Permit 4CITY r TIGARD PLUMBING PERMIT
4.
i DEVELOPMENT SERVICES
PERMIT #: PLM2005 -00263
1 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 - 4171 DATE ISSUED: 6/15/2005
PARCEL: 2S 109AD -03300
SITE ADDRESS: 14569 SW 130TH AVE ZONING: R -7
SUBDIVISION: WOODFORD ESTATES LOT: 025 JURISDICTION: TIG
Project Description: Installation of backflow device.
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
ALVERTS, ROBERT L + SHARON J
14569 SW 130TH AVE Description Date Amount
TIGARD, OR 97224 [PLUMB] Permit Fee 6/15/2005 $36.25
[TAX] 8% State Surcha 6/15/2005 $2.90
Phone : 503- 639 -0405 Total $39.15
Contractor:
JOHN DARBY LANDSCAPE INC
•
13867 SW BENCHVIEW TERRACE
TIGARD, OR 97223 REQUIRED ITEMS AND REPORTS
Phone : 503 -579 -5298
Reg #: LIC 7110
PLM 12319LCL
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 0001 -0010 through OAR 952 - 0001 -0100. You may obtain copies of
these rules or direct questions to OUNC by calling 503 - 246 -6699 or 1- 800 - 332 -2344.
Issued By: b � Permittee Signature: p q\c [u"
n
Call 503 - 639 -4175 by 7:00 a.m. for an inspection that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
FROM •: JOHN DRRBY LANDSCAPE INC FAX NO. : 5035246613 Jun. 15 2005 11:28AM P3
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Pllumbin� ]Permit ApP %� ���� 1 / j i •aR oFF� u$i Qrt%x t ;� a _.
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City of Tigar - t 6 0 03 1)E1- Per N'... l d 4
13125 SW Hall Slvd., Tigard, OR 97223 JUN 15 2 Plan Review
� iJ , ,md 'r i. t , � ' other Permit No.: + • i
Phone: 503.639.4171 FaX 503.598.1960 _ , al>< Date/Sy: o ;
24- Hour Inspection _inc : 503.639.4175 GIT ''OF Ti :fir ".'!I, DateReady/By: " • • Jr " /! Sec Ya6c 2 for :
Internet: • wwwCi.tigard•or.us r .. ill P1 IC; niviaty' ;V NoufScdMtethod' u Supp)comicut Irirorr,>>io:
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d•r e. -1 �• y rr'{` ! +t:7t�ti.�.�.L' F'- �,�ff',� n 4E'' . �J: �'r �+l�a -- -.
�?•" 7 k i r� � lam}- \ 3 , f' ' "s '� ',' ; '7 y y', .. - - .... '.
; ti y: .Y,�.,....:, For spcc •ialirtform«liun use cAeckHsr. _^ ■
❑ New construction ❑ Demolition • _ '
Description I Qty. r. Ea. I ibur'
Other: New 1- 2-f d ,ngs (includes 100 ft. for ea ch u'.i1iry co:un;et,o::) I
r• Addition/alteration/replacement [ O ray Y w elli
f ry e 5 c �t f, i a as R r_ l t1 a g H i 11'lii �'4� stir d� SFR l bath 2a9 20 _ ..
SFR (2) b I 350.00 I
w ,�1 -and 2- family dwelling • • ❑ Commcrciallindustrial SFR (3) bath 399.00
❑ Acccsso D building build' ❑ Multi- fatriily •
- - • Each additional bath/kitchen 45.00 i
❑ Master builder ❑ Other:. . • • . l + Ik Fite sprinkler ( sq. ft,) Y o I - •
` ; '•�'�� +.• . � .t. W'. ..: h1r °A� � at ., ,� �S 'i . Y X 11 ��+ ' f ./4 i L � -
l t .'ar �:j'y , � .� �- . �:�.�,�•: �' �' t � �r.�,y � .�0J ft.:s S lteutflitics
Sob site address: ir( Catch basin or area drain _I 1 6.60
City/State/ZIP: ' i , '14 Drywell, leach tine, or trench drain 16,60 I -
t�t'� rooting drain.(no. linear ft.: ) Pap - ' 1
Suite/bldgJapt. no.: Project name: I ^
Manufactured home utilities I 110.00 I
Goss saeeddircctions to job site: - Manholes I 16.60 I =
Rain drain connector Ip.
