Permit C ITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT PERMIT #: PLM2008 - 00237
i G n ►i 1 3125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 5/28/2008
PARCEL: 1 S 136DC -04400
SITE ADDRESS: 11945 SW 70TH AVE ZONING: C -G
SUBDIVISION: DARTMOUTH SQUARE LOT: 030 JURISDICTION: TIG
PROJECT: DARTMOUTH SQUARE
Project Description: Installing backflow preventer.
CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS: 1
OCCUPANCY GRP: B 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
DARTMOUTH SQUARE, LLC
7165 SW FIR LOOP # 100 Description Date Amount
TIGARD, OR 97223 [PLUMB] Permit Fee 5/28/2008 $72.50
[TAX] 12% State Surch 5/28/2008 $8.70
Phone : Total $81.20
Contractor:
PEAK LANDSCAPING
2200 NW CORNELIUS PASS RD STE
HILLSBORO, OR 97124 REQUIRED ITEMS AND REPORTS
Contact # : PRI 503 -533 -8173
FAX 503 -533 -8176
Reg #: PLM 8339
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 = 11111111
ermittee Signature /. g
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.
Plumbing Permit Application
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1 tilding Fixtures g�S ro ll o i i (.;.SE '.6_,Y.`.: \ I
i de City of Tigard
(VI ��� /� Permit No PL a�I.anO vo
n 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review /
P /
Phone: 503.639.4171 Fax: 503.598.1960 t, • :Y: Othe r Permit t N o w/ --I__ - : "ii. Inspection Line: 503.639.4175 MH 1 2 8 ' t .;!,►; Ready/By: Awls: ® See Page 2 for
. Internet: www.tigard -or.gov Notified/Method: Supplemental Information
TYPE OF WORK QTY OF TIGARC k, F EE* SCHEDULE
ew construction ❑Demo,; ' %LDING DIVISI® For special information use checklist _
D'LJ D escription Qty. a. i Tot ;
❑ 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 J ❑ 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 Site utilities
Job site address: / I G2�.� 7O A ,c , , Cat basin o r area drain 1 16.60
J'
1
e ll, -leach line, or trench drai 16:60
_ . City/State/ZIP: �_,: Gf -- q7 3 . - i
Suite/bldgJapt. no.: 1 I Project name: i ry
S UQI� Footing drain (no. linear ft.: Page 2
Manufactured home utilities 110.00
Cross street/directions to job site:
Manholes 16.60
Rain drain connector 1 6.60 ■
Sanitary sewer (no. linear ft.: _) Page 2 i
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.: 1
Absorption valve 16.60 ,
DESCRIPTION OF WORK '
Backflow preventer Page 2
ri I Ct--d"t - 0.- fie_ k '7"/0 LAD Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
❑ PROPERTY OWNER I ❑ TENANT Drinking fountain 16.60
Ejectors/sump 16.60
Name: Expansion tank 16.60
Address: Fixture/sewer cap 16.60 1
City/State/ZIP: Floor drain/floor sink/hub 16.60
Phone: ( ) Fax: ( ) Garbage disposal 16.60
e �PLICANT ❑ CONTACT PERSON Hose bib 16.60
lee maker 16.60
Business name: 2e a .e_ ✓ . Interceptor /grease trap 16.60
Contact nam. �
� uvL p / p� ( a vl__ _ _ _ )Q Medical gas (value: $ ) I Page 2 {( - - --
Address: ate n (' tv, / Primer 16.60
City /State/ZIP: / ') j (O Da. 6 3 70z-i Roof drain (commercial) 16.60
Sink/basin/lavatory 16 .60
Phone: 3 ��..3E . - el I Fax: : C 5533. ergo - ry
Tub /shower /shower pan 16.60
E - mail:
Urinal 16.60
CONTRACTOR Water closet 16.60
Business name: ,, -G._ fie. 0.S Water heater 16.60
Address: Other:
City/ State/ZIP:
Subtotal L.I & , go
Nlinimum permit fee: $72.50
Phone: ( ) F/im-(' x- ) Residential backflow minimum permit fee: $36.25 7c . 5
LB Lic.: bin L no.: Plan review (25% of permit fee) 4 4 7 State surcharge (12 %ofpermit lee � , I 0
Authorized signature: !� /� _ TOTAL PERMIT FE , „.
Print name: ) Sot/N � - J Date: 5160/0 RI This 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.
1:\ Building \Pennita\PLMF- PennitApp.doc 12/27/06 440- 4616T(10 /O2/COM/WEB)
CITY OF TIGARD -
BUILDING DIVISION PERMIT #: PLM2008-00237
13125 SW Hall Blvd., Tigard, OR 97223 i DATE ISSUED: 5/28/2008
Phone: (503) 639 -4171 u
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 11/12/2008 TIME: 7:00AM PAGE: 51
SITE ADDRESS: 11945 SW 70TH AVE CLASS OF WORK:
SUBDIVISION: DARTMOUTH SQUARE LOT #: 030 TYPE OF USE:
PROJECT NAME: DARTMOUTH SQUARE
DESCRIPTION: aai n j ;xi l!dlow prey nt r.
OWNER: PHONE #:
CONTRACTOR: PEAK LANDSCAPING PHONE #: 503.533 -8173
Inspection Request Scheduled For: Date: 11/1712008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
399 Plumbing final 077903-01 503 - 535 -9761 N
Corrections /Comments/ Instructions:
1
/ j 3I\
li
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASS . SSED
Woz
Insp ector: Date: \ ` 1146 Phone #: (503) 718 - it 71(1