Permit CI TY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT PERMIT #: PLM2008 -00170
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 4/22/2008
PARCEL: 2S 103AD -07300
SITE ADDRESS: 12645 SW 108TH TERR ZONING: R-4.5
SUBDIVISION: MILESBROOK LOT: 004 JURISDICTION: TIG
PROJECT: MILESBROOK
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
BUENA VISTA CUSTOM HOMES Description Date Amount
5665 SW MEADOWS RD. #150
LAKE OSWEGO, OR 97035 [PLUMB] Permit Fee 4/22/2008 $36.25
[TAX] 12% State Surch 4/22/2008 $4.35
Phone : 503- 443 -6033 Total $40.60
Contractor:
TRUSCAPES INC
21600 NW ANBERWOOD DR.
HILLSBORO, OR 97124 REQUIRED ITEMS AND REPORTS
Contact # : PRI 503- 969 -2144
FAX 503 -531 -9216
Reg #: LIC PLUS BACKFL
PLM 7962
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 Permittee Signature: .7 / 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.
Apri.21 08 05:19p PENIUK 503 - 352 -4607 p.3
Plumbing Permit Application
Building Fixtures .ii* ECE \JE' FOR OFFICE 1 SF ONLY
Receir+ ^ i _
City of Tigard Date/By: U d d V 08 ✓ P it No.: PL/41 • 7
■ 13125 SW Hall Blvd., Tigard, OR 97223 AP R 2 2 2005 _ { et
1111 Z
Other Permit No.: Plan Review r} �. Gag m
Phone: 503.639.4171 Fax: 503.598.1960 Date•By: &
•- T I G A RD Inspection Line: 503.639.4175 t D Date Ready/By: lurisr El See Page 2 far
Internet: www.tigard- or.gov CITY OF TIG ', lotified/Method: SupplementaI information
TYPE OF WO��Li�1?'�l�tll ro FEE* SCIJEDULE
f�New construction ❑ Demolition For I ecial information use checklist
Description Qty. Ea. Total
❑ Addition/alteration/replacement ❑ Other: New I- 2- family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (1) bath 249.20
il- and 2- family dwelling ❑ Commercial/industrial SFR (2) bath 350.00
❑ Accessory building ❑ Multi- family SFR (3) bath 399.00
• Each additional bathlkitchen 45.00 '
❑ Master builder ❑ Other:
Fire sprinkler ( sq. ft) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities
Job, site address: /26 5 S i 0 $ 7'" Catch basin or area drain 16.60
City /State/ZIP: 1) 6 fk Qh 9) 2 3 Drywell, leach line, ortrench drain 16.60
Suite/bldg./apt. no,: 1 Project narne: vyt l' /� h Footing drain (no. linear ft.: ) Page 2
1 �`c� Manufactured home utilities 110.00
Cross street/directions to job site:
Manholes 16.60
Rain drain connector 16.60
Sanitary sewer (no. linear ft.: , ) Page 2
Storm sewer (no. linear IL: ) Page 2
Subdivision: MIL g /,O OK Lot no.: Water service (no. linear ft.: ) Page 2
Fixture or item
Tax map/parcel no.:
Absorption valve 16.60
DESCRIPTION OF WORK Backflow preventer i Page 2 a 7, s 5
)JSTU, RAC FLOW QEVIGE fV1Z f l6A.noIJ Backwatervtrlve 16.60
Clothes washer 16.60
Dishwasher I6.60
Drinking fountain 16.60
[!PROPERTY OWNER ❑ TENANT
Ejectors /sump 16.60
Name: E'V ENA VI-SPA lit1 S ('p fil RDM e S Expansion tank 16.60
Address: 5 (96 S SW J Mj t A'D QIN S PO Fixture /sewer cap 16.60
City /Stale/ZIP: LP psL( &O, ClR. t')O3S Floor drain/floor sink/hub 16.60
Phone: (' 3) LL I , - trt, 3 3 Fax: ( ) Garbage disposal 16.60
•
APPLICANT ❑ CONTACT PERSON .Fir Hosc bib 16.60
f Ice maker 16.60
Business name: T `l� S C? Q 1 9E L.LC Interceptor /grease trap 16.60
Contact name: r f v F.42f P EN l u K Medical gas (value: S ) Page 2
Address: 21 ,4L .1)W #) eE WOOD P. Primer 16.60
CityfStatefZlP:
N r 6 ( , 5 1 97 i v , Roof drain (commercial) 16.60
D p Q t� V op. _l 16.60
Phone: (9) ) I{ lI Fax: c 1 3) 5^31?- ! f r 4 Sink/basin/lavatory
� Tub /shower /shower pan 16.60
E -mail: t
Urinal 16.60
CONIRACTOR Water closet 16.60
Business name: (, �
S " &S, (LC p Water heater 16.60
Address: 2i i? Do /VW 1 M B E ' Uu 4) OD ,Yhn .. Other:
t-O , OA. 9'11 111
City /State/ZIP: NJ CO permit fee: $72.50
Phone: (n) 3) 1 t, et- c ). (L LI Fax: (5 03) 5'3J-qv(' Residential backflow minimum permit fee: $36.25 3 6 de
CCB Lie.: L,c,0 4 - 764 ) j, Plumbing Lie. no.: _ Plan review (25% of permit fee)
State surcharge (12% of permit fee) Yf t 35
Authorized signature: • TOTAL PERMIT FEE i{./p, 31/
Print name: f ( f E U k Da te : y_2,1-0 E This permit application expires if a permit is not obtained within
180 days after it has been accepted as complete.
*Fee methodology set by Iri -County Building 'Industry Service Board.
MY F TUG g
PL,042o071 [ :70
UOLDONG DOVDS0®N PERMIT #:
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 112 MOM
Phone: (503) 639- 4171d�illi „I�iiiph�”
Inspection Requests (24 Hrs.): (503) 639 - 4175
INSPECTION WORKSHEET FOR DATE: 11/2009 TIME: 7:00AM PAGE: 713
SITE ADDRESS: 12645 SW 108TH TEPR;' CLASS OF WORK:
SUBDIVISION: MILL SBROOE< LOT #: 004 TYPE OF USE:
PROJECT NAME: MILES ROOK
DESCRIPTION: Now s >F - DEMO CREDITS FROM UP200& 00497 APPLIED TO THIN PERMIT.
OWNER: BUENA VISTA CUSTOM HOMES, PHONE #: 503 - 443 -6033
CONTRACTOR: BUENA VV,3TA HOMES PHONE #: 503
Inspection Request Scheduled For: Date: 5/1/: O0? Pour Time:
Code # Inspection Description Confirm # Contact # Message
399 Plumbing Tina! 0€ 91 7.0 i g13 N
Corrections /Comments /Instructions:
k P LINA 2zoQ'- Da i 7� .. �( 7', 1s-
Care. eL,,,k 9 v
•
X PASS I 1 PARTIAL APPROVAL I I CANCEL
NO ACCESS
1 1 FAIL CALL FOR INSPECTION Ti ADDITIONAL FEES ASSESSED
Inspector: k-i- A V s -..-- Date: :S7 / /l)? Phone #: (503) 718-