Permit CITY TIGARD PLUMBING PERMIT
I� DEVELOPMENT SERVICES PERMIT #: P /23/20 -00509
_� I1 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 10/23/2006
PARCEL: 1S134DB-09500
SITE ADDRESS: 11247 SW FOREST LN ZONING: R -4.5
SUBDIVISION: STONECHASE LOT: 019 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 HILLSDALE
BEAVERTON, OR 97005 [PLUMB] Permit Fee 10/23/200€ $36.25
[TAX] 8% State Surcharl 10/23/200f $2.90
Phone : 503 - 619 - 4668 Total $39.15
503 - 526 - 2084
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- 011.0._through OAR 952 - 0001 -0100. You may obtain copies of these rules or direct questions to OUNC by
calling 5 - 246 - 669 800 - 332 -2344.
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Issued By. ,. Q_4k Permittee Signatures e _-
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.
;.
5 r Q004,- oollaq
Plumbing Permit Application : : . FOR OFFICE ISE ONO'
City of Tigard Received ,
Date/By: 1 • e9(.. a 4 .A-P-4 4107,66
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review Permit No.:
Phone: 503.639.4171 Fax: 503.598.1960 A
• iIlia Date/By: Other Permit No.:
t
24- Hour Inspection Line: 503.639.4175 N 1 Date Ready/By: 1 ir - gi See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method: Supplemental Information
i s
TYPE OF li/ORK•;;:,;:;A:gi5 : K4: ' g.ka:; ; :SW,ag#,.tgOfk0.t#:V:;‘; . .
Kew construction 0 Demolition For special information use checklist
E
Description Qtra71 Total
0 Addition/alteration/replacement 0 Other: New 1- 2-family dwellings (includes 100 ft. for each utility connection)
CATEGORY. OF CONSTRUCTION:444, SFR (1) bath 249.20
Eli( and 2-family dwelling 0 Commercial/industrial SFR (2) bath 350.00
SFR (3) bath 399.00
0 Accessory building 0 Multi-family
Each additional bath/kitchen 45.00
0 Master builder 0 Other:
,. . . . Fire sprinkler ( sq. ft.) Page 2
JOB SITE INFORMATION AND LOCATION.,a,'.::: .''.. Site utilities
Job site address: 1 ,2 ( roY ro Lo Catch basin or area drain 16.60
C ity/State/ZIP : e f(&( (1( g7).), L( Drywell, leach line, or trench drain 16.60
Suite/bldg./apt. no.: 1 Project name: -wo ( A„,,, Footing drain (no. linear ft.: ) Page 2
Manufactured home utilities 110.00
Cross street/directions to job site: Al D 64_, 9_/,2/
Manholes 16.60
Rain drain connector 16.60
Sanitary sewer (no. linear ft.: ) Page 2
Storm sewer (no. linear ft.: ) Page 2
Water service (no. linear ft.: ) Page 2
Subdivision: ,..)--0,,e_e_vAase-, 1 Lot no.:
Fixture or item
Tax map/parcel no.:
. . . ... _ „. . Absorption valve 16.60
- , • " ' WORK Backflow preventer / Page 2 3
, -';:y-...i::.:;;;. , :::;;',i4 ,- ,..:.o.,i 1, ' , i:;:::'.;;
/ DESCRIPTION OF
. ' . .- r
4- OD z.2.41 61 ge 1-)zepoyie Backwater valve , 16.60
Clothes washer 16.60
Dishwasher 16.60
.. .. .., Drinking fountain 16.60
0 PROPERTY OWNER • I . - ' :,.0. TENANT.....;..„. ''-,.....
' / • / L ' ' ' • '" • I ii ," - Ejectors/sump 16.60
Name: (' 6 7 - a ll_ <.,61 I ei_451-0M 110 file.:5 " L.C.A.'-- Expansion tank 16.60
Address: 56-- , c __Lv ei .". 0( . 7 /4/Ai, goy Floor drain/floor sink/hub 16.60 Fixture/sewer cap 16.60
•
C ity/State/ZIP: , e 0 \ 10 n 07 970Q5
Phone: 0 19 _ 4 &b
Fax:, ,..)
