING DIVISION A le PERMIT #: PLM2005 -00450
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 9/9/2005
Phone: (503) 639 -4171
Inspection Requests (24 Hrs.): (503) 639 -4175 I _.. 44'3
INSPECTION WORKSHEET FOR DATE: 10/10/2005 TIME: 7:04AM PAGE: 114
SITE ADDRESS: 11255 SW VIEWMOUNT CT CLASS OF WORK:
SUBDIVISION: VIEWMOUNT LOT #: 022 TYPE OF USE:
PROJECT NAME: BIRKMEIER
DESCRIPTION: BacI4low preventer for irrigation.
OWNER: BIRKEMEIER, GEOFF & ROSE PHONE #: 503 -639 -1509
CONTRACTOR: SIGNATURE LANDSCAPE PHONE #: 503 - 673 -0252
Inspection Request Scheduled For: Date: 10/10/2005 Pour Time: v // � s . s p
Code # Inspection Description Confirm # Contact # Mes age Wri f
325 RP /backflow preventer 017823 -01 503 -673 -0252 / 6 DeA5
(-.Ni) eL b �. '
Corr ctions /Comments /Instructi s:
CG,.5 3---S2
(72 . .
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V '. f , '(
14
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑` CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
VCA Cl/L l b rD /35
Inspector: Date: Phone #: (503) 718-