Permit CITY TIGARD PLUMBING PERMIT
i � I DEVELOPMENT SERVICES PERMIT #: PLM2006 - 00441
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 9/22/2006
PARCEL: 2S 110AA -01500
SITE ADDRESS: 10823 SW CANTERBURY LN BLDG 1 ZONING: R -12
SUBDIVISION: CANTERBURY CREST CONDOS LOT: 010 JURISDICTION: TIG
Project Description: Bldgs. 1 & 4 Backflow preventer for irrigation.
CLASS OF WORK: OTR GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: MF WASHING MACH: BACKFLOW PREVNTRS: 1
OCCUPANCY GRP: R1 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
CANTERBURY PLACE, LLC
109 EAST 13TH STREET Description Date Amount
VANCOUVER, WA 98660 [PLUMB] Permit Fee 9/22/2006 $72.50
[TAX] 8% State Surcha 9/22/2006 $5.80
Phone : 360 - 695 -7700 Total $78.30
Contractor:
ANCTIL PLUMBING INC
16900 SW MERLO RD
BEAVERTON, OR 97008 REQUIRED ITEMS AND REPORTS
Contact # : PRI 503- 642 -7323
FAX 503- 642 -7755
Reg #: LIC 24184
PLM 26 -162PB
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. Y may obtain copies of
these rules or direct questions to OUNC by calling 503 - 246 -6699 or 1- 800 - 332 -2344.
Issued By: 4-c-Zei---e..) Permittee Signature;/; l
�—�
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.
Pl Permit Applica • cult t►rrit -: t s I►\I., ' . .
City of Tigard ��� /06 B6 Permit N, . w. / '19e
13125 SW Hall Blvd -, Tigard, OR 97223 . ' " Plan, Re w
Phone: 503.639.4171 Fax: 503.598.1960 - - - •' . . , . - , Datelfly. Other Permit No.:
24- Hour Inspection Line: 503.639.4175 i
_ • �f � Date Ready/By: ltw. ® See Page 2 for
Internet: www.tigard- or.gov Notified/Method - Supplemental Information
- 1:' . TYPE OF WORK •. .. ... ' , . . FEE* • SCHEDULE' . . "" ; ; ..
❑ New construction ❑ Demolition For special information use checklist.
- Description 1 Qty. 1 Ea. 1 Total
Addition /alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 R for each utility connection)
•, "' ,. 4 t CATEGORY OF CONSTRUCTION . • - SFR (I) bath 249.20
11 1- and 2 -family dwelling commercial /industrial _ SFR (2) bath 350.00
0 Accessory building Multi- family SFR (3) bath 399.00
Each additional bath/kitchen 45.00
❑ Master builder ❑ Other:
Fire sprinkle ( sq. ft.) Page 2
,... - JOB SITE INFORMATION AND LOCATION
Site utilities
Job site address: 1 O� .� - 1 Y 'a 1 S ti ��/ j j . j Catch basin or area drain 16.60
City/State/ZIP: L 5 ✓/ Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: I Project name: 0j1 /B Jyk,/ Cr�f F ooting drain (no. linear ft.: ) Page 2
��"' �` / Manufactured home utilities 110.00
Cross s Udirections to job site: L GO^/�° J Manholes 16.60
4,1 y 7 S Rain drain connector 16.60
Sanitary sewer (no. linear ft.: ) Page 2
Storm sewer (no. linear ft.: ) Page 2
Subdivision: I Lot no.: Water service (no. linear ft.: ) Page 2
Fixture or item
Tax map /parcel no.: -
- Absorption valve 16.60
•
DESCRIPTION OF ,WORK .".. - Backflowpreventer / Page2 /-7163 l t
1 / /L ; ( rt 9 4.6 ••,-) R4" (K14W Q� OE Backwater valve e ( 16.60 /
f ° M ✓ G e M M dr1 ci ✓N � f Clothes washer 16.60
�� Dishwasher 16.60
'(PROPERTY OWNER . I . ❑ TENANT Drinking fountain 16.60
I ^" Ejectors/sump 16.60
Name: O Cy 6 IJ /v • w• Coent / Expansion tank 16.60
Addre:;s: Fixture/sewer cap 16.60
City /State/ZIP: Floor drain/floor sink/hub 16.60
Phone: ( ) Fax: ( ) Garbage disposal 16.60
❑ APPLICANT " ' . ❑ CONTACT PERSON Hose bib 16.60
Ice maker 16.60
Business name:
Interceptor /grease trap 16.60
Contact name: Medical gas (value: S ) Page 2
Address: Primer 16.60
City /State/ZIP: Roof drain (commercial) 16.60
Phone:( ) I Fax::( )
Sink/basin/lavatory 16.60
Tub/shower/shower pan 16.60
E -mail: Urinal 16.60
CONTRACTOR Water closet 16.60
Business name: 4- p/ G 11* ( /Di ( /m /3 a4 , q/c Water heater 16.60
Address: / 9 00 SL) 4i E e to e-a Other:
City /State/ZIP: 1 1,-.-4 L'7 1J Or. 9 9150 (p Subtotal �--
/ Minimum permit fee: $72.50 � 4
Phone: (93) (6, `i 2- 3 Z 3 Fax: ( k /, ' f 2... 99.3 Residential backtlow minimum permit fee: S36.2 at. , `7 {J
CCB Lic.: 2 (4 1 $ (� Plumbing Lic. `� Plan review (25% of permit fee)'
/ State sur (8% of permit fee) ZO
Authorized signature: - -- --- -e _ - I / TOTAL PERMIT FEE 7 0 + 2)p
Print name: 73 ite. ielivc,ht Date: 9 I O 6, This permit application expires if a permit is not obtained within
180 days after it has been accepted as complete.
'Fee methodology set by Tri -County Building Industry Service Board.
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gs BETHANY STEWART
� n � .. t . �, '4 ENGINEERNG DEPARTMENT NOTE: ALL ADDRESSES ARE OFF OF CANTERBURY LANE
I 13125 S.W. HALL BLVD.
�' 4 l i 4- ' TIGARD, OREGON 97
� FA �so3� 6 12 4 -(176 ADDRESS R E V I S I O\ S 10/1/2006
CITY OF TIGARD IA 44 (
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BUILDING DIVISION PERMIT #:
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED:
Phone: (503) 639 -4171 ',Pt tit
■ Inspection Requests (24 Hrs.): (503) 639 -4175 ...' — `:_..
INSPECTION WORKSHEET FOR DATE: TIME: PAGE:
SITE ADDRESS: l,11zr, S CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME:
DESCRIPTION: 11 �� ( (f ' \ - `
(OWNER: .�T4 5 T � L ,/ � Loy \SQ-A I t:#1 4 PHONE #:
cCONTRACT0_52 T . S L , ( t PHONE #:
Inspection Request Scheduled For: Date: Pour Time:
Code # Inspection Description Confirm # Contact # Message
144 `r3& - Ci � °
Corrections /Comments /Instructions:
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❑ ❑ P RTIAL APPR V 4r L'
A _ _ I CANCEL O ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Date: Phone #: (503) 718-