(c0366,2- ,U91 Garbage disposal 16.60
PER ,,....,....,4, Hose bib 16.60
0 APPLICANT,-..:,,,,.... .... .. ' ,Elt(0 .:i.41:...
' ii " " Ice maker 16.60
Business name: C. el0 .-7 c/ c in ■Ai a / /,
,..,--10,, e ii,„,......, , ,c., Interceptor/grease p 16.60
tra
Contact name: 6, A n (. -4. Medical gas (value: $ ) • Page 2
Address: 455 ,)) reryo gey
Primer Roof drain (commercial) 16.60
Sink/basin/lavatory
Tub/shower/shower pan 16.60
16.60
16.60
City/State/Z1P _ i V f) (94, (/75 phone:60/3 6 iq _.• / ( I Fax: : (
E-mail:
Urinal 16.60
: .cONTRAROiR . . Water closet 16.60
Business name: friOE._ 6 Rat)/ Lan456len r Water heater 16.60
Address: . p,o. 8 7 t 7 LI Other:
Subtotal
City/State/ZIP: , ve h 0 -0, (A) ii- g Ri4, ‘,707qq---- Minimum permit fee: $72.50 ,„?‘-„,
Phone:• 503 -- 64„7 Fax: 3 ‘,0.-993_5" 3 _ Residential backflow minimum permit fee: $36.25
CCB Lic.: h--7 - 7q' Plumbing Lic. no.: , Plan review (25% of permit fee)
.. . .
- . State surcharge (8% of permit fee) ,- '7 0 _
,...-) .
Authorized signature: ' / ,. .zer TOTAL PERMIT FEE 0 9-', / 5
Print name: iiia) 13120-1,Or Date:10-,20-067 This permit application expires if a permit is not obtained within
180 days after it has been accepted as complete.
*Fee methodoloev set by Tri-County Buildine Industry Service Board.
CITY OF TIGARD , -' .. fl..H 200 lve 0 06'41
BUILDING DIVISION PERMIT #:
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: /Q / > - /Q/,
Phone: (503) 639-4171 n11100 1, v�
Inspection Requests (24 Hrs.): (503) 639 -4175 ' "L
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INSPECTION WORKSHEET FOR DATE: 7/ /A . TIME: PAGE:
SITE ADDRESS: 1 1 7# q, Sr L.0 9 CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME:
DESCRIPTION:
OWNER: PHONE #:
CONTRACTOR: PHONE #:360 94,3..1 €q 3
Inspection Request Scheduled For: Date: Pour Time:
Code # Inspection Description Confirm # Contact # Message
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Corrections /Comments /Instructions:
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❑ PASS ❑ PARTIAL APPROVAL ❑ CANCEL n NO ACCESS
1jj AIL n CALL FOR INSPECTION 1 1 ADDITIONAL FEES ASSESSED
Inspector: WA Date:1 /il 6 Phone #: (503) 718-
CITY OF TIGARD # ?,O0 (. 6060
BUILDING DIVISION a PERMIT #:
13125 SW Hall Blvd., Tigard, OR 97223 ✓ DATE ISSUED:
Phone: (503) 639- 417111414144140
Inspection Requests (24 Hrs.): (503) 639-4175
INSPECTION WORKSHEET FOR DATE: ' /'{ / TIME: PAGE:
SITE ADDRESS: 1 ? ..c ' 4 5 k • CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME:
DESCRIPTION: (, ^
OWNER: �L $4 PHONE #: log 4. . b )
CONTRACTOR: 'nA 4 S elAM,/ PHONE #: • et/ 3 raq 3
Inspection Request Scheduled For: Date: Pour Time:
Code # Inspection Description Confirm # Contact # Message
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Corrections /Comments/ Instructions:
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c 119
-ASS n PARTIAL APPROVAL n CANCEL ❑ NO ACCESS
❑ FAIL I I CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
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Inspector: Z`V(L Da te: 7/�/0 r #: (503) 718 - (