_._ .. Sanitary sewer(no.linear ft.: Fags 2 I Storm sewer (no. linear ft.: ) Fait 2 I, _
t
1.4 Water service (no. linear R.: ) I Page 2 1
Sabdivision: 1 no,: -
.. Fixture or Item
Tax map /parcel no.: Absorption valve 16 6 -- I
4i - , nr - 't p FAA 1 y �,� '`f � ;K Y,Fil BaCY.flow reventer ! f,c
< t7'v'', t A ' J i,' tt1V • 07 '4 f..'7. t t : el.1 1` ,iilif +' 1 5 16's p F " I .. - -
:;. ue_._. ;3c. E �_> .. -
wr ♦ . fir/ 1 ` - • • ' Backwater valve : 16.60 1
IMP • .► �� i \ r.. ll I ,
I Clothes washer 16.60 •
Uiahwilshe� •. !.6 GO
,�w y .." r ; r ••z ;�:t a;u.4 Drinking fountain ! 16.60 I •
St A,-' _ ` c i ilt i�i�i „ Z .d + tet 3"1' `'' , l r t� �a,� I I
_ �;:1cig fs*1 z t E ° � r t d'i "ki !ce a ,k r.,E iii ,t�Irlki � . . Ejectors /sump , 16.60 , •
Name: C ` Ad .A.'bt Expansion tank 1 16.60 _
Address: MIMIIINTAO ��L` Fixture /sewer cap �- t 6 .60 I .
Ci /State/ZII': ■■' - • • Floor drain /floor sink/hub I 16.60 1 ry �� - Garbage disposal I 16.60 I
��� r t • _ I Fax ( ) , }
Phone: n + '' r ay, �(( ,fir SrT 7 r�T.,� Hose bib . 166 .
W:7 F Y I13 r TiFitiari t -RW T r k t 4 R A g t s � � 4(S QSkE , 4 e �Y,'�'�ra � ` R Ice maker i 16.60
Business name: _
'tit -k1 CG I Ai f ► f- 1 - I nterceptor /g rease trap' I l6 VO •
� i_► M g as (value: 5 ) I }''ap,c
" ---- 1 -
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Contact name:..
Address: - _Primer • • - 16.60 1 _., � 1
- • ' ' Roof drain (commercial) • 16,60 ! ■
City/State/,ZIP: ;
Sink/basin/lavatory I 1 6. 60 ;
Pone: ( ': ,,) ; ` Fax:: (. • •)
• Tub/shower /shower pan 1
E -mail: 4 ' Urinal • I S 60
P''� ;VP.'f rit' ! .1 h-W " ' - �i ' a, + l r - ikett � "n `�( F a� I Water I 16.60
r ; ' t of „f' rV.' ' 4' 3r;; :' .a� ,4 , i .4. i' likGr lTe W aer • closet
Business name: 1' 11 M. r .I [ t 1. _ W ater heater j 16.60 , -
i i .. . Other: I
Address: - -_ - --
► _ �+ll .1 l 1 a ,•tt Subtotal , _ __
City /State/ZIP: . , Minimum permit fee: 572.50
IV
r. Residential batk0ow minimum permit fee: S36 25
Phone'. ^�3) • -- 2 al .d _
CCB Lie.; 4 Plumbing Lie. no.: °
Plan review (25% of permit fee) r •
i State;urchrargu (8% of permit fee)
Authorized signature: TOTAL PGILy Cl F
Print name: _ Date' {�.-i .-.�f� '• This permit application expires if a permit ii not obuined ‘N itI ,0
`u V 180 days after it has boon A ccepted as complete,
•Fee methodology set by Tri.County Building Industry Service 3o 2re.
:a R,. n. ttn,o.=..,a.trtatP.peamiwoo.d« 12/01 440- 46167(10l07/COM/WaB) . .
CITY OF TIGARD
BUILDING DIVISION if PERMIT #: PLM2005-00263
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 6/15/2005
Phone: (503) 639 -4171 4,, Apypit6filiT \
Inspection Requests (24 Hrs.): (503) 639 -4175 °':_..
INSPECTION WORKSHEET FOR DATE: 6/24 /2005 TIME: 7:09AM PAGE: 86
SITE ADDRESS: 14569 SW 130TH AVE CLASS OF WORK:
SUBDIVISION: WOODFORD ESTATES LOT #: 025 TYPE OF USE:
PROJECT NAME: ALVERTS
DESCRIPTION: Installation of back[low device.
OWNER: ALVERTS, ROBERT L + SHARON J, PHONE #: 503- 639 -0405
CONTRACTOR: DARBY LANDSCAPE INC, JOHN PHONE #: 503 -579 -5298
Inspection Request Scheduled For: Date: 6/24/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
325 RP /back[low preventer 010041 -01 503-579 -5298 N
Corrections /Comments /Instructions: M
a y 0,
y , „ 5 0."- -
• . . 7 / / a' j -7/X7
7
\kil - SS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
o
Inspector: Date: 0 l 1 Phone #: (503) 718-