Permit CITY TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT PERMIT #: PLM2007 - 00153
TIGARD 131.25 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 4/19/2007
PARCEL: 2S112CB
SITE ADDRESS: 15425 SW 81ST AVE ZONING: R -
SUBDIVISION: ASHFORD OAKS NO. 2 LOT: 083 JURISDICTION: TIG
PROJECT: BURWELL
Project Description: Backflow preventer for irrigation.
CLASS OF WORK: GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS: I 4
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
BURWELL, MARTA K
15425 SW 81ST ST Description Date Amount
TIGARD, OR 97224 [PLUMB] Permit Fee 4/19/2007 $36.25
[TAX] 8% State Surcha 4/19/2007 $2.90
Phone : 503- 639 -5332 Total $39.15
Contractor:
OWNER
REQUIRED ITEMS AND REPORTS
Contact # :
Reg #:
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 By: /�i�) Permittee Signature
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.
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Plumbing Permit Applit „ -`" FOR OFFICE USE ONLY
City of Tigard pg pppp R eceived Permit N..: / �Z� �
n 131'25 SW Hall Blvd., Tigard, OR 9ialZ3\ v 2007 Date/By: /Jf� /� 136 /�+'/
II
= Phone: 503.639.4171 Fax: 503.598.1960 Plan Review
Date By: Other Permit No.:
7
Inspection Line: 503.639.415 `
TIGARD Ins p C11 ur iluiltui. Date Ready/By: See Page 2 for
Internet www ttgard or ov Notified/Method Supplemental Information
7 Y1 0 ,,;,',,:k° r S FEE* SCHEDULE
['New construction ['Demolition For special information use checklist
Description I Qty. I Ea. I Total
Addition /alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
4 !�CATEGORY'OF CONSTRUCTION SFR (1 bath
() a
+. yf *A. . ; ��,iwa F, �. v . . .- s„ . ,, - .,,,.. . O, , K :4 249.20
[2-r- and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 350.00
I=1 Accessory building ❑ Multi - family SFR (3) bath 399.00
Each additional bath/kitchen 45.00
❑ Master builder ❑ Other Fire sprinkler ( sq. ft.) Page 2
5 JOB SITE INI+'ORMATION ANLkg CATION Site utilities
Job site address: / 3 z._ f f 8'/ s• - s V E Catch basin or area drain 16.60
City/State /ZIP: if 4474) a I` 97 iZ 4 Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: Project name:Z2W - � `LV� Footing drain (no. linear ft.: _) Page 2
Manufactured home utilities 110.00
Cross street/directions to job site:
Manholes 16.60
S a --�� ,2 . Rain drain connector 16.60
• Sanitary sewer (no. linear ft.: _) Page 2
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
Absorption valve 16.60
j ,
k �_ , , `u. DESCRIPTION OF WORK :::,';:F.,,,
.... fat ,,, Backflow preventer Page 2
i ivi '7Au-A-51 onJ ' /L6-0(,/ ?2E {/e 4 N Backwater valve 16.60
b6 vs CE • . Clothes washer 16.60
Dishwasher 16.60
a I20PERTY4OWNER Drinking fountain 16.60
►}1 P l 1 TENANT w 16.60
. Ejectors /sump
Name: AgliZ,g v206 / Expansion tank 16.60
Address: /r4 L,f SW 3 /S� /d'vv Fixture /sewer cap 16.60
City /State /ZIP: it 4Ytize) d le 9p-z--4- _Floor drain /floor sink/hub 16.60
Phone: (5 °3) 6 35 - S - Fax: ( ) Garbage disposal 16.60
' • :7% ` APPLIC G PERSON 6 Hose bib
16.60
_, w, . �6� ,:.. . , . , � . re.- ;: , ,u,t,• Ice maker 16.60
Business name: Interceptor /grease trap 16.60
Contact name: Medical gas (value: $ ) Page 2
Address: • Primer 16.60
Roof drain (commercial) 16.60
City /State /ZIP:
Sink/basin /lavatory 16.60
Phone: ( ) Fax: : ( ) 16.60
Tub /shower /shower pan
E -mail: Urinal 16.60
` C ONTRACTOR ''. b i _ � g . , W ater c 16.60
.._ � -..... . .;'1 6: % r.^: ,..,. .,. ' iii,..,,,... .., ,.
Business name: .1/trill-it------ j Water heater 16.60
Other:
Address: Subtotal
City /State /ZIP: - Minimum permit fee: $72.50
Phone: ( ) Fax: ( ) Residential backflow minimum permit fee: $36.25
Plan review (25% of permit fee)
CCB Lic.: Plumbing Lic. no.:
.- Authorized signatu TOTAL PERMIT FEE ;. . J 5 Print name' Date: State surcharge (8% of permit fee)
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.
I:\ Building \Permits \PLM- PermitApp.doc 06/26/06 440- 4616T(I0 /02 /COM/WEB)
1
CITY OF TIGARD
BUILDING DIVISION PERMIT #: PLM2007-00153
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 4/19/2007
Phone: (503) 639-4171
Inspection Requests (24 Hrs.): (503) 639-4175
INSPECTION WORKSHEET FOR DATE: 5/1/2007 TIME: 7:00AM PAGE: 23
SITE ADDRESS: 15425 SW 81ST AVE CLASS OF WORK:
SUBDIVISION: ASHFORD OAKS NO. 2 LOT #: 083 TYPE OF USE:
PROJECT NAME: BURWELL
DESCRIPTION: Backflow preventer for irrigation.
OWNER: BURWELL, MARTA K, PHONE #: 503-639-5332
CONTRACTOR: OWNER PHONE #:
Inspection Request Scheduled For: Date: 5/1/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
399 Plumbing final 047422-01 503-639-5332
Corrections/Comments/Instructions:
1■4.4 Cc) (a).ALIc. c0 4‘v crer (-c
rb (/,)
Coble I fr
PASS fl PARTIAL APPROVAL I I CANCEL I NO ACCESS
FAIL I I CALL FOR INSPECTION I I ADDITIONAL FEES ASSESSED
Inspector: cro „_ Date: S)1 I ( C) Phone #: (503) 718-