Permit •
CITY TIGARD PLUMBING PERMIT
A�� I k DEVELOPMENT SERVICES PERMIT #: PLM2005 -00433
A. �.��I DATE ISSUED: 9/6/2005
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 PARCEL: 2S112CD 11700
SITE ADDRESS: 07683 SW ALDER ST ZONING: R -
SUBDIVISION: HAMBACH GROVE LOT: 015 JURISDICTION: TIG
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
LEGEND HOMES
12755 SW 69TH AVE # 100 Description Date Amount
PORTLAND, OR 97223 [PLUMB] Permit Fee 9/6/2005 $36.25
[TAX] 8% State Surcha 9/6/2005 $2.90
Phone : 503- 620 -8080 Total $39.15
Contractor:
MARTIN SANDERS GROUNDS MAINTEN
PO BOX 307
NORTH PLAINS, OR 97113 REQUIRED ITEMS AND REPORTS
•
Phone : 503- 647 -5567
Reg #: LIC 5742
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: 7.6La Permittee Signature:
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.
Sep 06 05 08:07a Martin Sander 503 -647 -9151 p. 2
n+�r�E��l i ® I O1'lI(-I. , i , ON
'lam bing_ Permit Appiic�hon�
Received Permit No l 04)..c-00C/33
:i ty of Tigard cy y O 200 Raeder: n1 �t� 79 �•
3125 SW Hall Blvd., Tigard, OR 9722.3 SEP Plan Re-w.cv Oi Permit No.:
ai I . �) l Date/By:
hone: Ho r i c: 503.639.4175 Date R � y � • J 1
st Ho t: www Line: 503.639.4175 G6 YIG -� a,Iw et See P.ee 2 for
1 1 Supplemental information
i]I' Notified/Method: atexnG: hwnv.ei.tigard.or.us -- ••�� ^pl i FEE* SCHEDULE
TYPE O]IJ \�Ipgl{
For special information use c/recklaz
),New construction ❑ Demo Description I Qty. J E� 1 Total
] Addi tion/alteration/replocernent 0 Other New 1- 2-family dwellings (includes 100 ft. for each utility connection)
SFR (!)bath 2490
CATEGORY OF CONSTRUCTION SFR
(2) bath 24920
] t -and 2 -family dwelling ❑ Ctxnmt rciallindttstrial SFR (3) bath 399.00
I Accessory building ❑ Multi- family
Each additional bath/kitchen 45.00
] Master builder
❑ Other_ Fire sprinkler (___ ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities
`` Catch basin or area drain 16.60
ill site address: to 3 s 1.A.) .1\ \ S - 16.60
r ' Drytveil, leach line, or trench drain
ity/StatclLlP: ,-, A ( R Z Z -[ Footing drain (no. linear ft.: __._) Page 2
zite/bldg./apt. no.: I Projeetname: } w x Manufactured home utilities 1 10.00
Toss street/directions to job site: - Manholes 16 60
Rain drain connector \ 16.60
Sanitary sewer (no. linear ft.: ) Page 2
Storm sewer (no. linear ft.: ) Page 2
� // / C, Water service (no. linear ft_: '1 Paec'_
Rain ba!1A levpS5tY,r{ ' Lot / 1
ubdivision: J Fixture or item
ax map /parcel no.: Absorption valve 16.60
DESCRIPTION OF WORK Backflow preventer ` Page 2 �t?C {'tv
Backwater valve 16.60
-� Clothes washer 16.60
■ il1 1J 1���CO Dishwasher 1660
e 16.60
Drinking fountain
12L PROPERTY OWNER ❑ TENANT Ejectors/sump 16.60
lame: (-1.:0 '' C 1u/ . Expansion tank 16.60
tddresS: { 2:1 SS S v J L--)9 TN A' . S e) 6) Fixture/sc•er cap
Floor drain /floor sink /hub 16.60
.ity /Statc/Z1P: Fort lo,.. n , 014 '`'t -7 %Z.3 Floor 16.60 i
'hone: 5D3) G 2_1) - a R� I Fax: ( 6--V. S9 ss - S9 cc> Garbage 16.60 l Hose tg
APPLICANT ❑ CONTACT PERSON Ice maker 16.60
3usiness name: )L.( Cc ,. - t - Iy 3 4,c, ,p ,.e C. ) ltiv1't G` ! S & tt - interceptor /grease trap 16.60
Medical gas (value: $ ) Pag 2
:ontoct name: C�1 A S 6 rZAe7� Page 2
L Primer
\ddrtss: L ; >>� 3c,-7 Roof drain (commercial) 16.60
,itylstatdi;IP: t r -(-(r, �.�- ti' O t 3 � Sink/basin/lavatory 16.60
'hone: (jU3) to 7 - S 5 -7. t Fax.. ( r s, c/7 - i c��s
Tub/shower/shower pan 16.60
mail: Urinal 16.60 1
CONTRACTOR Water closet
16.60
lusinessname: A-4a f- 1/ , c" 621'D6/h ,45--
Waxer heater 16.60
Other.
address: f . D . O "ice Subtotal
:itylStatelZW : iv Oi"C t (n -i ( -t....... ti t s' { 1 1.3 Minimum permit fee: $72.30
Fax: (5/?9) ( 7 `- r --- ... ..,/ ( 5 / Residential backflow minimum permit fee: $36.25
hone: (�jt7�1 ` ff p 7 515 t7 Plan review (25% of permit fee)
'CB Lic: 5 '7 L. Z Plumbing Lie no.: State surcharge (8% of permit fee)
• TOTA1 PERMIT FEE
.uthorized signature: ------1-1, 0 i. ' 11 C
,t Date: c ,• ' .6 . I This permit application expires if a permit is not obtained within name: !�� v �� �, i x G �� 180 days after it has been accepted as complete.
*Fee mcthodolaev set by Tri- County Buildine Industry Service Board