Permit •
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� , CITY OF TIGARD PLUMBING PERMIT
� DEVELOPMENT SERVICES
PERMIT #: PLM2005 -00330
t DATE ISSUED: 7/26/2005
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 PARCEL: 2S104BC -07400
SITE ADDRESS: 14210 SW WALNUT LN ZONING: R -7
SUBDIVISION: BAILEY WOODS LOT: 010 JURISDICTION: TIG
Project Description: Install residential backflow prevention device for irrigation system.
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
'YAJNAN LI Description• Date Amount
14210 SW WALNUT LN
TIGARD, OR 97223 [PLUMB] Permit Fee 7/26/2005 $36.25
[TAX] 8% State Surchari 7 /26/2005 $2.90
Phone : 503 888 - 6908 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
require . :. - ollow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 :101-0010 th ugh OAR 952 -0001 -0100. You may obtain copies of these rules or direct questions to OUNC by
ca ing 503-246-669' • . 1 0- 332 -2344.
Is ued By: , I I .. Permittee Signature: (
Call 503 -639 -4175 by 7:00 a.m. for an inspection that business da .
This permit cans 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 Jr .. ,' v
Plumbing Permit Application FOR OFFICE USE ONLY
City of Tigard DaceB ° ? ¢G Q� Permit No : � y , ,�3�
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 �' Date/By: Other Permit No.:
24- Hour Inspection Line: 503.639.4175 E' I Date Ready/By ® See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method: ''"/ La Supplemental
TYPE OF WORK FEE* SCHEDULE
❑ New construction ❑Demolition For special information use checklist.
Description I Qty. I Ea. 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
❑ 1- and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 350.00
❑ Accessory building ❑ Multi - family SFR (3) bath 399.00
Each additional bath/kitchen 45.00
❑ Master builder ❑ Other:
Fire spnnkler ( sq. ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities
Job site address: I (F?. to S W wA.Llvu. Le, Catch basin or area drain 16.60
City/State /ZIP: Tyr Cit , q 7Z2 3 Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: Project name: Footing drain (no. linear ft.: ) Page 2
Manufactured home utilities 110.00
Cross street/directions to job site: l Manholes 16.60
WO.- 0W\ GUAt Levu_ g 0 � j 7 Q -T)--& ;' Rain drain connector 16.60
Sanitary sewer (no. linear ft.: ) Page 2
Storm sewer (no. linear ft.: ) Page 2
Subdivision: g,. (p ,� i e - t ,- I Lot no.: 1
Water service (no. linear ft.. ) I Page 2
Tax map /parcel no.: '^ Fixture or item
Absorption valve 16.60
DESCRIPTION OF WORK Backflow preventer i Page 2
1l'tStiiii c Vyt111 CI 1;t Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
Cij PROPERTY OWNER I ❑ TENANT Dnnking fountain 16.60
Ejectors/sump 16.60
Name: Y� ; l,„ n LL Expansion tank 16.60
Address: 1 4 (41 10 S V✓ VM Vt
a+�t L r Fixture /sewer cap 16.60
City/State/ZIP: TA -1 L � cf'P "1 g122 3 Floor drain /floor sink/hub I 16.60
Phone:
( 5 ) 1 3 1 31‘ 1 1 0 g Fax: ( ) Garbage disposal 16.60
❑ 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: b j (7 N N Water heater 16.60
Address: Other:
City/State/ZIP: Subtotal
Minimum permit fee: $72.50 g 2
Phone: ( ) Fax: ( ) Residential backflow minimum permit fee. $36.25 Oft
CCB Lic.: Plumbing Lic. no.: Plan review (25% of permit fee)
State surcharge (8% of permit fee) ID Authorized signature:/1/4 / '
TOTAL PERMIT FEE ( . / `5
Print name. Y�� A n Date: p7I2 6 /20 OS- This permit application expires if a permit is not obtained
180 days after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
i \Build,ng \Pemuu \PLM- PemutApp doc 06/05 440- 46I6T( I0 /02/COM/WEB)
CITY OF TIGAiRD ip ,.
BUILDING DIVISION PERMIT #: PLM2005 00330
13125 SW Hall Blvd., Tigard, OR 97223 D ATE ISSUED: 7/26/2005
Phone: (503) 639 -4171 /� �,„, m �,��, i
Inspection Requests (24 Hrs.): (503) 639 -4175 - U-
INSPECTION WORKSHEET FOR DATE: 802805 TIME: 7 :07AM PAGE: 72
SITE ADDRESS: 14210 SW WALNUT LN CLASS OF WORK:
SUBDIVISION: BAILEY WOODS LOT #: 810 TYPE OF USE:
PROJECT NAME: LI
DESCRIPTION: Install residential backflow prevention device for irrigation system.
OWNER: LI, YAJNAN PHONE #: 503888 -6908
CONTRACTOR: OWNER PHONE #:
Inspection Request Scheduled For: Date: 8/8/2005 Pour Time:
Code # Inspection Description Confirm # Co Message
399 Plumbing final 013040-01 503- 888 -6908 Y
Corrections /Comments/ Instructions:
4/2 ,K,)/V1,
/ i
_ � / _ i � I �. /� /� /L�
/
e l l ' ' SS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Date: qt6--) Phone #: (503) 718 - _itMO__________ ■