Permit CITY TIGARD PLUMBING PERMIT
DEVELOPMENT SERVICES PERMIT #: PLM2006 - 00279
--a 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 6/2/2006
PARCEL: 2S 109DD -10400
SITE ADDRESS: 12700 SW DA VINCI LN ZONING: R -7
SUBDIVISION: BELLA VISTA LOT: 034 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
RIVERSIDE HOMES INC.
1925 NW AMBERGLEN PKWY, STE. 2 Description Date Amount
BEAVERTON, OR 97006 [PLUMB] Permit Fee 6/2/2006 $36.25
[TAX] 8% State Surcha 6/2/2006 $2.90
Phone : 503- 645 -0986 Total $39.15
Contractor:
STREAMLINE PLUMBING
2505 SW AUGUSTA DR.
ALOHA, OR 97006 REQUIRED ITEMS AND REPORTS
Contact # : FAX 503- 379 -9543
PRI 503- 888 -6657
Reg #: LIC 142111
PLM 34 -370PB
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 0001 -0010 through OAR 952 - 0001 -0100. You may obtain copies of
these rules or direct questions to OUNC by calling 503 - 246 -6699 or 1- 800 - 332 -2344.
Issued By: -, J4 . 117_ Permittee Signature: {�
Call 503 - 639 -4175 by 7:00 a.m. for an inspection that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
• - PIumbin Permit A iv f ED A . _ . f _ FOR OFFICE USE ONLY .
City of Tigard Received / C 1J
I' / �� Permit N-09) 1`I Z,y/�+
f A--- 7 �9
13125 SW Hall Blvd., Tigard. OR 97223 1 2006 Date/By
Review
Phone. 503.639.4171 Fax 503.598.1960 u V I Ii Other Permit No.:
24- Hour Inspection Line. 503 639 4175 a Other lm
CITY OF TIGAR y► �1 Date Ready See Page 2 for
Internet. www ci.tigard onus DING D • Notified/Method: ') Supplemental Information
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'i.�^ ^,'£$ '� � A3 � 'Sp.' wu: °� ',•✓".? `>{:.if�a, t ,`"��.' , ,i�',"'A•, �• �
F , „;;,�; „:,'�. , O - �; � , „', u� �” _ FEE .; E. SCFIEI?iJT�E
mow.,... ...., � _ .� „> ��' a� ".�.'�e_.,a %�,r�ar„�:;.u�'�s .'fir . . __ .. '�,h..�. , , �� �,� .v „�'�':.�,; _ �:�z, �., , t4sq, ._, ,.. ,e4, =W 4'
x New construction ❑ Demolition For special information use checklist.
Descnption Qty Ea Total
❑ Addition/alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft for each utility connection)
' w ^i ; -± LT E'' ICONS 'RU 4ON. SFR (1) bath 249.20
�; >s, -" ..: , - , ... „, , . �: �z:: is�' � ;+�
a I- and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 350 00
11 Accessory building ❑ Multi- family SFR (3) bath 399.00
Each additional bath/kitchen 45.00
❑ Master builder ❑ Other:
,- ; " ^,> Fire sprinkler ( sq. ft ) Page 2
s -;3,
,;.•, ,.:, OB> �I�I 2�IV DI:
.,, .,... - Q,+�ATI,flN; � Site tilt'
Job site address: 1Z, 7.0d C 4N Do Utbles' /u y oc, Catch basin or area drain 16.60
City/State /ZIP: - 11 , Q ky -6„ i O E_ o a .L 4 Drywell, leach lme, or trench dram 16.60
Suite/bldg. /apt. no.: J Project name: \\04 \tk ST1 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: e,k,a V FO Lot no.: 3 Water service (no. linear ft • ) Page 2
Fixture or item
Tax map /parcel no.:
5 ";:.; ;DES .;�: 1.::s Absorption valve 16 60
� v . it . Hr;- CIi1P TIfl�T:;tflF,.;U
W.,- R 1 444, „i 2' n � "t4 ;
Mill' i:; _, z, - Artikiilia ”„ .;;mom,, >,,,,a?.at„ ,:oC tet4 ;: .x k ,-;, 6 ... „_.tea Backflowpreventer i Page 3 C 2 +
Backwater valve 16 60
