Permit ,I
Ill I, CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT PERMIT #: PLM2006 -00576
DATE ISSUED: 12/1/2006
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 PARCEL: 2S114BA - 00300
SITE ADDRESS: 09875 SW SERENA WAY ZONING: R -4.5
SUBDIVISION: PICKS LANDING NO.2 LOT: 136 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
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
BONNIE B. WILSON Description Date Amount
9875 SW SERENA WAY
TIGARD, OR 97224 [PLUMB] Permit Fee 12/1/2006 $36.25
[TAX] 8% State Surcha 12/1/2006 $2.90
Phone: 503- 684 -6087 Total $39.15
Contractor:
OWNER
REQUIRED ITEMS AND REPORTS
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Contact # : ' 1
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Reg #: ,..
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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.
-"" r 7 Permittee Signature: _ q;
Issued By: om'" -- - , A v
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.
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_ _ �� CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT PERMIT #: PLM2006 - 00576
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 12/1/2006
PARCEL: 2S114BA -00300
SITE ADDRESS: 09875 SW SERENA WAY ZONING: R -4.5
SUBDIVISION: PICKS LANDING NO.2 LOT: 136 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
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
BONNIE B. WILSON
9875 SW SERENA WAY Description Date Amount
TIGARD, OR 97224 [PLUMB] Permit Fee 12/1/2006 $36.25
[TAX] 8% State Surcha 12/1/2006 $2.90
Phone : 503- 684 -6087 Total $39.15
Contractor:
OWNER
REQUIRED ITEMS AND REPORTS
Contact # :
Reg #:
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: ' ..---- rd j' c „... e .... - L. 7 Permittee Signature: S jz _e_. Pt.
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.
CITY OF TIGARD QLM7d0O 6Oe5'7(p
BUILDING DIVISION PERMIT #:
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED:
Phone: (503) 639 -4171 : /
Inspection Requests (24 Hrs.): (503) 639 -4175 & W
INSPECTION WORKSHEET FOR DATE: TIME: PAGE:
SITE ADDRESS: q ; s2,,, 4 a, V\( CLASS OF WORK:
SUBDIVISION: LO #: TYPE OF USE:
PROJECT NAME:
DESCRIPTION:
• NER: .1" ` PHONE #:
CONT' ' •R: PHONE #:
Inspection Request Scheduled For: Date: Pour Time:
Code # Inspection Description Confirm # Contact # Message
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Corrections/Comments/Instruction
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PASS n PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
FAIL n CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED 1
Inspector: Date: Phone #: (503) 718-
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$A, - A,. 2008 RESIDENTIAL BACKFLOW ASSEMBLY TESTER LIST
t' f ,0� x Updated February 5, 2008
Dear Water Customer:
Foryour convenience, a list of certified backflow assembly testers working within Tigard Water Service Area is provided below. This list is not inclusive.
Testers are private individuals or companies. Testing costs vag, so getting quotes from several companies is recommended
COMPANY ADDRESS PHONE NUMBER
A & A DRILLING PO BOX 585, CLACKAMAS (503)284 -3701
ACCURATE BACKFLOW 2715 HARVEST COURT, FOREST GROVE (503)357 -1444
AFP SYSTEMS 19435 SW 129TH, TUALATIN (503)692 -9284
ALL SEASONS BACKFLOW PO BOX 1811, BEAVERTON (503)644 -4913
ALOHA BACKFLOW TESTING 5074 NW STABLE CT, HILLSBORO (503)693 -1720
AMERICAN BACKFLOW SERVICES 5905 N INTERSTATE AVE, PORTLAND (503)289 -1745
AQUA -TECH BACKFLOW SERVICES 14655 NE RUSSELL CT, PORTLAND (503)251 -1683
BACKFLOW PREVENT. DEVICE TEST PO BOX 751, TUALATIN (503)692 -2885
BACKFLOW SERVICES PLUS 17675 SW FARMINGTON RD # 118, BEAVERTON (503)629 -8200
BASIC FIRE PROTECTION, INC 8135 NE MLK JR. BLVD, PORTLAND (503)285 -1855
BEAVERTON PLUMBING, INC 13980 SW TV HWY, BEAVERTON (503)643 -7619
BWE BACKFLOW TESTING 16923 KING RICHARD CT, SHERWOOD (503)625 -4083
CANBY PLUMBING INC. 805 NE 4TH AVE, CANBY (503)266 -2091
CLEARWATER BACKFLOW 717 E BURNSIDE, PORTLAND (503)703 -7821
COLUMBIA CROSS CONNECTION PO BOX 9217, PORTLAND (503)235 -6141
COOKMAN BACKFLOW 17895 NW TILLAMOOK, PORTLAND (503)645 -0296
DENNIS SEVEN DEES LANDSCAPING 7355 SE JOHNSON CREEK BLVD, PORTLAND (503)777-7777
