Permit CITY TIGARD PLUMBING PERMIT
i' I DEVELOPMENT SERVICES PERMIT #: PLM2005 -00510
'Ail DEVELOPMENT
SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 10/4/2005
PARCEL: 2S 112CD -12700
SITE ADDRESS: 07704 SW CYPRESS LN ZONING: R -12
SUBDIVISION: HAMBACH GROVE LOT: 025 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 Description Date Amount
12755 SW 69TH
SUITE 100 [PLUMB] Permit Fee 10/3/2005 $36.25
PORTLAND, OR 97223 [TAX] 8% State Surchan 10/3/2005 $2.90
Phone : 503 620 - 8080 Total $39.15
Contractor:
MARTIN SANDERS
PO BOX 307 REQUIRED ITEMS AND REPORTS
NORTH PLAINS, OR 97133
Phone : 647 - 5567 •
Reg #: PLM 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: , Permittee Signature: G 2. cal
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.
Sp 28 05 12: 00p Martin Sander 503 647 - 9151 p.
1.1- ECEIVE f...' 1.O1: (31.1 1('1•. t ,L (1 \1.1
IllmbinEPAIR tAMASI a t
05 ,, R � Permit Na.: O a.00s %S 1
ity of Tigard SEP 2 f' Received
Review Other Permit No.:
one: SW Hall Blvd., Tigard, OR 971 Plan 19 y. ., s. �. ; e/g : Pagel for
one: 503.639.4171 Fax: 503.598.1960 t .,�1� ' - - Date Ready/ay 121 sec Page l for
- Hour inspection Line: 503.639.4175 CITY OF Noti R dY1 tied:
cmcC �nvw.ci.tigardorus _ FEE* S MILE TYPE OF • t '1' For special informarion use deck dot
❑ Demolition (� Ea. Total
New construction Descri lion
lacement ❑ Other: New 1- 2-family dwellings (includes 100 92il utility connection)
Addition/alteration/rep SFR (1) bath
CATEGORY OF CONSTRUCTION SFR (1) bath 340.00
❑ Commercial/industrial 399.00
1- and 2- family dwelling SFR (3) bath _
45.00
❑ Multi - family
Accessory building Each additional batlt/kiteh
Page 2
Master builder ❑ Other: Fire sprinkler L__ sq• ft )
JOB SITE INFORMATION AND LOCATION Site utilities
7 Catch basin orates drain 16.60
b site address: ♦ . .. r Ihywcll, leach line, or trench drain 16.60
ZZ e2
tylStatefLiP: . j Q601 -a, V • Footing drain (no. linear ft : _)
ite/bldgJapt. no.: Project name: it - a & A. Manufactured home utilities
110.00
16.60
-ors street/directions to job site: Manholes
Rota drain connector
16.60
Sanitary sewer (no. linear ft.: _-)
Page 2
Sloan sewer (no. linear ft.: _
Page 2
Water service (no_ linear ft.: )
Page 2
((
rbdivision: �l.„ b l � !? t + ,r.. Lot no / i Fixture or item
Absorption valve 16.60 ,{
ix map /parcel no.: Page 2 , ICO3el_
DESCRIPTION OF WORK Backflow Qrcvcntcr
Backwater valve
16.60
Clothes washer 16.60
L(t(�SC(1 rQ� {��CO n Dishwasher 16.60
J Drinking fountain 16.60
❑ TENANT Drinking fountain 16.60
�. PROPERTY OWNER 16.60
am �
e: e-gC Ci OW � � • EXpansion tank
1 Fixturelscwcr cap 16.60
.ddress: ` W 9 Thi - ' . suite ) t �� 16.60
�� SS `-� E7oordrainlfloorsinldhub
:by /State/ZIP: Vole-- k�r ,-R 0 X2-3 Garbage disposal 16.60
3 � 9 - gel GO 16.60
hone: FjDj) ( 2....o D g� Fax: (S Hose bib
APPLICANT Cl CONTACT PERSON Ice maker 16.60
C ' r rrj f 'rt Cl •S 64 t. - interceptor/grrase trap 16.60
:trsint5s name: OA CG t l 6,.. Se,, �� P �� Page
�41iA0�'� Medical gas (value: $ )
:ontact name: 1,_,1 a 1 - �
tddress: F �� 16.60
t )fie 3C>---.) Primer � drain (commercial) 16.60
0 � 9 r .3 Roof 16.60
'h � � . -�� � C� -> S Sink/basinfavatoty
'hone: (50.) LO 'i s S V -) • l Fax:: (� ) 42 y7 - WS> Tublshowerlshower pan 16.60
16.60
:mail: Urinal
CONTRACTOR
Water closet 16.60
16.60
P ....,_41. Water heater
lusincss name: 1 a- • / _ • ...e i� Other.
tddr ss: P . O .. e> O
Subtotal
�
/ e 1 r3 7 Minimum permit fee: S72.50
Ito /St (5Q ND U1/•'�1n -� � • \'l s lcRow minimum permit fee: $36.25
hone: (503 !O K 7 - � r5 6, - / Fax_ 6/9) (p ti --- 9/ 5 i / Residential bac Plan review (25% of permit fee)
CB Lic: ' } y •0 V Piumbing Lie_ no.: State surcharge (8% of permit foe)
J TOTAL PERMiT FEE ,...3(.,. , 2.5 .utharized signature: . _.../_. ..
Date: 8' �� CJs This permit application espires if a permit is not obtained within
rint name l�� G ?��lir ��G :� i �/ ` 180 days after it has been accepted as complete.
*Fee methodolol!v set by Tri- County Buildina Industry Service Hoard
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CITY OF TIGARD -
BUILDING. DIVISION PERMIT #: PLIVI2001.40510
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 10/4/2005
Phone: (503) 639-4171
Inspection Requests (24 Hrs.): (503) 639-4175
INSPECTION WORKSHEET FOR DATE: 10/5/2005 TIME: 7:00AM PAGE: 54
SITE ADDRESS: 07704 SW CYPRESS LN CLASS OF WORK:
SUBDIVISION: HAMBACH GROVE LOT #: 025 TYPE OF USE:
PROJECT NAME: HAMBACH GROVE
DESCRIPTION: Backflow preventer for irrigation.
OWNER: LEGEND HOMES, PHONE #: 503-620-8080
CONTRACTOR: SANDERS, MARTIN PHONE #: 647-5567
Inspection Request Scheduled For: Date: 10/5/2006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
399 Plumbing final 017517-02 603-647-5667
Corrections /Comments/ Instructions:
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:A.
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pi 'ASS L1 PARTIAL APPROVAL EI CANCEL Li NO ACCESS
LI FAIL Li CALL FOR INSPECTION I I ADDITIONAL FEES ASSESSED
Inspector: tr Date: ( 6/0 Phone #: (503) 718-
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