Permit C TY OF TIGARD PLUMBING PERMIT
d iA DEV ELOPMENT SERVICES PERMIT #: PLM2006 -00505
l ),, DATE ISSUED: 10/23/2006
1 ''' 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171
PARCEL: 1 S 134DB -08200
SITE ADDRESS: 11098 SW 113TH TERR ZONING: R -4.5
SUBDIVISION: STONECHASE LOT: 006 JURISDICTION: TIG
Project Description: Residential backflow 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
GERRITZ BIGGI CUSTOM HOMES Description Date Amount
9550 SW BEAVERTON HILLSDALE HY
BEAVERTON, OR 97005 [PLUMB] Permit Fee 10/23/200( $36.25
[TAX] 8% State Surcharl 10/23/200( $2.90
Phone : 503 - 619 - 4668 Total $39.15
Contractor:
MARK BROWN LANDSCAPING
PO BOX 744 REQUIRED ITEMS AND REPORTS
VANCOUVER, WA 98666 -0744
Contact # : FAX 360 - 993 -5993
PRI 503- 234 -2667
Reg #: LIC 5192
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 50 46-669( 1- 800 - 332 -2344.
Issued B : �\ 1� _3Q Permittee Signature:. j ', 41
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.
ni rt.7Do5 - bo `/3S y
PCu Permit Application
City of Tigard Received r� permit No.: / F
13125 SW Hall Blvd., Tigard, OR 97223 Date/By: /(' �� d "/ Gi f e .62
Plan Review Other Permit No.:
Phone: 503.639.4171 Fax: 503.598.1960 / /N+a� ! r I �� Date/B
24- Hour Inspection Line: 503.639.4175 ■ �,1. •I I � Date Ready/By: El See Page 2 for
Internet: www.ci.tigard.or.us r Notified/Method: 77 .----_ Supplemental Information
II
. TYPE OF WORK c '' :. .,F. : • , ,FEE *;SCHEDULE'. , .
[few construction ❑ Demolition For special information use checklist
Description 1 Qty. 1 Ea. 1 Total
❑ Addition/alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION:; .,';:;:,:;' ;,1 ": ;,: SFR (1) bath 249.20
and 2- family dwelling ❑ Commercial/industrial SFR (2) bath 350.00
(11 Accessory building ❑ Multi - family SFR (3) bath 399.00
Each additional bath/kitchen 45.00
❑ Master builder ❑ Other:
Fire sprinkler ( sq. ft.) Page 2
JOB SITE INFORMATION AND LOCATION, .:..,,1,. Site utilities
Job site address: I /Q C/ 5 ' 7I * 3 1 3 ' 7 , 'j _-6 Catch basin or area drain 16.60
City /State /ZIP: � A &V g 7,- d l y Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: I O 1 Project name: nr ! A,,....., Footing drain (no. linear ft.: ) Page 2
N or1/ - / Di c(i ) ��� ,
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 ft.: ) Page 2
Subdivision: ne �1 h «s e- - I Lot no.: Water service (no. linear ft.: ) Page 2
Fixture or item
Tax map /parcel no.:
Absorption valve 16.60
1 DESCRIPTION OF WORK ' • r: f : ' " " ` Backflow preventer / Paget 3 5�
0 n 12 &, 170x7 oget ' JOw f 7..e rev - / Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
❑ PROPERTY OWNER I • 0 TENANT Drinking fountain 16,60
Ejectors/sump 16.60
Name: �i• �/ (1 � lofty f S LLB - Expansion tank 16.60
Address: 55 ,4`,c) c Tj'�c (6(. n 4 1 Fixture/sewer cap 16.60
City /State /ZIP: rAp - E n 6 970Q5 y Floor drain/floor sink/hub 16.60
Phone: 69 &/q- <I& 6 Fax: 36 6,2- 91 Garbage disposal 16.60
❑ APPLICANT Hose bib 16.60
❑ CONTACT•'1?ERSON o
^ �/ 7m 7 � s L / c _ Inc r maker
trap 16.60
tr 16.60
Business name: �/ S L Interceptor/grease
Contact name: h n (. e- / Medical gas (value: $ ) Page 2
Address: Q r � ��G ea (,/ // y Primer 16.60
City /State /ZIP /7,05- / Roof drain (commercial) 16.60
Phone:�(j O /(i_ 1 Fax: : b -��� Sink/basin/lavatory
ub/sh wer/s owe 16.60
Tub /shower /shower pan 16.60
E - mail: Urinal 16.60
CONTRA�TO/t ". Water closet 16.60
Business name: ma n� /I ( yf /J 6 , 2 p, 07,- Water heater 16.60
Address: Po. SOX 7 2- L Other:
V L n , w /4 981o� 4. - O 7// Subtotal
City /State /ZIP: /
o3
/ Minimu permit fee $72.50 � � S
Phone:. - Or 6.4,7 Fax:3 (00._ 993 _591 3 Residential backflow minimum permit fee: $36.25 , 9j p
, � Plan review (25% of permit fee)
CCB Lic.: �! Plumbing Lic. no.:' State surcharge (8% of permit fee) A .9Di
Authorized signat ure:: ►' /i f //e " TOTAL PERMIT FEE /'j
Print name: in ne_ 1 /� 1 Date: p-)0-06, )0 -D� This permit application expires if a permit is not obtaiddwithin
/J r " 180 days after it has been accepted as complete.
*Fee methodology set by Tri- Countv Buildine Industry Service Board.
^
CITY OF ��mm n ��w nn����nm��
BUILDING DUNG DIVISION #: puhuOm00506
13125SVV Hall 8hd, Tigard, OR07223 DATE ISSUED: 10/23/2006
Phone: (503) 639-4171
Inspection Roquoo�;24Hmj �
Hrs.): 639~4175 "��W� "�1.
INSPECTION WORKSHEET FOR DATE: 12/14/208S TIME: 7:02AhX PAGE: 52 ,
SITE ADDRESS: 11088EW113[HTERR CLASS OF WORK:
SUBDIVISION: STONECHASE LOT #: 006 TYPE OF USE: '
PROJECT NAME: STONECHASE
DESCRIPTION: Fegdoptioj foo
OWNER: GERR[TZMG CUSTOM HOMES, PHONE #: 503-619-4668
CONTRACTOR: MARK BROWN LANDSCAPING PHONE #: 503-234-2667
Inspection Request Scheduled For: Date: 12/1412006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
399 Plumbing final W105E0'82 503'718-2433 N
Corrections/Comments/Instructions:
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' FL:AS S [ PARTIAL APPROVAL | I CANCEL EI NO ACCESS
| | FAIL | I CALL FOR INSPECTION H ADDITIONAL FEES ASSESSED
Inspector: ' p � -- Date: 19
»r ' ,. 'V Phone#: (503) 718-
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