Permit CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT PERMIT #: PLM2009 - 00011
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 1/20/2009
PARCEL: 2S110DC -90111
SITE ADDRESS: 15655 SW 114TH CT G 11 -14 ZONING: R -25
SUBDIVISION: FOUNTAINS AT SUMMERFIELD CONDO LOT: 011 JURISDICTION: TIG
PROJECT: THE FOUNTAINS AT SUMMERFIELD
Project Description: Replace existing backflow device for irrigation. Backflow is located on the south end of the
building in a planting bed.
CLASS OF WORK: OTR GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: MF 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
THE FOUNTAINS AT SUMMERFIELD Description Date Amount
15655 SW 114TH CT
TIGARD, OR 97224 [PLUMB] Permit Fee 1/20/2009 $72.50
[TAX] 12% State Surcha 1/20/2009 $8.70
Phone : 503- 624 -2046 Total $81.20
Contractor:
WILLAMETTE LANDSCAPE SERVICES, INC.
TUALATIN, PACIFIC 97
062 TUALOR 97062 REQUIRED ITEMS AND REPORTS
TI
Contact # : PRI 503 -625 -9600
FAX 503- 625 -9714
Reg #: LIC 6949
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 OU NC b - • 503.246.6699 or 1.800.332.2344.
Iss ed By: . 4 4 / Permittee Sign ure: ' '' e r �
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.
,. 4 't'Jan, 19. 2009 11:14AM WILLAMETTE LANDSCAPE SERVICES No. 2290 P. 3
Plumbing Permit Application
Building Fixtures RECEIVE ) FOR OFFICE USE ONLY
City of Tigard JAN 2 0 2009 R e��y X30 09 4,k Permit No.! , � /
13125 SW Hall Blvd., Tigard, OR 97223 Pla Review
Ip
Phone: 503.639.4171 Fax: 503.598.196et oF T Ie1By: Other Permit No.:
rlGAltn Inspection Line: 503,639,4175 IVISI� 1 teR6ad* raris:
Internet: www.tigard- or.gov BUII Notified/Method: Supplemental Information
TYPE OF WORT( FEE* SCHEDULE
❑ New construction ❑ Demolition For special information UM char/ is .
Description Qty. Ertl Total
,Additiontaltcration /replacement ❑ Other: Ncw 1.2- family dwellings (includes 100 ft. for each utility connection) !
CATEGORY OF CONSTRUCTION SFR (1) bath 249.20
❑ 1- and 2- family dwelling Q Commercial/industrial SFR (2) bath _ 350.00
❑ Accessory building ❑ Multi- family SFR (3) bath - 399.00
Bach additional bath/kitchen 45.00
❑ Master builder ❑ Other: - .
Fire sprinkler L_ sq. ft) Page 2
J SITE INFORMATION AND LOCATION Site utilities w
Job site address: 15 4 95 5t-.D ` A IA's Ck , Catch basin or area drain 16.60
City /State /ZIP: �� �' 4a r C{ 7 - Awl v Drywall, leach lino, or trench drain 16.60
LCrh V� l
`] n Footing drain (no, linear ft.: ) Pa e 2
Suite/bldg. /apt. no.: i' 6 �$• Project name: , _ r 8
lJ �: wKVW� J de it„ Manufactured home utilities 110.00
Cross street/directions to job site:5 ,,,„„,,,,,. mw c, eve ,, d- i Li ti- (} , -
Manholes 16.60
r re Manh
C ..‘k o .i 10. c -t.e oti ' &'& So les-N e, v. J Rain drain connector 16.60
LI I 'K\, ` �, 1G4,,1A- ‘1,4- 1cr yy 1 Sanitary sewer (no. linear fl.: _ ) Page 2
Storm sewer (no. linear ft.: ) Page 2
