Permit CITY OF TIGARD
PLUMBING PERMIT
. � I� D EVELOPMENT SERVICES PERMIT #: PLM2003 -00131
, DATE ISSUED: 4/8/03
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS: 13728 SW 130TH PL PARCEL: 2S104DD -07400
SUBDIVISION: MOUNTAIN HIGHLANDS NO.3 ZONING: R -4.5
BLOCK: LOT: 032 JURISDICTION: TIG
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
Remarks: Installation of irrigation backflow prevention device.
FEES
Owner:
Description Date Amount
PETTIS, STEVE & MARION
13728 SW 130TH PL [PLUMB] Permit Fee 4/8/03 $36.25
TIGARD, OR 97223 [TAX] 8% State Tax 4/8/03 $2.90
Total $39.15
Phone : 503 -692 -6263
Contractor:
MATT SANDER LANDSCAPING INC
21785 SW TV HWY
ALOHA, OR 97006
REQUIRED INSPECTIONS
Phone RP /Backflow Preventer
hone : 503 642 1617
Final Inspection
Reg #: LIC 5703
MET 00002867
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.
Issued By: !/ , �� r Permittee Signature: jri -
-
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
FROM : MATT SANDER LANDSCAPING PHONE NO. : 5036429695 Apr. 04 2003 03:26PM P1
t.J/ 11/ 41)u, lu'J� Y_ .k•S. 51).3)J .U.:101) .tpl ( I11 1 1(:M i 81001
Building Fixtures
- Y � ,� ? A 9.d.Cl.� fl f 1 O 5[ , ,n i l vl,. n , , y 4 l. l , -•j ..Y .1.... A+ rl
Dew received: VA L/y Permit no.�200� - 013 /
l it', City of'ri.:aa r '
, ,,,, '�' Sewer permit n Building ilding per:tiit no.:
Address: 131 F;W Tall B1v tgud 0 , •1223 -
City o f Tigard Phone: (503) 631 : -41 71 A ' 4 (UU rojcctfappl. no.: �� 'Expire dare:
(503) 598-1 15( CITY OF TIGARD 1' es; ay ee oipt no_ � - _
Land use appruv2. L: BUILDING DIVISION Case file no.: acc issu Payment type:
, a ' . r f p irYY
Ci 1 & 2 family dwelling or actssSO; ❑ Commercial/industrial la Mut ti-family CI Tenant improvement
0 New ebnstrUCtion 0 Addition/alteration /replacement 0 Food service 0 Other:
3 Q , $ J` �' EE ' i< , ON � 1 r + rl ; l %; � . ,' r , I'. E , � S " CtU la! '� (f Qr�J cc iaj x n toI s % C. — C ,. ! , ) .:. -.,
Job add
6 ...( Pia c Description
Qty. ]bee ( Tota
Bldg. no.: Suits no.:
New ; and 2.fandly tdw' rags o y
Tax map/tax lot account rko,: � (incluclos 100 ft. for each 'utility conne an)
SFR (i) bath
Lot: Block T;3ut division: SFR (3) bath NM MIMI
-- --
Project nar.>,e: -tea, �C.�. o y1 _ S R (3) bath
City/county: Li)Q'Sl'11Y _ Z 9 70 Each additional baba /icita�, — EMIX111111
Description and location work on I,.;retnlseS: Siteutilit1esi
III
Catch basin/area drain
t r>
ES t. date of completion/inspection - Dtywetls/leach line /trenc . :
a 't s µ:.t: Footing drain (no_ lin. ft.) � �
.,PILN TDwikr ;((l i Itl;A -., , - ll s , ;' i -: Manufa horr�r� ut
Business name: 'At ■ ! i,aV /fit' ro . t `I'- ... Oleo mm . IOOIEIIIMI
• Address; ,. -- 7g5 -- 3 -{ j • ..�. _ _ w - P ' Rain drain connector _ _
EEL , Star . ZIP: ' 1 a • Sanitary sewer (no. lin. ft,) 061 IIIIIIII
Phone: . ._.E,, 7 Fax: 1) i E-mail: ( 11111•11111 • qtr sewer �• , f },)
CCB no.: Fitz .b. bus. rag. no •tiL' Water service no. lin. ft,) ��
City/metro tie. tr.: - /O 3i .3 Fixture or iteli> ; � ��
Contractor's representative signature: , MI ,...4 Absorption valve
r
irztuame�
Pt Date: -
y = tic flow preventer
BaC �ratar vaivt: 111711.111MM
. „ ',(!Or•ITi ,qt . :C . 01,$ .'. :i;∎ : ". . :' i a ns/1a
i
Clothes washer
Name: / 4.Q, t Le .� " l~►ishw£8h ®rte
Address: a17: -._� -I- 1►J -, `' ^ ' 5=1=
�� )?r fotuitain(s))
EMI 0 61/4., e'�Z- ZIP: , 6b L jectors / sum
Phone - (g 1 Fax: E -mail: Expansion tank — 11.1=111111111/11
: ; ,,,,. , '..., :: ::. :...,,.
? i11, l : 1 : .p',:.:::,,...9.,,. .. w; Fixture/sewer cam..
Name (print): a �I q I D • F loor drains/floor sinks/hub _
" atba a dis'osal i _
Mailing address: ,..4 S i : • * Bose bibb
Cit : ''�. state ZIP: ' . , ice maker
Phone: ,' Fax
_-� Interco rfor /grease tmp -- iiiM r
Owner insta lation/tesidential main- eni only: The Soma! installation Prime s)
will be made by me or the mairaten• : and repair made by my regular Roof draia commeiez
employee -on the property T own as per ORS Chapter 447. .Sink s , basin(s), lays(s)
O mer's si�ature: D Sump 11=riall.
