Permit CITY TIGARDPLUMBING PERMIT
i A DEVELOPMENT SERVICES PERMIT #: PLM2006 -00114
�i 1 , DATE ISSUED: 3/31/2006
`' 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171
PARCEL: 1 S 134AC -05400
SITE ADDRESS: 10932 SW GENEVA ST ZONING: R -4.5
SUBDIVISION: HART'S LANDING LOT: 025 JURISDICTION: TIG
Project Description: Backflow prevention device 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
HEATHER WOLF Description Date Amount
10932 SW GENEVA ST
TIGARD, OR 97223 1i3/ v!o 39
Total h 3 ./S
Phone : 503 670 - 1556
Contractor:
GREEN DAY LANDSCAPE
PO BOX 2613 REQUIRED ITEMS AND REPORTS
CLACKAMAS, OR 97015
Contact # : PRI 503- 658 -2685
FAX 503- 658 -5342
Reg #: LIC 8046
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 -000 4010 t gh OAR 952 - 0001 -0100. You may obtain copies of these 's& s& or direct questions to OUNC by
calli re, 503-246-6699 • r 1 8 t 332 -2344 -
■
Issu - d By: i Permittee Sig ature w --c.
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 am required on the job site at the time of each inspection.
MA X 06 /THU 10:57 AM • P. 001
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Plumbing Permit Application r,i- ,.� , �•� , ! r,.,ii rr�,r ; ,r c w� .: , , , /, ,
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City of Tigard lit 1� Received Q�
13125 SW Hell Blvd., Tigard, OR 21 EC EN �' ill CU/ 14A Poison No.: PCB•/ 49 �P' d0 # y
Plan Review
Phone: 503.639.4171 Fax: 503. 598.1960 / f r ti I , Oate%c Other Permit No.:
24- Hour Inspection Linea 503.639.4175��A ' , �� 2006 ` + 4' I pate Ready /AY: tv 81 See Page 2 fur
Internet: www.ei.tigand.or.us tdetilied/Methad: • of . Supplemental Information
r f *"'!`J7"'{ y��..�.C• t ,�S'.L ` , N .. -. tSl .'. A,, q ^r :=4:r3. F -- y ,yp j,�P�yZY' � � � :..
}� X y -� - • • `Ct r ;' i - kr Zo f ( X .y ij , . 4,,-,,,-i. yl �i� \ tl 4 7 y } • ",Fitt ,,:Lip ,Si!igil :=Y"ai..•s=Y.tti.=L:. kgi Tk k;;;Siz r h�e w� .. `.: ?:i �.N,a ,.....'>'.i�>t.aM. ✓_r4 . .._ l. i .. .i..47?t�. ` �'y„,iLti.• ° -
New construction BUt�DIN �l� - IA t ion For special ' use clrecklisl.
Description 1 Qty. 1 Ea, 1 Total
111 Addition /alteration/replacement ❑ Other: New i- 2- family dwellings (includes 100 It for each utility connection)
morif.,7f.r. 11r•(1Ti R : `fir o,migt,rev�s � _ SFR t bath 249.20
} 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 batlt/kitchcn 45.00
❑ Other:
{{��. (� f q:•. T„ c+� t � _ f � r Fire sprinkler ( sq. It.) Page 2
'* j'i .1i� ? ti'?1 t l ,mot 31712' ' ° - ° 1*4� ;!�a Site utilities
lob site address: , O01 3 a C-1 crrekro- -. Catch basin or Brea drain I I 16 -60 I
City /State /ZIP: -1 0__{0, ( os 9 72. 3 Drywell, leach line, or trench drain 16.60
Suite /bldg, /apt. no.: I Project name: Footing drain (no. linear R.: ) Pagc 2
Manufactured home utilities 110.00
Cr oss sheet /directions to job site:
Manholes 16.60
Rain drain connector 16.60
• Sanitary sewer (no. linear R.: ) Page 2
Sto+•iu sewer (no. linear R.: ) Pagc 2
Subdivision: I Lot no.: water service (no. linear R.: ) Page 2
Fixture or Item
Tax map/parcel no.: A.bson)tion valve 16.60
!s " s , A , ,; - - Ax' s;% , ,A.,„ 4. , : ' n ' " ° `''� ' t , # ; "a w *,te d,':s ' . Backflo�v preveuter ) Page 2 • . •:emu
Backwater valve 16.60
1 !r ' I )c - 6� 1 c L A , Clothes washer _ 16.60
�`� � Dishwasher 16.60
r 4.3 Q7s + > �t �c�� , z,� :,,,..r
:: l tors /sump 16 -60
Nance: ik Wo l c -- 1 Expansion tank 16.60
'I Address: )(1 `3 9_ c8-1,s y'e�'e v6,.._ S `- . Fixture/sewer cap 16.60
City /State /ZIP: `r 0�.rC3 I t I ..9- Floor drain /floor sink/hub 16.60
Phone: (61;4) Lit -- 1 ^ ' Fax: ( ) Garbage disposal _ 16.60
t Hose bib 6.
�.^L ; t 4 . 3 ": ��. d , Sz 1 s1n.F2i ;t I AA , , _ 6114; . , ,, ;, ' 4 I. � mg.. Ice mikcr 16.60
Business name: Cije t/� t,1A�►to)SGQ -�P� I ').Jc- • Interceptor /grease trap 16.60
Contact name: , l4.4„ 4-4.ele--e" medical gas (value: 5 ) Pagc 2
Address: Primer 16.60
p,
City /State/ZIP: �n -8- -'S 1�'f>>S Roofdraitn(coinrnercial) 16.60
Sink/basin/lavatory 16.60
Phone: (9»3) tt5? - 2- Le cr S J Fax:: (9,3) LQ'St' -- 5.34 1-
Tub /shower /slnowet pan 16.60
E-mail:
f� °.�.� �7, h.� i 4s. -•f ; "Alai - A,,,.y.✓� , ,� Urinal 1 G.60
" ' :, •,r. 4:a-:`>z,, . • iii" '' i� Y (' 1 yt tai ', i' 'i'`�' '. oWater closet 1640
Business name: Q - - O 1„2.2\ SG6-eQ_ 5 Water beater 16.60
blc a(� Other:
Address: IP b Yl
n` - 1 Subtotal _ 'a.-- •S S -
City /Slate/Z1P: C)e;Q -firAS , f5�- ` '9V t Cj Minimum permit fee: 572 -50
Phone: (r5 ) ( ' - "?{Q `ir 5 Fax: (5t,3) (2 5 S 7c4-'a- Residential backflow minimum permit fee: 536.25 ?3 Lr • a
GeB k� 31 `3ml61 Plumbing Lie. no -: �� - t:Gq -- Plan review (25 %ofpermnit f8e)
r p, 8% Stale surcharge ( of permit fee) 'a• .90
/wit hGrized signature: 31 15 TOTAL PERMIT FEE
Prins name: • QOD Dale: b fl Thls permit application expires if a permit is not obtained within
180 days after it has been accepted as complete.
*Fee methodology set by Tri- County Building Industry Service Board,
i a„adiabpVermita,P1,10.pc , dtiy>O.doc 1203 440.4616T(10!021COM•n'Ea)
CITY OF TIGARD .
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BUILDING DIVISION PERMIT #: (y-f '
13125 SW Hall Blvd., Tigard, 97223 DATE ISSUED:
Phone: (503) 639 -4171 ����� Agtoipl, , Inspection Requests (24 Hrs.): (503) 639 - 4175 4'+` "' L
INSPECTION WORKSHEET FOR DATE: TIM f) - Yv!,) PAGE:
SITE ADDRESS: I 0 i 3 - ( " .'v'\ eA.769 k - . CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME:
DESCRIPTION:
OWNER: I ! PHONE / #: 4" . ! s ,
CONTRACTOR: P . "t . 1,,jz_/ PHONE #:
inspection Request Scheduled For: Date: t i9 (' Pour Time:
Code # ' Inspection Description Confirm # Contact # Message-
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Corrections /Comments /Instructions: 7 - ) ( r
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4,,1 PASS 11 PARTIAL APPROVAL I I CANCEL I I NO ACCESS
FAIL CALL FOR INSPECTION ADDITIONAL FEES ASSESSED
Inspector: k �\ \ \:-..--/ Date: ! I S � ` t) Phone #: (503) 718-
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