Permit CITY TIGARD PLUMBING PERMIT
P,,,Ink DEVELOPMENT SERVICES PERMIT #: PLM2006 - 00360
DATE ISSUED: 7/26/2006
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171
PARCEL: 2S 103AC -01700
SITE ADDRESS: 11180 SW FONNER ST ZONING: R -4.5
SUBDIVISION: LOT: 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
COLLEEN SCHULTHEIS
11180 SW FONNER STREET Description Date Amount
TIGARD, OR 97223 [PLUMB] Permit Fee 7/26/2006 $36.25
[TAX] 8% State Surcha 7/26/2006 $2.90
Phone : Total $39.15
Contractor:
LANDSCAPE OREGON, INC
12200 SW MYSLONY RD.
TUALATIN, OR 97062 REQUIRED ITEMS AND REPORTS
Contact # : PRI 503- 692 -5945
FAX 503- 692 -0768
Reg #: LIC 7804
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:
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.
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Plumbin . Permit A I he i'c n
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City of Tigard Reied _
1 3125 SW Hall Blvd., Tigard, OR 97223 it ec ter By : 7 t�6 Permit Nn'� ` y� f1�
Phone 503.639.4171 Fax 503 598.1960 I JUL 2 5 Ilan Review ` I �*'[R�tl t/CJ�e/
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24- Hour Inspection Line 503 639.4175 ■ - } �' i '+ DatGBy Other Permit No
Internet: www.ci tigard.oi.us of '1 x _ ,. ��+ Date cd;Mc '13y Jung Bf p pale l for
N fl t H . n n_ r Notified-Method
A , g g '� i � Supplemental Information
TY+ gp y gK JfU FEE* SCHEDULE
❑ New construction �-1''.1J`-� D C, a t` "J i� ,�� t`�
❑ DemohUon For special information use checklist
® Additionialteranon /replacement Desctiplton ( Qty. � Ea 1 Total
❑ Other: New 1- 2- family dwellings (includes 100 IL for each utility connection)
CATEGORY OF CONSTRUCTION SFR (I) bath
249.20
® I - and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 350 D0 +
❑ Accessory building ❑ Multi- family SFR (3) bath 399,00
Each additional bath kitchen 45 -00
❑ Master builder ❑ Other:
JOB SITE INFORMATION AND LOCATION Fire sprinkler ( sq. ft.) Page 2
Site utilities
Job site address: 11180 SW Fonner Street
Catch basin or area drain 16.69
City /State /ZIP: Tigard, OR Drywell, leach line, of trench drain
1 6.60
Suite /bldg. /apt. no.: I Project name: Colleen Footing dram (no linear It ) Page 2
Cross street/directions to job site: Manufactured home utilities 1 10.00
Manholes 16.60
i
Rain drain connector 16.60
Sanitary sewer (no. linear ft.. ) Page 2
Storm sewer (no linear It • ) Page 2
Subdivision: ) Lot no.: Water service (no linear It.: ) Page 2
Tax map /parcel no.: 655 C4 Fixture or item
DESCRIPTION OF WORK Absorption valve ] 6 60
Backflow preventer / Page 2 ,D 7 C $`-
Landscape Backflow Device
Backwater valve 16.60
Clothes washer I 16.60
Dishwasher 1 16.60
® PROPERTY OWNER 1 ❑ TENANT Drinking fountain 16.60
Name: Colleen Schultheis Ejectors /sump 16 60
Expansion tank 10.60
Address: 11 180 SW Fonner Street
Fixture sewer cap 16,60
City/State /ZIP: Tigard, OR 97223 Floor drain/floor sink/hub
16.60
Phone: ( ) Fax: ( ) Garbage disposal
16.60
® APPLICANT ® CONTACT PERSON Hose bib 16.60
Business name' Landscape Oregon, Inc Ice maker 16.00
interceptor /grease trap 16 60
Contact name: Ellen Sparrow
Medical gas (value. $ ) Page 2
Address: 12200 SW Myslony Road Primer
16 60
City /State /ZIP: Tualatin, OR 97062 Roof drain (commercial) 16 60
Phone: (503 -) 692 -5945 I Fax: • (503) 692 -0768 Sink/basin/lavatory 16.60
E -mail: Tub /shower /shower pan 1 6.60
Urinal 16 60
CONTRACTOR
Water closet 16.60
Business name: Landscape Oregon, Inc Water heater
16.60
Address: 12200 SW Myslony Road Other:
City /State /ZIP. Tualatin, OR 97062 Subtotal
Phone: (503) 692 -5945 Minimum permit fee. $72 50
Fax: (503 -) 692 -0768 Residential backllow minimum permit fee: $36.25
CCB Lie.: 7804 Plumbing Lic. no.: Plan review (25 %of•permit fee)
Authorized signature.��. s ,� �Q State surcharge (8% of permit fee) 2
Print name Ellen Sparrow ` � ' � i ICJ //J TOTAL PERMIT FEE 131 ,, f S'
I Date: 7/25/06 1 This permit application expires if a permit is not obtained within
1111 189 days after it has been accepted as complete.
*Fee methodology set by To-County Building Industry Service Board.
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CITY OF TIGARD
_ .
BUILDING DIVISION PERMIT #: PLM2006-00360
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 7/26/2006
Phone: (503) 639-4171
Inspection Requests (24 Hrs.): (503) 639-4175 J744.
INSPECTION WORKSHEET FOR DATE: 13/17/2006 TIME: 7:01AM PAGE: 6:3
SITE ADDRESS: 111130 SW FONNER ST CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: SCHULTHEIS
DESCRIPTION: Bacidlow proventer for irrigation.
OWNER: SCHULTHEIS, COLLEEN PHONE #:
CONTRACTOR: LANDSCAPE OREGON, INC. PHONE #: 503-6915945
Inspection Request Scheduled For: Date: 8/17/2006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
Plumbing final 035102-01 W3-692-5945 N
Corrections/Comments/Instructions:
PASS I PARTIAL APPROVAL El CANCEL NO ACCESS
n FAIL I I CALL FOR INSPECTION ADDITIONAL FEES ASSESSED
Inspector: TB Lici
Date: III r )(64) Phone #: (503) 718-14%