Permit — a CITY OF TIGARD PLUMBING PERMIT
° COMMUNITY DEVELOPMENT PERMIT #: PLM2008 -00150
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 4/9/2008
PARCEL: 2S112CC -22400
SITE ADDRESS: 15767 SW 81ST AVE ZONING: R -12
SUBDIVISION: GAGE FOREST LOT: 031 JURISDICTION: TIG
PROJECT: GAGE FOREST
Project Description: Installing backflow preventer.
CLASS OF WORK: ALT 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
JT ROTH CONSTRUCTION, INC.
12600 SW 72ND AVE. Description Date Amount
SUITE 200 [PLUMB] Permit Fee 4/9/2008 $36.25
PORTLAND, OR 97223
[TAX] 12% State Surch 4/9/2008 $4.35
Phone : 503- 639 -2639 Total $40.60
Contractor:
FOREST LANDSCAPE, INC
40437 NW VERBOORT RD
FOREST GROVE, OR 97116 REQUIRED ITEMS AND REPORTS
Contact # : PRI 503- 357 -3808
FAX 503- 359 -1908
Reg #: PLM 8253
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: / '
j7 Permittee Signature: ` �, 75
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
Building Fixtures ` � , •
City of Tigard '•* ' J Received � / i` ' 1 , !Sv
• 13125 SW Hall Blvd., `' �,a 223 y: 7 No. - f/C� i M q � \\ \' Rcvicw )ntpe 503.639.4171 8x 503 59 1 7 ►� /By: paw Perron No. - wU - 7 .,,.�i /- �"'
{ c h a r inve, Line; 503.639.4175 i T D -!J
t www- tigartl-0r.gov P
near Date Ready/By. t�a
Notified/Method: S .. entpllnformstipn
PRO ` + r g r
Ed New construction irit t AI i w , • 'tion For special lnformarlon use eheeklisz
D Description y ______ Ay_._ j_ Ea. 1 Total
0 Addition/alteration/ rep lacement 0 Other - . ._
New 1- 2- Pamfry dwellings (includes 100 $, for each utility connection)
°/ `,'` : '1'" >OF;! x41011 L"il'
. ,.. „ ..: .,...::.. . ' ,,.. ,.. .. SFR(1)bath 249.20
® 1- and 2- family dwelling 0 Commercial/industrial SFR (2) bath 350.00
❑ Accessory building 0 Multi - family - SFR (3) bath 399.00
Each additional bath/leitchcn 45.00
❑ Master builder ❑ Other:
Fire sprinkler ( , sq. ft) Page 2
. ;: '30*�;S . ;' ►1FOpc�re� Q$:.'. : ;'
.. , .....: .... :.....,.., ,. .. .. , , '�*' , ,... _Site utitltles
Job site address: 13767 SW SP Ave. Catch basin or area drain 16.60
City/State/ZIP: Tigard, OR 97224 brywcll, leach line. or trench drain 16.60
Suite/bldgJapt. no.: ( Project name: Gage Forest Footing drain (no. linear R: ) Page 2
Cross stre:etldirecti oru to job site: Manufactured home utilities 110.00
.. , Manholes 16.60
Rain dram connector 16.60
Sanitary sewer (no.' linear ft: ) Page 2
w
Storm sewer (no. linear ft-: .. ,) Page 2
Subdivision: Gage Forest .. 1 it no.: 31 Water service (no, linear ft.: ) Page 2 ` Fl:tare or hero
Tax map/parcel no.: on valve Absorpti alv 16.60
WO1 ` '' :.
`^ .. • Backflow preventer 1 Page 2 27.55
Irrigation System Installation Backwater valve 16.60 .
Clothes washer 16.6o
Dishwasher 16.60
Drinking fountain. 16,60 -
....... ;:g ;,.,, ...,.. ... �: :...:.,. ;:;z;, Ejectors/snunp 16.60
Name: .IT Roth Coastroction Expansion tank 16.60
Address: 12600 SW 72" Ave. Fixture/sewer cap 16.60 -Y
City/State/ZIP: Tigard, OR 97223 Floor drain/Dear aink/h ub 16.60
Phone: (503) 39 -2637 Fax: (503)624 .0239 Ctazbagc disposal 16.60
16.60
, •'; >:.. ..,... 0 ,�.. 0 ... ..... `.; , . .. Hose bib
1 a mAlaer 16.60
Business name: Forest Landscape Inc. - Interceptor /grease trap 16.60
Contact name: Vanessa _ Medical gas (value: $ ) Page 2
Address: 40437 NW Verboort Rd. Primer 16,60 , .
City/State/ZIP: Forest Grove. OR97116 Roof drain (commercial) 16.60
Phone: (503) 357 -3808 I Fax:: (503) 359 -1908 - Sink/basin/lavatory 6.60
Tub /shower //showeshows r pan 16.60
E-mail: Urinal 16.60
^t : } n
4 . Water c loset 16.60
Business name: Forest Landscape, Inc. Water heater 16
Address: 40437 NW Verboort Rd.
-'- Subtotal 27.55
City /State/ZIP; Forest Grove, OR 97116 Minimum permit Re: $72.50
16.25
Phone: (503) 357.3808 Fax: (503) 359 -1908 Residential backflow minimum permit fee: $3625
CCB Lie.: LCB 8253 Q k k ph \ - Plumbing Lie. no.: Plain review (25% of p fee) -
t'`(:41-111)1'4.--) State surcharge (12 /o of pemait fee) 4.35
Authorized signature: TOTAL PERMIT FEE 40.60
Print name: Vanessa Castaneda I Date: 4/9/08 I This permit appicatiou expires if a permit is not obtained within
_ _-, m 180 days after it has been accepted as complete.
• *Fee methodology set by Trt -County Building Industry Service Board.
1:VauadinPa UN - mcrmiu+Pp.dot 12/2>ro6 4404616rn0/02./COWWEB)
90/50 39t/d ONI 3ddOSQNd1 iS3NOA 806T69EEO5 LO :EZ 800Z/80/110
r *r
CITY OF. TIGARD
BUILDING DIVISION :.
.„ f PERMIT #: Pi_Ivi200 00 50
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: ,4/9/2008
Phone: (503) 639 -4171 ' ryljll . ,.
Inspection Requests (24 Hrs.): (503) 639 -4175 =j
Az '
INSPECTION WORKSHEET FOR DATE: 4122f 8 TIME: 7:00AM PAGE 46
SITE ADDRESS: 15767 SW 81ST AVE CLASS OF WORK:
SUBDIVISION: GAGE FOREST LOT #: 031 TYPE;OF'USE:
PROJECT NAME: GAGE FOREST _
DESCRIPTION: Installing backflow preventer.
•
OWNER: Sr ROTH CONSTRUCTION, INC., PHONE #: . 503 -639 -2639
CONTRACTOR: FOREST LANDSCAPE, INC , PHONE #: 503 357 - 3808
Inspection Request Scheduled For: Date: 4/22/2008 Pour Time:
Code # Inspection Description Confirm # - Contact # Message
395 Misc. inspection :: 068696 -02 503-806-0602 Y
Corrections/Comments/Instructions:- _ ' .
F 7 , r p _
•
•
.
.. .
.
it '. ARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: _< 4� Date:- 6 Phone #: (503) 718-