Permit C ITY OF TIGARD PLUMBING PERMIT
PERMIT #: PLM2006 -00166
DEVELOPMENT SERVICES DATE ISSUED: 4/27/2006
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 PARCEL: 2S111 DA - 11800
SITE ADDRESS: 08901 SW PIPPEN LN ZONING: R -7
SUBDIVISION: APPLEWOOD PARK NO. 3 LOT: 111 JURISDICTION: TIG
Project Description: Install backflow device for landscape irrigation
CLASS OF WORK: U GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS: 1
OCCUPANCY GRP: 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
JEFF CAVENAUGH
8901 SW PIPPEN LN Description Date Amount
TIGARD, OR 97224 [PLUMB] Permit Fee' 4/27/2006 $36.25
[TAX] 8% State Surcha 4/27/2006 $2.90
Phone : 503- 693 -3563 Total $39.15
Contractor:
THOMAS E. DARNELL IRRIGATION
PO BOX 1022
WILSONVILLE, OR 97070 REQUIRED ITEMS AND REPORTS
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Contact # : PRI 503- 799 -4582
FAX 503- 390 -2742 •
Reg #: LIC 7185LCB
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 Signatur 1> . ir I
CaII 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.
• Plumbing Permit Application
. City of Tigard Received permit No - //
13125 SW Hall Blvd., Tigard, OR 97223 DateBy: ��/�� �l rP
Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 r Date/By: Other Permit No.:
24- Hour Inspection Line: 503.639.4175 �.•1 � � Date Ready/By: t °m El See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method: Supplemental Information
TYPE OF WORK FEE* SCHEDULE
❑ New construction ❑ Demolition For special information use checklist
Description I Qty. I Ea. I Total
K Addition/alteration /replacement ❑ Other: New 1 - 2 - family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (I) bath 249.20
❑ 1- 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:
Fire sprinkler ( sq. ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities
Job site address: O [ l / j 5 u) 'PIP P5 a/ Lk). Catch basin or area drain 16.60
City/State /ZIP: O r f -1 1 C) �,� 9 1 Z 2 1( Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: y Project name: I Footing drain (no. linear ft.: ) Page 2
Manufactured home utilities 110.00
Cross street/directions to job site: 1 it° Manholes 16.60
° �-"GS't cr ti S /'Y\ f0 ) -- 1 rret- G e-- O P Rain drain connector 16.60
' 1 o i-L s'i`de_ O i" -p4 n e ,, L Sanitary sewer (no. linear ft.: ) Page 2
r Storm sewer (no. linear ft.: ) Page 2
Subdivision: APp je t„JoocL L. )Vd .3 I Lot no.: i / / Water service (no. linear ft.: ) Page 2
Fixture or item
Tax map /parcel no.: C.20 Absorption valve 16.60
J DESCRIPTION OF WORK J Backflow preventer _i Page 2 . 9 �
SYl .S'Cet tt, b ./F --e- en G k. -Pll0 G / !� � Yom. -�BrY Backwater valve 16.60 4t
ah d - c c t I ✓'tr) ) 1 a, T 110 Clothes washer 16.60
YY ✓✓ Dishwasher 16.60
lyk PROPERTY OWNER I ❑ TENANT Drinking fountain 16.60
f� ` Ejectors /sump 16.60
Name: 6 I c A V / ��e-h tA- v Expansion tank 16.60
/9 0 Address: / 1 _ eR Fixture /sewer cap 16.60
City /State /ZIP: p Floor drain/floor sink/hub 16.60
Phone: (spa) 6 $ - a s - Fax: ( ) 3
Garbage disposal 16.60
XAPPLICANT ❑ CONTACT PERSON Hose bib 16.60
Ice maker 16.60
Business name: 'TA 6 yl , tA.S" C • - bra - n e.ii _l,rr /`c �b1'� Interceptor /grease trap 16.60
Contact name: � jt - 6 YvLet "Da cn 1p.k C ✓ Medical gas (value: $ ) Page 2
Address: p, 6 , 0 x 10 2-- Z Primer 16.60
City/State/ZIP: tJ) S'6 V 1 it ` 0 9170 70 Roof drain (commercial) 16.60
Phone: (i'o 3) 7 7 9 _ Li 5g • I Fax: : ( ) Sink/basin/lavatory 16.60
�f do ` )4e,..4- Tub /shower /shower pan 16.60
E -mail: -7 /'LOY1 t ti� ✓ e 4' 1 RJ CQyy GLt
I Urinal 16.60
CONTRACTOR Water closet 16.60
Business name: -" 24A4< �' 1i1 a (I Water heater 16.60
Address: -pO, -g OX 102, 2...., � Other:
City/State /ZIP: L c ) , 1 ` n - l � j� &e , .97 0'7 0'70 Subtotal
` Minimum permit fee: $72.50
Phone: (,SO ) 711 _ L/ p Fax: ( ) Residential backflow minimum permit fee: $36.25 3(. LS
CCB Lic.: Lc R LE 7 ! � n - Pl um b in: Lis'. no.: Plan review (25% of permit fee)
1 ,
Authorized signat - State surcharge (8% of permit fee) •9O
to, APP„ PERMIT FEE J '. IC
Print name: PADS E , yn t Date: " .„,2 7 0 4 This permit application expires if a permit is not obtained within
180 days after it has been accepted as complete.
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CITY OF TIGARD
BUILDING DIVISION PERMIT #: PLM7.00 01)1G6
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 4/27/201X
Phone: (503) 639 -4171 4'441
Inspection Requests (24 Hrs.): (503) 639 -4175 I -
INSPECTION WORKSHEET FOR DATE: 5/16/2006 TIME: 7.02AM PAGE: 134
SITE ADDRESS: 011901 SW PIPPEN LN CLASS OF WORK:
SUBDIVISION: APR EWOOD PARK NO. 3 LOT #: '1'I'I TYPE OF USE:
PROJECT NAME: CAVENAUGH
DESCRIPTION: Install backflow device for landscape irrigation
OWNER: CAVENAUGH, JEFF PHONE #: 503 - 693.3563
CONTRACTOR: DARNELL IRRIGATION, THOMAS PHONE #: 503
Inspection Request Scheduled For: Date: 5/16/2006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
3!.:15 Misc. inspection 029899 -01 503.799 -4502 Y
Corrections /Comments /Instructions: - 3q'-
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Ill, -ASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
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Inspector: rvi( �� Date: Phone #: (503) 718- —?)
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