Permit y _ ;
CITY TIGARD CITY OF 1 IGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT PERMIT #: PLM2007 -00440
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 9/26/2007
PARCEL: 2S112BD
SITE ADDRESS: 14778 SW 76TH AVE ZONING: R -
SUBDIVISION: PROSPECT MEADOWS LOT: 004 JURISDICTION: TIG
PROJECT: PROSPECT MEADOWS
Project Description: Backflow preventer for irrigation.
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
LEGACY HOMES, INC.
17825 S. FIELDSTONE LANE Description Date Amount
OREGON CITY, OR 97045 [PLUMB] Permit Fee 9/26/2007 $36.25
[TAX] 8% State Surcha 9/26/2007 $2.90
Phone : 503 -544 -6783 Total $39.15
Contractor:
LEGACY PLUMBING
8985 SW HAZELVERN WAY
PORTLAND, OR 97223 REQUIRED ITEMS AND REPORTS
Contact # : PRI 503 -816 -8887
FAX 503- 297 -4587
Reg #: LIC 159281
PLM 26 -517PB
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.
I
Issued ��� , _ ",� At , ,_...4 Permittee Signature: ern 92.��`"` Q /t.
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.
09/25/2007 11:11 5036317283 LEGACY HOMES /TMR PAGE 04/04
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Plulnrlibilla� Permit.A»u ' ca�ioi�l FOR ()FFkk:1. I' ()Nil_.1'
x eiv d Permit No
City o£ ` xgard• , s 11 ''''D-,1
t 1 4, 0 3 1A a y
IN
f v 13125 SW Hall 131vd Tigard, OR "Revie Oihcc Petrcrit 130,:
F • Phone: 503:639.4171 Fax: 503.5987960 Dateray: .
Inspection Line: 503.639,4175
T I GA.F7 S .2 J 20 07 Date P, ead'/13y: lcn / 5( : E i>3 See Page 2 for
Internet: www.tigerd- or.gov ott£sed/Method: Supplemental Information .
N
O1F WO.= ��: EE° F ; . , ' ' iixt�E:
'New construction 7-. olitton' 2- - >s- T b o
Forspecial rmaJon use checklist.
T r"' >r Description Otv: I Ea- (. • Total
0 Addition/alteration/repiacement ' . 1 � ' y r� O - • New 1- 2-family dwellings (includes 100 ft- for each utili>,y connection)
'.;" .:.. CAncOdt)•QF':CONSU&UCTXUN .', ., SFR (l) bath 249 -20 •
'Si, 1 and 2-family dwelling . ❑ Commercial /industrial SFR (2) bath • ' 350.00
• 0 Accessory building ' • ❑ Multi- family
SFR (3) bath • 399.00
'Each additional bath/kitchen 45.00
[a Master builder . ❑ Fire sprinkler (' _ sq. ft.) _ . Page 2
JOB S110E 1 IFORM1]ON ANA. }VOCATION_. Site utilities •
Job site address:'. I All • s, - . . Catch basin or area drain 16.60
City /State /ZIP: `T i .. 4A cis] 'Z z-�', • ' ihywell, leach line, or trench drain 16.60
h aw.
Suite/bld ./a t. no.; Project name: f t . : • Page 2
Manufactured hontc utilities 1 10.00
Cross street/directions to job.site: • 16.60
• Mat, idles
. .. • . Rain drain connector 16.60
. Sanitary sewer (no. linear ft.: ) Page 2
. Storm sewer (no. linear ft: ,_ ) Page 2
Subdivision: Lot no.:
Water service (no. linear ft,: ) Page 2
Fixture or item
faX map /parcel n0.: 2 �j f3 • •0 Sc\ 0P, Absorption valve
16.60 -
a ve 1 6 . 601 •
. • DIrSCiR I(ON Uk" WO Eackflow prevcnter Page
2
h `J t Backwater' valve 16.60
s � B. , • . s' w -� All . - -
S�i 1 R2 C) ® ° CO 0 Clothes washer 16.60 .
Dishwasher . . 16.60
mS Tz 00'7 IR Drinking f
16:60
': : • . • ' '1. Q[ . • 1P1i W •iUW t ..... . ; Q A Tg, 16.60 NNt..:
Ejectors/sump _
Narne: L s 0, c _ 'm, z ■ . T A ' Expansion tank 16.60
Address: ii` sz i 6 . 1 E 1f- S , __, '', Fixture/sewercap' • _ .16.60 ,
City /State/ZIP: ` -- a . • O / • ,.: .. Floor drain/floor sink/huh 16.60 .
Garba disposal . 16.60 I MF; Phone: ( 643) 103 - ., a3 6 . 6 - - 16.60
CONTACT PERSON: Hose
0 • APP GTCArI!iT' ; :. • :1.: fl , Ice maker 1 6.60
Business name: . • Interceptor /grease trap 16.60
Page Contact name: : r r , r, Medical $ as ( value: $ ) P age 2 2 . - • Address: Primer _ ,_ City / State/ZIP: Roof drain (commercial) 16.60 _
Sinwbasin/lavatory 16.60
Phone: (C ∎ Fax: ; ( ). - 16.60 J . Tub /shower /sbowet pen . .
E •s s • u F it :� �A Urinal 16.60 •
.' :, ':',CONTCTOR 16,60 .:.. • , . ::.:.. . . .... . Water closet
L 16.60
Business name: L - s, • N YYl • Water heater
Address: J. ' ,, - Other. _ i -• Ati Subtotal
City / State/ZIP: ' • , . • 4111 L. a 1 _ - Minimum permit fee; $72.50
• ( ' - Ci] ova. _ Fax:
( ) Residential b'ackflow minimum permit fee: $36.25 •
Ph° '�' ® Plan review (25% of permit fee)
PI fbing l✓ic. no. :' •
S tate surcharge (8% of permit fez) G I
Authorized signature: r /Mer.� - TOTAL PERMIT FEE •
Date: .... This permit application expires if a permit is not obtained within '
t�rr 180 days after it has been accepted as complete.
. • *Fee methodology set by Tri -County Building Industry Service Board.
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