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Permit CITY OF TIGARD PLUMBING PERMIT I DEVELOPMENT SERVICES PERMIT #: PL /23/20 -00506 �^ 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 106 PARCEL: 1 5134 0 S134DB -09600 SITE ADDRESS: 11265 SW FOREST LN ZONING: R -4.5 SUBDIVISION: STONECHASE LOT: 020 JURISDICTION: TIG Project Description: Residential backflow 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 GERRITZ BIGGI CUSTOM HOMES Description Date Amount 9550 SW BEAVERTON HILLSDALES H BEAVERTON, OR 97005 [PLUMB] Permit Fee 10/23/200€ $36.25 [TAX] 8% State Surcharp 10/23/200€ $2.90 Phone : 503 619 - 4668 Total $39.15 Contractor: MARK BROWN LANDSCAPING PO BOX 744 REQUIRED ITEMS AND REPORTS VANCOUVER, WA 98666 -0744 Contact # : FAX 360 - 993 -5993 PRI 503- 234 -2667 Reg #: LIC 5192 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 - 4_6-6699 or 1- 800 - 332 -2344. Issued B : _e_i(1Z ��� k ,{ Permittee Signature: 61pp 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. m y, 0 200 6 - 00005 y Plumbing Permit Application FOR OFFICE USE o Li City f Tigard Received / � Permit No.: , vel / tY g Date/By: f0 9.° e10 R . & 49 4 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review Phone: 503.639.4171 Fax: 503.598.1960 / /;�r I� Date/By: Other Permit No.: 24- Hour Inspection Line: 503.639.4175 .41:1111 • Ju `' Date Ready/By: ® See Page 2 for Internet: www.ci.tigard.or.us Notified/Method: / t i, Supplemental Information ;�: •,i^ ,.h! r.:x %:; ", , .'.. .,. FE ,S'G" DUI:E i,:. TYPE OF WORK - � ., . [Few construction ❑ Demolition For special information use checklist. Description Ea Total ❑ Addition/alteration/replacement ❑ Other: New 1- 2 - family dwellings (includes 100 ft. for each utility connection) CATEGORY. OF CONSTRUCTION ; 'i'tr';; t ; ';: SFR (1) bath 249.20 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 JOB SITE INFORMATION AND' LOCATION, :'f';': `t':' "' ''''' : '`' Site utilities Job site address: 1 I a (f 5 io>'657 Lv/t Catch basin or area drain 16.60 City /State /ZIP: Pri gjw1(J1 l'V 1 -7) L( Drywell, leach line, or trench drain 16.60 Suite/bldg. /apt. no.: 1 I Project name: � h /, .€_..., Footing drain (no. linear ft.: Page 2 ��j� Manufactured home utilities 110.00 Cross street/directions to job site: / _l I7 ,D 0. 9-- 1,r Manholes 16.60 Rain drain connector 16.60 Sanitary sewer (no. linear ft.: ) Page 2 Storm sewer (no. linear ft.: ) Page 2 Subdivision: � 0�' e, a S e-- Lot no.: Water service (no. linear ft.: ) Page 2 Fixture or item Tax map /parcel no.: Absorption valve 16.60 'DESCRIPTION OF • WORK';,,-' ,:;,.,,: +.�' ,'" r ^,:";: A f Backflow preventer / Page 2 3 4 , � fi iD D 2241 G'f1-17or"1 .gQ (j(} /(l Teen/ / Backwater valve 16.60 Clothes washer 16.60 Dishwasher 16.60 ❑ PROPERTY OWNER Drinking fountain 16.60 1 ,., .. � ❑. TENANT.::,: / , . ,:.;� :�. >.; Ejectors/sump Name: o.FL � r � i j S L. t % L ectors/sump 16.60 - Expansion tank 16.60 Address: q j`,J - ' b��1Un "hi l Fixture/sewer cap 16.60 City /State /ZIP: ‘ 4 n to/( 97005 / Floor drain/floor sink/hub 16.60 Phone: (..5-0 & / - 4& Fax:,...) ).5 6 Z ? 1/ Garbage disposal 16.60 Hose bib 16.60 . ❑ APPLICANT:;..':,,::;., •.,• . CONTACT;;PI RSON;,, ;;rs:!:: / / /� Ice maker 16.60 Business name: rl � 5 � � 5 LPL I . Interceptor /grease trap 16.60 Contact name: l' n Medical gas (value: $ ) Page 2 Address: 455 ,) iCIJ �f .A //5 y Primer 16.60 City/State/ZIP / , , / n (97c c 7095 / Roof drain (commercial) 16.60 Phone:60/3) / 7 f 1 6 V Fax:: (5 -, ®y Sink/basin/lavatory 16.60 Tub /shower /shower pan 16.60 E -mail: Urinal 16.60 .CONTRA�O/ 'r =,: �..I s!t, :, ;,,,,:..',.,,:.4::.:: Tr .; closet 16.60 Business name: '/102 re_L 8 `o/1 j/ /4, Water heater 16.60 Address: Po. 7 y L/ _ "T ( Other: City/State /ZIP: / © k � /�/ �� /�j © Subtotal 11! n o w L ,�v" "" " `� / O. / 7�� permit er, Minimum ermit fee: $72.50 i j � Phone:. D3 - � ) 7 Fax:3 ( 3 _ 59R 3 Residential backflow minimum permit fee: $36.25 CCB Lie.: ���'�/� / Plumbing Lic. no.: Plan review (25% of permit fee) �lL -k. * State surcharge (8% of permit fee) 90, Authorized signature: !/�//' /6" -------) TOTAL PERMIT FEE fg . /5 Print name: /1 y/ y e Date: J9_ -06 This permit application expires if a permit is not obtained within I 180 days after it has been accepted as complete. *Fee methodoloev set by Tri- County Buildine Industry Service Board. , . CITY OF TIGARD BUILDING DIVISION PERMIT #: P1M2006-00506 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 10/23/2006 Phone: (503) 639-4171 g A is . avp, Inspection Requests (24 Hrs.): (503) 639-4175 ,..J61" INSPECTION WORKSHEET FOR DATE: 10/4/2007 TIME: 7:02AM PAGE: 31 SITE ADDRESS: 11265 SW FOREST LN CLASS OF WORK: SUBDIVISION: STONECHASE LOT #: 020 TYPE OF USE: PROJECT NAME: STONECHASE DESCRIPTION: Residential baddlovit for irrigation. OWNER: GERRITZ f3I60I CUSTOM HOMES, PHONE #: 503-619-4668 CONTRACTOR: MARK BROWN LANDSCAPING PHONE #: 503-2343657 Inspection Request Scheduled For: Date: 10/4/2007 Pour Time: Code # Inspection Description Confirm # Contact # Message 399 Plumbing final 06970-01 503-320-2703 Y Corrections/Comments/Instructions: T, (----t--&-A C -e e 'e 6 gelp z/1 -- 4t--) ca rt- cgt PASS n PARTIAL APPROVAL 0 CANCEL NO ACCESS El FAIL n CALL FOR INSPECTION 0 ADDITIONAL FEES ASSESSED Inspector: CrO ( vr 1 / 4 A-; IA 6-1-- Date: 1 0/ ei ) - 7 Phone #: (503) 718-