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12440 SW NORTH DAKOTA ST
CITY OF TIGARD PLUMBING PERMIT
DEVELOPMENT SERVICES PERMIT#: PLM2005-00449
13125 SW Hall Blvd.,Tigard, OR 97223 503-639-4171 DATE ISSUED: 9/9/2005
PARCEL: 1 S134CB-06000
SITE ADDRESS: 12440 SW NORTH DAKOTA ST ZONING: R-7
SUBDIVISION: ANTON PARK LOT: 022 JURISDICTION: TIG
Project Description: Backflow preventer for irrigation.
CLASS OF WORK: OTR GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS: 1
JCCUPANCY GRP: R3 FLOOR DRAIAS; TRAPS:
STORIES: WATER HEATERS: CATCE BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN LRAINS:
SINKS: URINALS: GREASE TO,APS:
LAVATORIES: OTHER FIXTURES:
TUB/SHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Owaer:
FEES
BUCK SMITH _
12440 NORTH DAKOTA S f Description Date Amount
TIGARD, OR 97223 [PLUMB] Pennit Fee 9/9/2005 $36.25
[TAX]8%State Surcharl 9/9/2005 $2.90
Phone: 503-673-0142 Total $39.15
Contractor:
SIGNATURE LANDSCAPE
PO BOX 304 REQUIRED ITEMS AND REPORTS
TUALATIN,OR 97062
Phone: 503-673-0252
Reg#: PLM 6195LCB
a
m This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes
Wand all other applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is
J 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 503-246-0699 or 1-80,,0--3332-2 44.
Issued By: ,a, rl. _ Permittee Signature: kL kz —
Call 503-639-4175 by 7:00 a.m.for an Inspection that Vusiness 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.
IME
Plumbing Permit ARq&qjjSL
City of Tigard HtutiVED R"* -Qn�`� ! �N . y
1312.5 SW Hall Blvd.,Tigard.OR 97223 Phan Rrmw - ��
Phone: 503.6394171 Fax: 503.599.1 MEP 0 (, 2005 - OdwpongNo.:
24-Hour Inspection Line: 503.639.4175 vJC poW Re.,d,Myd gK Pqp 2 M,
Internet: www.ci.tigwd.or.us /Ma askWkwanosllFIB
afaraeaelns
ION 11CHMIli E
❑New crosbWion ❑Demolition F-~ r I
- Uascri Ea. Z Totr
[]
Addition/alteration/replacement 'V Other:&eIAO w- New 1-2rhmily dweRlep(includes 100 R.for each utility arrrectiort)
CATEGORY OF (:ONgI t1C`TM SFR(I)bath 249.20
and 2-family dwelling - ❑Commercial/industrial SFR(2)bath -- 350.00 -
❑Accessory building -- ❑Multi-family SFR(3)bath ---_ 399.00
Each additional bslhhitchen 45.00
❑Master builder ❑Other.
-._. Fire sprinkler(_sq.R.) Pace 2
JOB SITE INFORMATION AND LOCATION Site stpltles
Job site address: I2 q 0 N, Oq KA��St Catch basin or area drain 16.60
City/State/71F - T-6,t-o( 6Q. -97-7-Z3 _mak,leach line,or beach drain - 16.60
Suite/bldg./rpt.no.: Project name: Footing drain(no.liner ft.:_) - Page 2
Manufbetured home utilities 110.00
Cross street/directions to job sits 1 'W TML4 (1wrt
- Manholes 16.60
S�Odpjfiij 0" L,�t's. Eg+ ` Rain drain cnrrroctor - - - 16.60 -
T^ Sanitary sewer(no.linear R.: Page 2
-�- -- Shim sewer(no.linear R.:._� Page 2 �+
Subdivision: _�I.at no.: Water service(no.liner ftp_) -- Page 2 ---
Fltrtun or Item
T map/parcel no.:
_. -- Absorption valve 16.60
DF.S(IRIMON OF WORK _ Backflow preventer Page 2
5il r{e't'�`-`i 1 i.3f_ -__-� Bw kwou valve _ 16.60
Clothes Washer 16.60
�-
Dishwasher 16.60
PROPERTY OWNER ❑ TENANT Drinking fountain -- 16.60
e Ejec4xs/sum;i 16.60
NNW �e,r SN'1���j Expansion tank 16.60
Address: 2e�t fo N , e,2 SY ' _ Fhmxr)sewer cap --- 16.60
City/Statell.IP: j�,�p/ Q7 22 v Floor drain/floor sink/hub 16.60 -
Phone:(5o 3) 6 7 -Fax: - dispoa16.60
iciIlose bib 16.60 -
❑ i,PPLICANT ❑ CONTACT PER&NV -
-- - Ice maker 16.60
Business name:
leterkx!ptkx/grease trap 16.60
Contact name: Medical gas(value:S )� Page 2
LL Address: Primer 16.60 -
FIt.. City/Stete/7IP: - Roof drain(commercial) 16.60
N Phone: Fax::Fax::( ) - Sink/basiMavehrry 16.60
( ) Tub/shower/ahk wer pan 16.60 - -
E-lo�el: Urinal 16.60
m CONTRACTOR Water ckwd 16.60
dMlijeb11M tttere: $' a LO.'60ky er ('w e Water heater - 16.60
_J Adkltaaa: _ ,v�JQk►-.�� oder:
Chy/9t@WJ7.IP: permit Rx
7-i<q�i t7 �_-� Minh an Subtotal
'e : $72.50
l�rknR C 7� 2-5-Z- Fax:( ) Residential backflow minimum k Re: 536.23 Sa 29-
_ Plumbieg Lic.no.: -_ Pim rnwiew (25%of permit fist)
CCB L,�,: C/ --
Authorire d signature: Sttllr seecltarLT'AI. of permit Re)
To7PER,'1Qf1'FEE r
Print name: � � �1� [?ale: Z �,Is persalt a�Neatieu eq*a Ir a p miS b.M ebleim wN
ThWr DIM dqa Nkr ltbaa bee acmpkd m e�lete.
-Fee methodokrav sed by Tri-County Biondi ttr Industry L%rAce Burd.
CITY OF TIGARD 0 . •
BUILDING DIVISION PERMIT#: PLM200&00449
13125 SW Hall Blvd.,Tigard, OR 97223 DATE ISSUED: 9N2005
Phone: (503) 639-4171
Inspection Requests (24 His.): (503) 6j9-4175
INSPECTION WORKSHEET FOR DATE: 100/2006 TIME: 7:05AM PAGE: 76
SITE ADDRESS: '12440 SW NORTH DAKOTA ST CLASS OF WORK:
SUBDIVISION: ANTON PARK LOT M: 022 TYPE OF USE:
PROJECT NAME: SMITH
DESCRIPTION: B;**fh)w prwenter for irrigation-
OWNER: SMITH, BUCK PHONE 0: 5036730142
CONTRACTOR: SIGNATURE LANDSCAPE PHONE#: 5036730252
Inspection Request Scheduled For: Date: 10/7/2005 Pour Time:
Code # Inspection Description Confirm If Contact # Message
325 RP/baddlow preventer 01767301 6036730262 N
Corrections/Comments/Instructions:
D
'PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
[_] FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: [late: ail-I Phone 11: (603) 718-