Clothes washer 16 60
Dishwasher 16.60
"`;�: ;g • i„ , , ;
,� ,. , , ,,, . > ._ ..: -.. f ,a ,., : ;,;, b;,; 4 Drmking fountain 16.60
, .: f . 1' ; _; ';r - '.,;', , • ,.,<' '
iw ; , , ,,,'W'. t z >; �i,i „ _ -._ r .;:, ,,,:,. Ejectors /sump 16 60
Name: 1 V ` A ,.- 6 ; C PO e e .- • Expansion tank 16.60
Address: !G ”) 5 / l/ 7y Fixture /sewer cap 16 60
City/State /ZIP: :Fe 4 ,x_4 pa_ c - 10 v L' J Floor dram/floor sink/hub 16.60
Fax: ( S.� ) Garbage disposal 16.60
Phone: (4 ) Le Li - D . . . t 1„,(:)-2,___q cZ Li Z
:. <: , x -' ,:ii ? - ':. 'z e "x, r 400,,.x..,,:: , Hose bib 16.60
i. z< z Q , ,A P „ 4.,I' A-7. - r ` 'i ,;;r<r , -,, 3 i MCO ITACT PERsoN,:r
Ice maker 16.60
Business name: Lii V l f ► 'C' i `� i T. ►6 Interceptor /grease trap 16.60
Contact name: , "'CC (_. ¶-L }-4,c-c-1 �7 Medical gas (value. $ ) Page 2
Address ( CI 2 AAA/ Aryl )4- „ ao e Y`ri,e,�tl If 700 Primer 16 60
City/State /ZIP: Roof drain (commercial) 16 60
Sink/basin/lavatory 16.60
Phone: ( ) I Fax:: ( )
Tub /shower /shower pan 16.60
E -mail:
°,,�� . , 'a , '`, @ • .;(",frei;,r- i;, n ;ial :...; - ;,:'�,'::,; 3� ;a�s:?;�' x,S -i Urinal 16 60
; rlf +3f
a,ta�- N 3a._r,,, :. ,•i- :;',.,',' . CONTR.4CTQR.. �' . ,.,;,: -'-- - „i” „ ; a ; ,, ,
,1
_,.. _.. �_' ..._ „., .. , .. _. ,.�,• �..�,._...;_:�,: „z " ., ,��... ,. , ,_ .. � ,. , W ater closet 16 60
Business name: ,3'j-v prwtyt I i VI t iI V vii 640 Water heater 16 60
Address: 2 S D5 - S • (;,/ . A v> . - Other
City/State /ZIP: )-1 L k CAE 1 7 OO ' Subtotal
Minimum permit fee: $72.50
Phone: (555 ) agj�� - ( 65 7 Fax: (503 ) ?Ar 2. - 95 Li 3 Residential backflow minimum permit fee $36.25
CCB Lic : i 2 (I I Plumbing Lic no.: 3 1-f - 37o '1)6 Plan review (25% of permit fee)
� .� —�/ ,
TOTAL PERMIT FEE 3 f s
State surcharge (8% of permit fee) ,,Z /2
Authorized signatur /J`y p.
Print name: 3304,t44 to 8 M I Date' : — e_.0,) This permit application expires if a permit is not obtained within
180 days after it has been accepted as complete.
*Fee methodology set by Tn -County Building Industry Service Board
i \Buiidmg\Permts \PLM- PermiiApp doe 12/03 440- 4616T(i0/02/COM /WEB)
CITY OF TIGARD ..
BUILDING DIVISION PERMIT #: PLM200&-00279
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 6/2/2006
Phone: (503) 639 -4171 u °N�pi
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 8/29/2006 TIME: 7 :01AM PAGE: 35
SITE ADDRESS: 12700 SW DA VINCI LN CLASS OF WORK:
SUBDIVISION: RELLA VISTA LOT #: 034 TYPE OF USE:
PROJECT NAME: RELI..A VISTA
DESCRIPTION: Sacl<4IoW preventer for irrigation.
OWNER: RIVERSIDE HOMES INC., PHONE #: 503-645-0986
CONTRACTOR: STREAMLINE PLUMBING PHONE #: 503- 8138.6657
Inspection Request Scheduled For: Date: 8/29/2006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
399 Plumbing final 035723 -01 503-572-4708 N
Do t4114 C �1-?.tk 1 L,�
Corrections /Comments /Instructions: S ✓✓ (w- d'J S � r -
-e rT De �; c c , �- S �� ;�1 - re i i..4 , 17) G.l Ott
vt 91
PASS PARTIAL APPROVAL CANCEL n NO ACCESS
n FAIL CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED
Inspector: C7 111,114A4_ Date: r j 1 1 c 6 Phone #: (503) 718-
1