Subdivision: Lot no.: Water service (no. linear R.: ) Page 2
Tax map /parcel no.:
Fixture Or item
Absorption valve 16.60
T DESCRIPTION OF WORK 13ackflow preventer 1 Page 2
�4∎A 1.c4.tt / tycrf.(_ {tno._ ercS {Z a " Backwater valve 16.60
1'j C { g c9e. u.r c P
Clothes was 16.60
Dishwasher 16.60
❑ PROPERTY OWNER El TENANT
Drinking fountain 16.60
Ejectors /sump 16.60
Name: go ko \( eU u , \A.0 ( v,.. St k.Z C O tn,} c .0 . /
Expansion tank 16.60
Address: xs I, (5 st k i �1. ^• t �, u tat k- / [ et Fixture/sewer cap 16.60
City /State /ZIP: : . ,,„...Q, . b t 7 a al.( Floor drain/floor sink/hub 16.60 w
Phone: (50 j) [9a ti _ ao K 6 Fax: ( ) Garbage disposal 16.60
ID APPLICANT ❑ CONTACT PERSON 1-lose 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 ( ) Fax:: ( ) Sink/basin/lavatory 16.60
Tub /shower /shower pan 16.60
E -mail;
- Urinal 16.60
CONTRACTOR Water closet _ 16.60
Business name: (,,a: , s S ce ..-L Water heater 16.60
Address: 1 1,1V0 54.-a) PG �" 1 0.. Other:
CilylSCatc /ZIP: '~' �.ctil ct,W tA btotal
t 0 lz 1 C O - i e ti a Minimum permit fee: $72.50
fee) (25% review Phone: (503) 6:4e. w q Le [7� Fax: (So a 614 ei t (q Resid backflovv minimum zormit fee: S36.25 I c - 5O
permit m 10
„�.1c,; LC CS 4 4- K 6 i 1 Plumbing Lie. no.: Plan rev ( P ) $-
•
tir a.e___
State surcharge (12% of permit fee) -'
Authorized signature: TOTAL PERMIT FEE
Print name; l (ase- S4e)t klA - I Date: 1, I \ CI / O Ct This permit application expires if a permit is not obtained within
180 days after It has been accepted as complete.
RFce methodology set by Tri -County Building Industry Service Board.
I\ BUiIsingTenniis \Pi.MF -PermuApp,doe 12/27106 44a,46I6T(10/o2 /CONOWEB)
CITY OF TIGARD
BUILDING DIVISION PERMIT #: pu.." :* *0011
13125 SW Hall Blvd., Tigard, OR 97223
a i \
0 D SUED: . ..' ,s9
Phone: (503) 639-4171 041015,,it \
Inspection Requests (24 Hrs.): (503) 639-4175 /ZY
INSPECTION WORKSHEET FOR DATE: 2/1212009 TIME: 7:00AM PAGE: 4
SITE ADDRESS: 1:;655 SW 114TH CT G 11 CLASS OF WORK:
SUBDIVISION: FOUNTAINS AT SUMMERFIELD COND LOT #: 011 TYPE OF USE:
PROJECT NAME: THE FOUNTAINS AT SUMMERFIELD
DESCRIPTION: Replace existing backflovv device for irrigation. f3ackflow is located on the t. end of the building
in a planting bed. ---------.
OWNER: THE FOUNTAINS AT SUMMERFIELD, PHONE #: 503-624-2046
CONTRACTOR: WILLAME I tE LANDSCAPE SERVICES, INC. PHONE #: 503-625-9600
•
Inspection Request Scheduled For: Date: 2/12/2009 Pour Time: 4 ,fte
Code # Inspection Description Confirm # Contact # Mes-.. (.."' - (5 I `-'-)•
399 Plumbing final 080514-01 503-572-8427
/Pv"i`
Corrections/Comments/Instructions: t2 to• af,t
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`("TIASS I 1 PARTIAL APPROVAL fl CANCEL 1 NO ACCESS
FAIL ri CALL FOR INSPECTION fl ADDITIONAL FEES ASSESSED
Z ‘4
Inspector: Date: Phone #: (503) 71 8 2_ - -a- cf