Permit ,., TIGARD OF IGARD PLUMBING PERMIT
DEVELOPMENT SERVICES PERMIT #: PLM2006 -00258
�I DATE ISSUED: 6/2/2006
;-- 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171
PARCEL: 2S109DD -08200
SITE ADDRESS: 12867 SW DA VINCI ST ZONING: R -7
SUBDIVISION: BELLA VISTA LOT: 012 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 #200 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 Permittee Signature: c") \,
p 1
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 REC;EIVEDA Received ` -r 06 �'' �. J co '
Date /By:
6 Permit N o.:
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Date/By:
Phone: 503.639.4171 Fax: 503.598.1960 ,; IN 1 2006 I ', Other Permit No.:
��
24 - Hour Inspection Line: 503.639.4175 -L� Al . ! Date Ready /By: 19 0 See Page 2 for
" - _
Internet: www.ci.tigard.or.us CITY OF TIGA - Notified /Method: i Supplemental Information
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I New construction ❑ Demolition For special information use checklist
Description Qty. Ea. Total
❑ Addition/alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
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. � .- , CATEGOR £ F�GoNSTIiTSC -- SFR 1 bath 24920
- ?�. , �� 3�� � ..�� -, - a- , at .,,,..Zas
a 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:
_` . .: . , JO
` = ,,,,� 3 ,s Fire sprinkler ( sq. ft.) Page 2
� B e 0i3I2I1 Irit3RISIMi( lkiii i&F40
.��__ `s_a��.,�.�:1:1 1 �:- Site utilities
Job site address: 12 U.7 51,1i Da V ivi .54-rcei Catch basin or area drain 16.60
City/State /ZIP: • � i p on ,a1-4 Drywell, leach line, or trench drain 16.60
-
Suite/bldg. /apt. no.: J Project name: ,\\ \t‘ sin:,. 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 v f, Lot no.: I z Water service (no. linear ft.: ) Page 2
Fixture or item
Tax map /parcel no.:
s ton valve
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__ :,_ :_ �� . _- : � g -.- sy � M� , �,a °o :����•,��a.,. �� . ,u= �,9� �.A _. > -:. ., ..,;., <•� �.a Backflow preventer 1 Page 2 3
Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
+± c• >= "K -� r rm �.� ,t£:. Drinking fountain
16.60
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;.., :w,; ' ep,, �•: =Ko_ :::E<:: ... .
1' ° Ejectors/sump 16.60
Name: 1I V-e/1 -4; C t4CJYt -ze 7 YA! , Expansion tank 16.60
Address: G" 2 S /Vt,V +tir ,. , 1 ' 41 > Fixture/sewer cap 16.60 •
City/State /ZIP: V ti y 100 cf' • Floor drain/floor sink/hub 16.60
Phone: (��j L (-�� - (7r? � (,o Fax: (Ct�") t'v 7 l"� - � r '! U z
Garbage disposal 16.60
4 ;, , . erg ;..=x; :r pst: :: s ,.,.<, >' gborp sg ;;.' Hose bib 16.60
" � .; ' - Ice maker 16.60
Business name: Li v'r51 (tt H1 e `a f `.VV')C.. Interceptor /grease trap 16.60
Contact name: .L" (.4' 5rY2_c.(_k_A Medical gas (value: $ ) Page 2
Address: ( 2 jv W A, 6. / pr ; h # oo Primer 16.60
City/State /ZIP: Roof drain (commercial) 16.60
Phone: ( ) Fax: : ( ) Sink/basin/lavatory 16.60
Tub /shower /shower pan 16.60
E- mail: Urinal 16.60
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, � ". ,�,.., �_ ��. -..a ,G_r.. � .a� .- ��_�a: ,,. . ;' '._�,.�_da��r Water closet 16.60
Business name: j-v pWlyl 1 1 Y1 C •I V vvi 6 Y15 Water heater 16.60
Address: '2.S 05 • S • t.e/ . A 05 i,4 b{ . Other:
City/State /ZIP: 4ko \ci 012. y 7 00 . Subtotal
Minimum permit fee: S72.50
Phone: ( ) OM - 06s 7 Fax: (563 ) ;7 a, - 95" 3 Residential backflow minimum permit fee: $36.25
CCB Lie.: / ii 2 (} ( Plumbing Lic. no.: 3 - 370 1 6 Plan review (25% of permit fee)
� State surcharge (8% of permit fee) , t,�
Authorized signaturet�7 G , 1� TOTAL PERMIT FEE 39 r.5-
Print name: ,3 - 64 (t 44 1 ,.. \. , v 8 d l `( Date: !' - e_. 05" 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.doc 12/03 440-46 16T( I 0 /02 /COM /WEB)
CITY OF TIGARD pLl42o -C?oD
BUILDING DIVISION ,* PERMIT #: P Mt
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 6/2/2006 a �
Phone: (503) 639 -4171 "lilt
Inspection Requests (24 Hrs.): (503) 639 -4175 '! �
INSPECTION WORKSHEET FOR DATE: 9/11/2007 TIME: 7:00AM PAGE: 8
c
SITE ADDRESS: 12867 SW DA VINCI ST CLASS OF WORK:
SUBDIVISION: BELLA VISTA LOT #: 012 TYPE OF USE:
PROJECT NAME: BELLA VISTA
DESCRIPTION: Backflow preventer for irrigation. 9/4/07 Reinstated for (30) days for final inspection.
OWNER: RIVERSIDE HOMES INC., PHONE #: 503-645-0986 `
CONTRACTOR: STREAMLINE PLUMBING PHONE #: 543
Inspection Request Scheduled For: • Date: 9/11/2007 Pour Time:
Code # Inspection Description `' Confirm # Contact # Message
399 Plumbing final 055490 -01 971 - 246 -1996 N
Corrections /Comments /Instructions:
Ln 7 -IrVI # \ I I. .. - C q •1 , e. i -'. " ‘ v - , •
1),,ab le Gk.cc1/44, Li —-k4 cfe.,e. 1 0. � %/"-
C. r . c . EJ ,_ l mot" 94,,)
X PASS ❑ PARTIAL APPROVAL ❑ CANCEL NO ACCESS
FAIL n CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED
L YE - - i).\ 1�
Inspector: Q� Date: 9'1/ l lo -) Phone #: (503) 718