Permit CITY OF TIGARD
' PLUMBING PERMIT
COMMUNITY DEVELOPMENT PERMIT #: PLM2007 - 00386
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 8/23/2007
PARCEL: 1 S 134CA -FB009
SITE ADDRESS: 11176 SW 118TH TERR ZONING: R -4.5
SUBDIVISION: FEHRENBACHER NO. 2 LOT: 009 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
17275 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. .0 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: I
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.
pP p q job P
Plumbing Permit Application
Btiilding Fixtures RECEIVE FOR. OFFICE USE ONLY
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City of Ti and (- n ] Received Q
III • J g j FF '� �U01 a t eBy .��'3�? Permit No.:7 /. I a001 ,, 3012
13125 SW Hall Blvd., Tigard, OR 97223 AIJU Pl an Review I1I�1
Phone 503.639.4171 Fax. 503.598.1960 DateB Other Permit No.:
Inspection Line: 503 .639 4175 CITY OF TIGARD Fa See Page 2 for
TIGARD. Internet: ww.tigard- or.gov Date Read /By y: Juris:
BUILDING DIVISIQ: otified /Method. Supplemental Information
TYPE OF WORK FEE* SCHEDULE
For special information use checklist
Z. New construction 0 Demolition
Description Q ty. � E J Total
❑ Addition/alteration /replacement ❑Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION. SFR (1) bath 249.20
L,1- and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 350.00
❑ Accessory building ❑ Multi- family SFR (3) bath 399.00
❑ Master builder Each additional bath/kitchen 45.00
❑ Other: Fire sprinkler ( sq. ft.) Page 2
JOB SITE INFORMATIO AND, LQQATION Site utilities
Job site address: f , i (0O /j }} �� �-efA Catch basin or area drain 16.60
City /State /ZIP: TII,LePtl, 0R CO 2.-212.-21-/ � Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: I Project name: re.e L aCie..✓- Footing drain (no. linear ft ) Page 2
1(I L �f /�� k ) c / d fin Manufactured home utilities 110.00
Cross street/directions to job site: '�f (�
Manholes 16 60
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
Tax map /parcel no.:
Fixture or item
Absorption valve 16.60
DESCRIPTION OF WORK
f Backflow preventer Page 2
1-P . x.' Gq -1 ) Backwater valve 16.60
Clothes washer 16 60
Dishwasher 16.60
❑ PRO -ERTY OWNER I ❑ TENANT Drinking fountain 16.60
/t `� Ejectors /sump 16.60
Name: ��C G I �. Expansion tank 16.60
Address: 172.7 5� 0,,,/1j Uirl(./ Fixture /sewer cap 1660
City/State/ZIP: Y Ki e i 5 �`/ 1_A q 721)/ Floor drain /floor sink/hub 16 60
Phone: �) / / - - 7 . - - - - S - 0 0 2 Fax: ( ) Garbage disposal 16.60
Hose bib 16.60
❑ APPLICANT ❑ CONTACT PERSON
Ice maker 16.60
Business name: 4 GJ
� ` (,- ?[tSC yF� Interceptor /grease trap 16 60
Contact name:
/ . (1 S L- e re( Medical gas (value: $ ) Page 2
Address: q 0j f b 5 L i ) C is �- C , Primer 16.60
6 City /State /ZIP: eCtVer \ � 6)` g7DO g Roof drain (commercial) 16.60
I
Phone: ( } ) lr? - I S 07 Fax: : ( ) Sink/basin/lavatory 16.60
Tub /shower /shower pan 16.60
E -mail:
Urinal 16.60
CONTRACTOR Water closet 16.60
/t
Business name: /6( 1.-a1G' c ,r;/ �i f Water heater 16.60 Address (�( L Ste' ra S i Oill / Other:
c
City /State /ZIP: i� -� O �2 ��
Subtotal
(� 9 c u Minimum permit fee: $72.50
Phone: (� 3) T / - 1 Fax: ( ) Residential backflow minimum permit fee: $36.25
CCB Lic.: b I Plumbing Lic. no.: Plan review (25% of permit fee)
State surcharge (8% of permit fee)
Authorized signatur-:
TOTAL PERMIT FEE j /, /5
Print name: I • 77" Date: - 7 0 _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:\ BuildingVPermits\PLMF- PermitApp doe 12/27/06 440- 4616T(10/02/COM/WEB)
CITY OF TIGARD
BUILDING DIVISION
hbAA i • PERMIT #: PLM2007-00386
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 8/23/2007
Phone: (503) 639-4171 —fteouvvili It' 7
Inspection Requests (24 Hrs.): (503) 639-4175
INSPECTION WORKSHEET FOR DATE: 11115/2007 TIME: 7:01Aivt PAGE: 15
SITE ADDRESS: 11176 SW 11811-1TERR CLASS OF WORK:
SUBDIVISION: FEHRENEACHER NO. 2 • LOT #: agg TYPE OF USE:
PROJECT NAME: FEHRENBACHER NO. 2 .
DESCRIPTION: Baddlovv prevent& for irrigation.
OWNER: PAYS CUSTOM HOMES, INC. PHONE #: 503.475
CONTRACTOR: BLAZER LANDSCAPE PHONE #: 503-99o-1507
•
Inspection Request Scheduled For: Date: 11/15/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
399 Plumbing final 069727-11 603-840-7332 N
Corrections/Comments/Instructions:
T -ir-- - e1i - a Li. cii — 614(-----
V
/ 1 S C vv■... c --,k.--
M . A S H PARTIAL APPROVAL 0 CANCEL 7 NO ACCESS
0 FAIL El CALL FOR INSPECTION 0 ADDITIONAL FEES ASSESSED
14/V\Ile______ .-2■(
Date: tyk C I ° 7 Phone #: (503) 718- 24
Inspector: —