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Permit ` p CITY OF TIGARD PLUMBING PERMIT ,- . COMMUNITY DEVELOPMENT PERMIT #: PLM2007 - 00411 TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 9/6/2007 PARCEL: 25111 CB -01749 SITE ADDRESS: 10104 SW LADY MARION DR ZONING: R -3.5 SUBDIVISION: HOOD VIEW LOT: 2 JURISDICTION: TIG PROJECT: BROWN . 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 RICHARD BROWN D 12670 SW 68TH. AVE #300 • Description Date Amount TIGARD, OR 97223 [PLUMB] Permit Fee 9/6/2007 $36.25 [TAX] 8% State Surcha 9/6/2007 $2.90 Phone : Total $39.15 • Contractor: PACIFIC LANDSCAPE PO BOX 1155 HILLSBORO, OR 97123 REQUIRED ITEMS AND REPORTS Contact # : PRI 503- 648 -3900 Reg #: PLM 7318 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: 6,,,L,,,,,_ • Permittee Signature: Gi.tPaO�C�c_. 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. 7 r \ , 3 . Plumbing Permit Applicat' F OR OFFICE USE ONLY City Tigard R eceive 4/01 ^� Ci of Ti an d y P ermit No. r Date/B IN y: 13125 SW Hall Blvd., Tigard, OR 97223 r- .., Plan Review Phone: 503.639.4171 Fax: 503.598.194( UV L r Date /By: Other Permit No.: Inspection Line: 503.639.4175 Date Read /B t See Page 2 for TIGARD Internet: www.tigard- or.gov CITY OF TIGARD Notified /Method: Supplemental Information ;�� a,f.� "rr� 3� E�+tyar�we I n ° .. � .. �t t i � �. #' " �a .�"- - � � ' " a "a� a yam r �,,. „. �. .'i ` " TYPE OF 1 D I r � i ,- ' .. FE *' SC HEDULE ) , r K 44N!� , 4,, " 11 tS iii 3: 'r M ∎-N., 4<<.:;a � , . ,, , , "A11111� e h V ; it kii; " � ,: ,i vx. Ill "�t ; k .- t,, :.� ,e �.. ,,10,1= Nn' ' ,-mx, i r ,, �, . � . ,,A.0 k o" ,� ` New con struction ❑ Demolition For special information use checklist Description I Qty. I Ea. I Total ❑ Addition/alteration/replacement ❑ Other: New 1 - 2 - family dwellings (includes 100 ft. for each utility connection) , o r CATEGORY OFa CONSTRUCTION r " "3" r,',{ SFR (1) bath 249.20 X l- and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 350.00 ❑ Accessory building ❑ Multi - family SFR (3) bath 399.00 Each additional bath/kitchen 45.00 ❑ Master builder ❑ Other: " ,, n ��INF � t Fire sprinkler ( sq. ft.) Page 2 ,' . l al pB SITE'O a rr NF AND LOC 0 4,r 1' t ) ��, Site utilities Job site address: ) ()1e y § J ✓1 hl ifitia d lg f tle Catch basin or area drain 16.60 City/State /ZIP: 6046 , O2 g722' D leach line, or trench drain . 16.60 Suite/bldg. /apt. no.: Project name: Footing drain (no. linear ft.: ) Page 2 Manufactured home utilities 110.00 Cross street/directions to job site: Manholes 16.60 IJ itiE tit 5r t 14.) Loy O. Rain drain connector • 16.60 Sanitary sewer (no. linear ft.: _ ) Page 2 Storm sewer (no. linear ft.: _ ) Page 2 Subdivision: Lot no.: Water service (no. linear ft.: _ ) Page 2 Fixture or item Tax map /parcel no a Absorption valve 16.60 4 - / 2RIPTIO OF: ` = , 41 ° . , . -r : __ - � 114 t errirwodo,w s �_ item ) --. Backflow preventer 1 Page 2 rrz� .l-+.+.(t 4(1Jr fl oAJ 0X BI 4.J 0.649.4p Backwater valve 16.60 Clothes washer 16.60 Dishwasher 16.60 ' PROI'1rRCYO eAli) t 'r " 81 ®:fig A it , , Drinking fountain 16.60 Ejectors/sump 16.60 Name Expansion tank 16.60 Address: L Z.�Cp .S� b c � Fixture/sewer cap 16.60 City /State /ZIP: L ®{L. --VA.-., Floor drain/floor sink/hub 16.60 Phone: (3 EA/4,6 Fax ( ) Garbage disposal 16.60 dts o i ApCANTi , ` ',l' 0 _ CONTAGTPERS N �� I Hose bib 16.60 • : 6a. . .... rn.0 a 6trcrta_ k iE4 ma,.,, ,.. -.� Ice maker 16.60 Business name: PAcIfie_ /� ? 17 '^^�1 ``�� c, %r k4 s y(tti Interceptor /grease trap 16.60 Contact name: > � Y )(, # Medical gas (value: $ ) Page 2 Address: 2- kV oc® Da. Primer 16.60 City/State /ZIP: AGO p� q7 Z,q Roof drain (commercial) 16.60 Phone: (.,,p 0 f�- J fa Fax: : (! 4 yL -. Z 36,L Sink/basin/lavatory 16.60 C► Tub /shower /shower pan 16.60 E -mail: ��, Urinal 16.60 . � : � t,- ,�, nONTRAGTOR 1? ,,,J1 1, 1 i A Water closet 16.60 Business name: s�„�//? /�� 1p Water heater 16.60 Address: / �� 'PCB h Other: City/State/ZIP: �, Subtotal Minimum permit fee: $72.50 Phone: ( ) I ` Fax: ( ) Residential backflow minimum permit fee: $36.25 No ZS i CCB Lic.: 731? P bing Lic. no.: ' �Z� Z _ Plan review (25% of permit fee) Authorized signature: Q J 4� State surcharge (8% of "pamiit / /� TOTAL PERMIT FEE 6 /5 Print name: Kit.LGY C, la+ Date: ? /y.7 This permit application expires if a permit is not obtained within I 180 days after it has been accepted as complete. *Fee methodology set by Tri- County Building Industry Service Board. I:\Building \Permits \PLM- PermitApp.doc 06/26/06 440- 4616T(10/02 /COM/WEB) r CITY OF TIGARD BUILDING DIVISION PERMIT #: PL M 2 0 ©7 -- LI 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: q 1 6, / 2,c.)07 Phone: (503) 639-4171 „ 0/4Huy 11 4 Inspection Requests (24 Hrs.): (503) 639 -4175 INSPECTION WORKSHEET FOR DATE: G I IZ- )07 TIME: PAGE: SITE ADDRESS: I 0 i 0 L< SW L- 4 D Y M k 101-) D " CLASS OF WORK: SUBDIVISION: LOT #: TYPE OF USE: PROJECT NAME: DESCRIPTION: OWNER: PHONE #: 6 95 &2 8� CONTRACTOR: g c,\., ■ fa w LA PHONE #: Inspection Request Scheduled For: Date: Pour Time: Code # Inspection Description Confirm # Contact # ' Message Corrections /Comments/ Instructions: 74„ PASS E PARTIAL APPROVAL .D_CANCEL _ NO ACCESS FAIL fI CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED Inspector: \-/ �'�� Date: C' 2)7117-7 Phone #: (503) 718-