Permit CITYOF TIGARD PLUMBING PERMIT
DEVELOPMENT SERVICES PERMIT #: PLM2006 -00359
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 7/25/2006
PARCEL: 25111 DA -05800
SITE ADDRESS: 08835 SW BELLFLOWER ST ZONING: R -7
SUBDIVISION: APPLEWOOD PARK NO. 2 LOT: 053 JURISDICTION: TIG
Project Description: Install residential backflow prevention device 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
CRAIG KOZAK
8835 SW BELLFLOWER LN Description Date Amount
TIGARD, OR 97224 [PLUMB] Permit Fee 7/25/2006 $36.25
[TAX] 8% State Surcha 7/25/2006 $2.90
Phone : 503- 682 -0469 Total $39.15
Contractor:
ON THE MARK ENTERPRISES INC
25350 SW GARDEN ACRE RD
SHERWOOD, OR 97140 REQUIRED ITEMS AND REPORTS
Contact # : PRI 503- 682 -0469
FAX 503- 682 -8082
Reg #: LIC 5868
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 rul - direct stio to OUNC by calling 503 - 246 -6699 or 1- 800 - 332 -2344.
Issue By: Permittee Signature: a -
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 FOR OFFICE USE ONLY
City of Tigard Received U Permit No.: ,
13125 SW Hall Blvd., Tigard, OR 97223 Date /By: � �1 rah L/yaG�l�o LLB 5
�/anaa
Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 Date /By: Other Permit No.:
24- Hour Inspection Line: 503.639.4175 W ' Date Ready /By: r" � RI See Page 2 for
y Internet: www.ci.tigard.or.us Notified/Method: / l Supplemental Information
TYPE OF WORK FEE* SCHEDULE
ID New construction ❑ Demolition For special information use checklist
Description I Qty. I Ea. I Total
❑ Addition /alteration/replacement E. Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (1) bath 249.20
❑�4 nd 2- family dwelling ❑ Commercial/industrial SFR (2) bath 350.00
❑ Accessory building ID Multi-family SFR (3) bath 399.00
❑ Master builder Each additional bath/kitchen 45.00
❑ O ther: Fire sprinkler ( sq. ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities
Job site address: '8g7j5 .5\ '17. 1- -v_t_o ee_ G.t-. Catch basin or area drain 16.60
City /State /ZIP: T o I O 9 2 4_ Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: Project name: Footing drain (no. linear ft.: ) , Page 2
Manufactured home utilities 110.00
Cross street/directions to job sited E i ' - -�-� �
�'�� 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
Fixture or item
Tax map /parcel no.:
Absorption valve 16.60
DESCRIPTION OF WORK
Back preventer V Page 2 ; /.7.53 -
I1 -,\ 1 13._, 6 .4, �(zit.4l4 er •-,-1-.euA Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
I PROPERTY OWNER . ❑ TENANT Drinking fountain 16 -
Ejectors /sump 16.60
Name: (.TZi Y- Oz.A.�
Expansion tank 16.60
Address: 93T 5\ - dC L- -FL-OW C-2.. Fixture /sewer cap 16.60
City /State /ZIP: 7 to3,9 t" ) O 6 117 74_. Floor drain/floor sink/hub 16.60
Phone: ( 50.3) (,74. - 24oZ2_ Fax: ( ) Garbage disposal 16.60
�PPLICANT ❑ CONTACT PERSON Hose bib 16.60
[�r
Ice maker 16.60
Business name: O -G F- - EtA17fik fie.. Interceptor /grease trap 16.60
Contact name: t--k G
fL M SS ' Medical gas (value: $ ) Page 2
Address: 2530 -/ 7\, , i (7C.eS -2.3;) Primer 16.60
City /State /ZIP: ) Oz 6 0140
i4 � Roof drain (commercial) 16.60
_
1 Sink/basin/lavatory 16.60
Phone: (503) (052_ -04.+� o . Fax: : ( So 5 ) L' 2 Z - SOS
`�' 1 Tub /shower /shower pan 16.60
E -mail: hn0.,-1.- @ cA-rK3.A-e, r COw\
Urinal 16.60
CONTRACTOR Water closet 16.60
Business name: Water heater 16.60
Address: Other:
City/State /ZIP:
Subtotal
Minimum permit fee: $72.50
Phone: ( ) Fax: ( ) Residential backflow minimum permit fee: $36.25 ' 'L
CCB Lie.: Sie) (a 7/3/ /o . 7 Plumbing Lic. no.: Plan review (25% of permit fee)
State surcharge (8% of permit fee) PN. 70
Authorized signature: `,,,.K2 TOTAL PERMIT FEE 39, f5
Print name: tp _ C_A-t-Azj s5 Date: This permit application expires if a permit is not obtained within
180 days after it has been accepted as complete.
*Fee methodology set by Tri -County Building Industry Service Board.
i:\Building\Permits\PLM- PermitApp doe 06/05 440- 4616T(10 /02/COM/WEB) •
If , v
'CITY OF TIGARD
BUILDING DIVISION PERMIT #: PLM 00ti00359
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 7/26/2006
Phone: (503) 639 - 4171��"l� '� ii t
Inspection Requests (24 Hrs.): (503) 639- 4175±4►
INSPECTION WORKSHEET FOR DATE: 7/31/2006 TIME: 7 :06AM PAGE: 74
SITE ADDRESS: 08835 SW BELLFLOWER ST CLASS OF WORK:
SUBDIVISION: ApPLEWOOD PARK NO. 2 LOT #: 053 TYPE OF USE:
PROJECT NAME: KOZAK
DESCRIPTION: Install residential backflow prevention device for irrigation.
OWNER: KOZAK, CRAIG PHONE #: 503.662- 0469
CONTRACTOR: ON THE MARK ENTERPRISES INC PHONE #: 503
Inspection Request Scheduled For: Date: 7/31/2006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
399 Plumbing final 034002 -01 503-682-0469 N
Corrections/Comments/Instructions:
$PASS I I PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
FAIL n CALL FOR INSPECTION _ ADDITIONAL FEES ASSESSED
Inspector: / D ate: I Phone #: (503) 718 - - /3'