....... :: ', -, - /b
• �; � • " :� <'Y_; .:.,. ? -. ?: f: 4� 'T'ubS/ shower s over an
k i dZ rx .. y ; , ai r_ � '
! • 4 p
Name:
Water closet
Address: _ + ater heater V
Water
City; State: ZIP: - tber: • -
Phone: Fax �_�" E•maiL• 1 Val • • 111.1.111111
No; all jurisdictions earga aradit earth, ply= cull jar. u m llcdoa for more inn-TEr r1, a i nii rnu n fee
Notice; This perm ie application Ilan review (et aka) $
O Vii. ster ass , esxpir:o it a permit is not obtained o
Cm." cazd orm Y '� ^ ) 1 ,2 r 62. 1610/63 State surrhatge (8%) _. _ $
w i SO days after it has beco
c> � sapi+ae edzBl?t98 8s compEete, TOTAL S • --
sale of cardholder as gull 011 41 .and
sign � A
CarJholaer at ' .___ • 4Uei 44(L4.$76 {6/OOICOIvt}
4 . .,_ „ tr
553670 `
• ❑ NEW
® ❑ EXISTING
PNWS -AW WA BACKFLOW ASSEMBLY TEST REPORT ❑ REMOVED
PROPERTY ❑ REPLACEMENT
OWNER: r -- — — —
MAILING PETTIS RESIDENCE ` '`y'
ADDRESS: I , •
13728 SW 130 PL
A SSEMBL• ''
TIGARD OR 97223 ' -
L J j yr
F ADDRESS: SAME 1
1 ❑ R.P.B.A. TIGARD iIR GAP .
SIZE: L I
WATER •
PURVEYO I
ASSEMBLY'
LOCATION J
REDUCED PRESSURE ASSEMBLY P.V.B.A. I S.V.B.A. INITIAL TEST •
El CHECK I D"QUBLE: CHECK'.: AIR CHECK PASSED 13
PRESS DROP (A) .CHECK/. #1 INLET FAILED ❑`
• INITIAL OPENED AT VALVE (B)ITIGHT 10 4•6, OPENED AT: PRESS DROP D' •I I
TEST MIN 2 PSID ❑' PSID A
RESULTS BUFFER
'LEAKED u' /
PSID PSI 4
A - B = I CHECK, #2 -.
MIN 3 PSI .1
RELIEF VALVE ITIGHT 1E01, , DID NOT FAILED SYSTEM
PASS ❑ FAIL ❑ I LEAKED
1--1 MD OPEN ❑ ❑ PSI ,
:I -
COMMENTS
REPAIRS
AND /OR
PARTS
REDUCED PRESSURE ASSEMBLY T P. V.B.A. /S. V.B.A AFTER REPAIRS
Ill CHECK D.0 Vi�A::,::: :: -
TEST PRESS DROP (A) I ( CHECK #1 • DATE: •
RELIEF ' OPENED AT PRESS DROP
AFTER OPENED (B) TIGHT ❑ PSID4 i•
• REPAIRS BUFFER "@ �"� _ I CHECK #2
A -B= emu ra ITIGHT ❑ PSID PASSED CI PSID
. IN COMPLETING AND SUBMITI1NG THIS TEST REPORT, THE TESTER CERTIFIES THAT THE •
ASSEMBLY HAS BEEN TESTED AND MAINTAINED IN ACCORDANCE WITH ALL APPLICABLE
RULES AND REGULATIONS OF THE WATER SYSTEM, AND STATE REGULATIONS.
GAUGE CALIBRATION DATE I / DETECTOR METER READING
r■—'_ I t el 0
TESTER SIGNAtRJRE, . 1 O \ f • yy, • ... 1 — , I 12 _ _T SI
TESTERS NAME PRINTED 1 t 1 Q (J 20 ¶ L .� GAUGELE 1
TESTERS ADDRESS ( ` PHONE N
0_12-Wit n�'ThA.� ,
*COMPANY NAME 1
REPORT RECEIVED BY: / SERVICE RESTORED
(REPRESENTATIVE OF OWNER) ,
• t
t WHITE - Water System Copy PINK - Customer Copy YELLOW - Tester Copy
CITY OF TIGARD ,Y 24 -Hour
WILDING r . — , Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received Date Requested AM PM BUP
Location / 7 aZ /3 7 (1 Suite MEC
Contact Person - 471#Q/1 / ( 1 Ph ( ) 5 761- 3667 PLM 3 _e) 0 13 l
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation ELC
Access:
Ftg Drain ELR
Crawl Drain �
Slab Inspec i' Notes: SIT
Post & Beam
Shear Anchors •
Ext Sheath /Shear
Int Sheath/Shear
Framing
Insulation
Drywall_Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final
PASS PART FAIL
( 7
-• (-/ a /
PLUMBING )
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other: • F.
" PART FAIL
HANICAL
Post & Beam
Rough -In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
Service
Rough -In
UG /Slab
Low Voltage
Fire Alarm
Final Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE ❑ Please call for reinspection RE: ❑ Unable to inspect - no access
Fire Supply Line -
ADA • Date I Inspector / 9V" - t Ext
Approach /Sidewalk
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL