Permit CITY OF TIGARD
PLUMBING PERMIT
COMMUNITY DEVELOPMENT PERMIT #: PLM2007 - 00385
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 8/23/2007
PARCEL: 1 S 134CA -FB008
SITE ADDRESS: 11152 SW 118TH TERR ZONING: R -4.5
SUBDIVISION: FEHRENBACHER NO. 2 LOT: 008 JURISDICTION: TIG
PROJECT: FEHRENBACHER NO. 2
Project Description: Backflow preventer for irrigation.
CLASS OF WORK: OTR 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
PAYS CUSTOM HOMES INC.
17278 SW SONNET WAY Description Date Amount
KING CITY, OR 97224 [PLUMB] Permit Fee 8/23/2007 $36.25
[TAX] 8% State Surcha 8/23/2007 $2.90
Phone : 503- 475 -5041 Total $39.15
Contractor:
BLAZER LANDSCAPE
13995 SW FERN ST.
TIGARD, OR 97223 REQUIRED ITEMS AND REPORTS
Contact # : PRI 503- 998 -1507
Reg #: PLM 6872
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 ? ay obta codes of .
these rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344. //
Issued By: l t it Permittee Signature: /<__ , If '
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
RECEIVED FOR OFFICE USE ONLY
City of Tigard � Received "
T. Date/By. / � ' s/®7 6 Permit N » 0)7_vog5
�.
° v
IIII NI
13125 SW Hall Blvd , Tigard, OR 97223
Plan Review
Phone: 503.639.4171 Fax: 503.598. 2007. Date /By: Other Permit No..
Inspection Line 503.639 4175
TIGA1iD Date Ready/By y IA See Page 2 for
Internet: www.tigard gov Notified/Method: OF e t ur�y
d/Method: � Supplemental Information
TYPE OF atADING DIVISION FEE* SCHEDULE
For special information use checklist
0. New construction ❑ Demolition
Description Qty Ea. Total
❑ Addition/alteration /replacement ❑ Other: New 1 - 2 - family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (I) bath 249.20
b 1- and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 350.00
❑ Accessory building ❑ Multi - family SFR (3) bath 399.00
Each additional bath/kitchen 45.00
❑ Master builder ❑ Other:
Fire sprinkler ( sq ft ) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities
Job site address: , !i ( L / r Catch basin or area drain 16 60
City /State /ZIP: T i �ja 0 \ c7) Z Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: J l Project name: f " /i L_ c /s . f Footing drain (no. linear ft.: ) Page 2
lb + Manufactured home utilities 110 00
Cross street/directions to job site: lb ( -- L j , ) _ 7 I ' , .,
Manholes 16.60
Rain drain connector 16.60
Sanitary sewer (no. linear ft.. ) Page 2
Storm sewer (no. linear ft.: _ ) Page 2
Lot no.: Water service (no linear ft
Subdivision: ( _ ) Page 2
Tax map /parcel no.:
Fixture or item
Absorption valve 16.60
DESCRIPTION OF WORK Backflow preventer Page 2
ray, G .x = c Otl Ge.ckfIo4C) Backwater valve . 16.60
Clothes washer 16 60
Dishwasher 16.60
❑ PROERTY OWNER I El TENANT Drinking fountain 16.60
/ r Ejectors /sump 16.60
Name: c� C C JT Expansion tank 16 "60
Address: 1727 �` 5t-ti .S ._ Uti t;;'V Fixture /sewer cap 16.60
City /State /ZIP: " t 1 1 , 9 , • `, '772,2)/ Floor drain /floor sink/hub 16.60 IM
Phone: (SD - 2,/ -x S Fax: ( ) Garbage disposal 16 60
❑ APPLICANT ❑ CONTACT PERSON Hose bib ■ 16.60
Ice maker 16.60
Business name: 6 iy2,er - tsc P�
, � Interceptor /grease trap 16.60
Contact name: /��S (I S c..Dyer' Medical gas (value: $ ) Page 2
Address: 5 ` � g
l� (� �. CtS t �} C Prime 16.6
C ity /State /ZIP: r — Q:.)/1 � �`, q7(J Og Roof drain (commercial) 16.60
Phone: (% ) ‘7 - l l G Fax: : ( ) Sink/basin/lavatory 16.60
Tub /shower /shower pan 16.60
E -mail:
Urinal 16.60
CONTRACTOR Water closet 16 60
//11
Business name: /6(7..ei /.--Ctij C Water heater 16.60
Address: i• o. t (? S �-�-� (a . ! ` c , / , l / f " Other:
City /State /ZIP: i/A7 L JCi — O ' C e 1 C �j Subtotal
�� Minimum permit fee. $72.50
Phone: (95 �) , �� Fax: ( ) Residential backflow minimum permit fee: $36 25
CCB Lic.: V --) Plumbing Lic. no.: Plan review (25% of permit fee)
Authorized signature:
A State surcharge (8% of permit fee)
TOTAL PERMIT FEE j
Print name: /
�/ V Date: c - 70 -7 This permit application expires if a permit is not obtained within
180 days after it has been accepted as complete.
*Fee methodology set by Tn -County Building Industry Service Board.
I:\ Building \Permns\PLMF- PermiApp.doc 12/27/06 440- 4616TO 0 /02 /COM /WEB)
CITY OF TIGARD
BUILDING DIVISION
Ak PERMIT #: Pl..M2007-00385
1 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 8,123/2007
Phone: (503) 639-4171 104 101iff '
Inspection Requests (24 Hrs.): (503) 639-4175
INSPECTION WORKSHEET FOR DATE: 10/1002007 TIME: 7:01AM PAGE: 16
SITE ADDRESS: 1'1152 SW 118TH TERR CLASS OF WORK:
SUBDIVISION: FEHRENBACHER NO. 2 LOT #: 008 TYPE OF USE:
PROJECT NAME: FEHRENBACHER NO. 2
DESCRIPTION: Backflow preventor for irrigation.
OWNER: PAYS CUSTOM HOMES INC., PHONE #: 034175-50M
CONTRACTOR: BLAZER LANDSCAPE PHONE #: J.:B
Inspection Request Scheduled For: Date: 1 worm Pour Time:
Code # Inspection Description Confirm # Contact # Message
399 Plumbing final 07337-01 503-840-7332 N
Corrections/Comments/Instructions:
•
• - . - •. ..) ' - • - Fe r - _Q e_. (2 \ 1
C A. j , G. c 4/k.AC-A 94.)
•
IXPASS 71 PARTIAL APPROVAL ri CANCEL 0 NO ACCESS
I I FAIL fl CALL FOR INSPECTION I I ADDITIONAL FEES ASSESSED
Inspector: C 1 I 14' .4-.4— Date: ) (31 4 ? Phone #: (503) 718-