Permit C ITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT PERMIT #: PLM2007 -00432
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 9/21/2007
-.\(' PARCEL: 2 S 112C B -09200
SITE ADDRESS: 15196 SW KENTON DR ZONING: R -7
SUBDIVISION: ASHFORD OAKS NO. 2 LOT: 106 JURISDICTION: TIG ,
PROJECT: WORNATH
P roject 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
HARRY WORNATH
PO BOX 1015 Description Date Amount
MCMINNVILLE, OR 97128 [PLUMB] Permit Fee 9/21/2007 $36.25
[TAX] 8% State Surcha 9/21/2007 $2.90
Phone : 503- 472 -1657 Total $39.15
Contractor:
MONAGHAN'S LANDSCAPE
7925 SW CANYON LANE
PORTLAND, OR 97225 REQUIRED ITEMS AND REPORTS
Contact # : PRI 503 -499 -1173
F X Sv3•25I2-- O 310
Reg #: PLM 7419
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.
5 hA _L4. Issued By: 6. Permittee Signature: U '' v ' C.Cj—&,...
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.
E
RECE i V ra 1
Plumbing Permit Application
city Td Re ceived
}� o Tigard SAP " 0 2007 q�,/ Penis, Nn.: Melee) -eV .7.-- •J Ili 1];s1r/Ry'
• 13125 SW Ilan Blvd„ Tigard, OR] 1223 Plan Review
n Phone: 5(13,639.4171 Fax: 50,3,1941V0 Ut I jtJ j. atcBy: Other Permit NJ..
Inspection Line: 503.639.41, , x Date Rcndy y: luri : ® fiee Page 2 for
1 1 ` v "t � Internet: www,tigardi�r.gy Jfl DJ R tbal; Supplemental'
-
ficd�Mc
TYPE OF WORK a FEE* SCHEDULE:
El Ncw constructiun El Demolition h'or.specia, information use checklist.
Description rOty. 1 F.a. I Total
0 Addition /alteration /replacement ❑ Other: _ New I- 2- family dwellinga (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (1) bath y - 249.20
❑ I- and 2- family dwelling ❑ Commercial /industrial SFR(2) bath 350.00
❑ Accessory building 0 Multi - family SFR (3) bath 399.00
• Each additional bath/kitchen 45,00
❑ Master builder ❑ Other: W
Fire sprinkler ( sq, ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities
Job site address: r c l(G> k e Y1 .47 Dr Catch basin or area drain 16.60
City/State/ZIP: Drywch, leach Tine, or trench drain 16.60 ,. Suite /bldg" /apt, no.; P roject name:
Footing drain (no. linear ft.: ,_) Page 2
Manufactured home utilities 110.00
Cross street /directions to job site. j ms s I ' A ( Manholes 16•60
Rain drain connector 16.60
• -_ —
Sanitary sewer (no. linear ft.: _) Page 2
...,—. Storm sewer (no. linear R.: ) Page 2
- Water service (no. linear ft.: ) Page 2
Subdivision: 1 Lot no.; • -•-
Fixture or Item
Tax map /parcel no.:
- Absorption valve 16.60
DESCRiPTION OF WORK Backilow prcventer / Page 2 ^�
"
- t < c • S .. RaCkwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
❑ PROPERTY OWNER f ❑ TENANT Drinking fountain 16.60
I Ejectors /sump 16.60
Name; . : ) Expansion tank 16.60
Address: r !< f � fixture /sewer cap 1 6.60
City /State %1..IP"yy4 C ., 7 It pZ
eFK -._. Floor drain/fluor sink/hub 16.60
Phone: ( ) 411 .- " 1(0 Fax: ( ) Garbage disposal 16,60
❑ APPLICANT 0 CONTACT PERSON Hose bib 16.60
- ice maker 16.60
Business name Interceptor /grease trap 16.60
'Contact name: Medical gas (value: $ ) Page 2
Address; Primer _ 16,60
City /5tatc /7,IP: Roof drain (commercial) 16.60
Phone: ( ) Fak:: ( ) Sink/basin/lavatory 16.60
Tub /shower /shower pan 16.6o
I? -mail:
Urinal 16.60
CONTRACTOR Water closet 16.60
Business name: • Water heater 16.60
Address: 7C./ c� V C�Y1�Nl ■�-C3 Yom. Other:
City /State /L IP: (+ ,a �t Subtotal
(�7 �(�R Y'1 C�Y� l )T C '� 7, •XS Minimum permit tee: $72,50
Phone: (SL■ 3 ) (( r-/r, _ I 1 , j Fax: (SC .: r.1;) . & (./U _ _ Residential backflow minimum Permit f_er: $36.25 _
- - — - CC:R -laa: f Plumping Lie. nn:: Plan nevi
cw (25 °�of permit_ feel_ _
// r State surcharge (8% of permit fee)
Authorized signatuic:
(.3_ 1 �,�Y p
Y 1 (l C�� �R'�'� TOTAL PERMIT FEE
Print name: „Sc.), „Sc.), v. A c Y r lC') r (•�,c YI Date:C, - 2L�j This permit application expires if a permit is not obtainer) within
r 1 180 days after it has been accepted as complete.
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CITY OF TIGARD
BUILDING DIVISION PERMIT #: PLM2007-00432
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 91210007
Phone: (503) 639-4171 Ayodovitii
Inspection Requests (24 Hrs.): (503) 639-4175 '
INSPECTION WORKSHEET FOR DATE: 10/2/2007 TIME: 7 PAGE: 56
SITE ADDRESS: 15196 SW KENTON DR CLASS OF WORK:
SUBDIVISION: ASHFORD OAKS NO. 2 LOT #: 106 TYPE OF USE:
PROJECT NAME: WORNATH
DESCRIPTION: Backflow preventer for irrigation.
OWNER: WORNATI HARRY PHONE #: 503472-1657
CONTRACTOR: MONAGHAN'S LANDSCAPE PHONE #: 503
Inspection Request Scheduled For: Date: 10/212007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
399 Plumbing final 056755-01 503-929-3910
Corrections/Comments/Instructions:
D.e t'c T e e_ Re_
CX c't•
•
•
PASS
I I PARTIAL APPROVAL El CANCEL EI NO ACCESS
I I FAIL [7 CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED
Inspector: CI .1 1 t Date: 4 "' - i ° Phone #: (503) 718-