Permit Ili CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT PERMIT #: PLM2008 -00106
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 3/12/2008
PARCEL: 1 S125DC -08200
SITE ADDRESS: 07070 SW ASH CREEK CT ZONING: R -4.5
SUBDIVISION: ASH CREEK ESTATES LOT: 015 JURISDICTION: TIG
PROJECT: ASH CREEK ESTATES
Project Description: Installing backflow preventer.
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
Owner:
FEES
WINDWOOD CONSTRUCTION INC
12655 SW NORTH DAKOTA Description Date Amount
TIGARD, OR 97223 [PLUMB] Permit Fee 3/13/2008 $36.25
[TAX] 12% State Surch 3/13/2008 $4.35
Phone : 503- 780 -4375 Total $40.60
Contractor:
BURNESS LANDSCAPE
9330 SW LEHMAN ST
TIGARD, OR 97223 REQUIRED ITEMS AND REPORTS
Contact # : PRI 503- 432 -8525
FAX 503- 432 -8525
Reg #: PLM 13007
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: /� / � J - A � Permittee Signature: �� ✓ % � }�,�L
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 `��
City of Tigard � Received 4.0
-5,4i o (3 Permit No /L/'1 XV - cbI
VVV.../// Q
o 13125 SW Hall Blvd., Tigard, OR OQU Plan Review �
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Phone: 503.639.4171 Fax: 503.5 .1960 rt P� 1 D ate B y:
TIGARD Other Permit No.: MS./ O -- UL l 1 3
Inspection Line: 503.639.4175 \\1\N ((( (���� ate Ready/By: Page 2 for
. Y .runs: El See PB
Internet: www.tigard �` j ® F'C O P� B rA tified/Method: Supplemental Information
TYPE OF WORK `C1 S `` FEE* SCHEDULE
® New construction ❑ ll0llt n For special information use checklist
Description I Qty. I Ea. I 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
® 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: 70 ��) /1 Comte a Catch basin or area drain 16.60
7--/- City/State /ZIP: 02 97a a.3 Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: I Project name: Footing drain (no. linear ft.: ) Page 2
Manufactured home utilities 110.00
Cross 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
Subdivision: A h s - I Lot no.: 15 Water service (no. linear ft.: ) Page 2
Fixture or item
Tax map /parcel no.: Absorption valve 16.60
DESCRIPTION OF WORK
Back preventer I Page 2 36.25
landscape irrigation Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
❑ PROPERTY OWNER I ❑ TENANT Drinking fountain 16.60
Ejectors /sump 16.60
Name: Expansion tank 16.60
Address: Fixture /sewer cap 16.60
City/State /ZIP: Floor drain/floor sink/hub 16.60
Phone: ( ) Fax: ( ) Garbage disposal 16.60
Hose bib 16.60
@ APPLICANT ❑ CONTACT PERSON
Ice maker 16.60
Business name: Burness IJS
Interceptor /grease trap 16.60
Contact name: Tom Burness Medical gas (value: $ ) Page 2
Address: 9330 SW Lehman St Primer 16.60
City/State /ZIP: Tigard, OR 97223 Roof drain (commercial) 16.60
Phone: (503) 432 -8525 Fax: : (503) 432 -8525
Sink/basin/lavatory 16.60
Tub /shower /shower pan 16.60
E -mail:
Urinal 16.60
CONTRACTOR Water closet 16.60
Business name: see above Water heater 16.60
Address: Other:
City/State /ZIP: Subtotal
Minimum permit fee: $72.50 36.25
Phone: ( ) Fax: ( ) Residential backflow minimum permit fee: $36.25
CCB Lie.: 13007 Plumbing Lic. no.: Plan review (25% of permit fee)
State surcharge (12% of permit fee) 4.35
Authorized signature: 0 , _ TOTAL PERMIT FEE I 40.60
Print name: o v ,.. ‘ U {And Date ./a . i08- This permit application expires if a permit is not obtained within
180 days after it has been accepted as complete.
*Fee methodology get by Tri -County Rnildino Indnctry Service Roard
CITY OF TIGARD ,� I a Od /b 7
BUILDING DIVISION PERMIT #:
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED:
Phone: (503) 639 -4171 Allk
Inspection Requests (24 Hrs.): (503) 639 -4175 `__.. ,,,., - - --
INSPECTION WORKSHEET FOR DATE: 1 -fr i k /" 3 TIME: PAGE:
SITE ADDRESS: 763 3 O gsq/t CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME:
DESCRIPTION:
OWNER: PHONE #:
CONTRACTOR: PHONE #:
Inspection Request Scheduled For: Date: Pour Time:
Code # Inspection Description Confirm # Contact # Message
36i 1...0 e - Piot/kJ - 1).e,h,--e„, 3;
Corrections /Comments /Instructions:
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PASS n PARTIAL APPROVAL n CANCEL ❑ NO ACCESS
❑ FAIL n CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED •
Inspector: � Date: Phone #: (503) 718 1 - J