DON MARTIN PROPERTY MAINT. 2255 SE 73RD, HILLSBORO (971)570 -7630
DRAKE'S 7 DEES, INC. 16519 SW STARK, PORTLAND (503)256 -2224
FARR. BETTER BACKFLOW TESTING PO BOX 389, BORING (503)475 -9080
FIRE EXTINGUISHER SERVICE CTR 3460 SW 209TH AVE, BEAVERTON (503)356 -9445
FITZERALD LANDSCAPING 10835 SW TIGARD ST, TIGARD (503)620 -4761
GARDENVIEW LANDSCAPE IRRIG. 1095 NE CORNELL RD, HILLSBORO (503)693 -6823
GREEN DAY LANDSCAPE, LLC PO BOX 2613, CLACKAMAS
(503)658 -2685
HEATH BACKFLOW TESTING PO BOX 1565, SHERWOOD (503)625 -8553
JACK HOWK PLUMBING PO BOX 20698, PORTLAND (503)235 -8784
JANE GANSER & CO. 8960 SW DOLPH ST, PORTLAND (503)247 -9562
KENNEDY PLUMBING, INC 13985 SW FARMINGTON RD, BEAVERTON (503)643 -5535
LANDSCAPE EAST & WEST 8850 SE 76TH DR, PORTLAND
(503)256 -5302
LANDSCAPE ENTERPRISE PO BOX 436, WILSONVILLE (503)682 -3343
LANDSCAPE SERVICES CO PO BOX 1623, CLACKAMAS (503)656 -6890
METRO SAFETY & FIRE INC 14324 SE STARK, PORTLAND (503)231 -2999
MP PLUMBING PO BOX 393, CLACKAMAS (503)655 -9161
NW BACKFLOW INSPECTION & TEST PO BOX 1536, HILLSBORO (503)695 -3286
OREGON BACKFLOW TESTING 212 SE 3RD ST, TROUTDALE (503)491 -9402
OREGON IRRIGATION 15916 S AMES ST, OREGON CITY (503)656 -9826
PM BACKFLOW PO BOX 981, WILSONVILLE (503)830 -0171
PROGRASS, INC 29895 SW KINSMAN RD, WILSONVILLE (800)776 -4727
ROTO ROOTER 25599 SW 95TH AVE STE B, WILSONVILLE (503)682 -9774
Approved Residential Backflow Tester Luting Updated:
Page 1 of 2 2/5/2008 3:01 pm
COMPANY ADDRESS PHONE NUMBER
SUNRISE LANDSCAPE PO BOX 665, BORING (503)658 -1828
T &R BUILDING SERVICES 6880 ROGUE LN, WILSONVILLE (503)318 -6313
TIMBER VALLEY PLUMBING PO BOX 34, CANBY (503)266 -4300
TOM HEMPEL TESTING 82696 WILSONVILLE RD # 184, WILSONVILLE (503)579 -0923
WATER METRICS 16120 SW 72ND AVE, TIGARD (503)603 -9988
WESTERN STATES FIRE PROTECTION 13896 FIR ST, SUITE B, OREGON CITY (503)657 -5155
WOMACK WATER WORKS, INC PO BOX 608, BEAVERTON (503)643 -0466
A current public list of DHS- Certified Backflow Testers is available at:
http: / /oregon.gov/ DHS /ph /crossconnection /publiclist.shtml
•
Approved Residential Backflow Tester Ltstmg Updated -
Page 2 of 2 2/5/2008 3:01 pm
INSPECTOR'S SIGNATURES ARE NOT
Inspections Required for: PLM2006 -00576 REQUIRED ON GREEN INSPECTION CARD.
✓ Code Inspection Description PASS Date By ✓ Code Inspection Description PASS Date By
BUP - Building Permit ELC - Electrical Permit
405 Excavation 105 Underground/slab cover
410 Fill 110 Temporary electrical service
415 Grading 115 Electrical service
205 Footing 120 Electrical rough -in
805 MFG - Structure grading /footing 125 Wall cover
210 Foundation walls 130 Ceiling cover
215 Footing drain 135 Low voltage
220 Slab 140 Sign installation
310 Crawl drain 145 A/C or heating unit circuit
225 Post/beam structural 150 Hot tub /spa /pool
230 Underfloor insulation 195 Misc. inspection:
235 Shear walls /anchors 199 Electrical final
240 Exterior sheathing
245 Firewall
250 Roof nailing ELR - Restricted Energy Permit
255 Wtr proofing basement walls 135 Low voltage
260 Tilt -up panel 195 Misc. inspection:
265 Masonry 199 Electrical final
270 Reinforcing steel (rebar)
275 Framing
810 MFG - Structure set-up MEC - Mechanical Permit
280 Insulation 605 Post/beam mechanical
285 Drywall nailing 610 Gas line
287 Suspended ceiling 615 Mechanical rough -in
295 Misc. inspection: 620 Hydronic piping
899 MFG - Structure final 625 Duct work
498 Grading final 630 Fire damper
299 Final inspection 635 Smoke detector shutdown
640 Exhaust hood
695 Misc. inspection:
699 Mechanical final
BUP - Fire Protection System Permit
905 Sprinkler underfloor /slab PLM - Plumbing Permit
910 Sprinkler rough -in 305 Plumbing underslab
915 Fire alarm rough -in 310 Crawl drain
920 Suppression trip test 315 Post/beam plumbing
995 Misc. inspection: 320 Plumbing rough -in
998 Alarm final 322 Shower pan
•
999 Sprinkler final 330 Water service
335 Rain drain
340 Storm drain
SIT - Site Work Permit 505 Sanitary sewer
405 Excavation 345 Culvert/catch basin
410 Fill 350 Septic tank
415 Grading 395 Misc. inspection:
205 Footing X 399 Plumbing final
210 Foundation walls
215 Footing drain
420 Sprinkler supply lines _ SWR - Sewer Permit
495 Misc. inspection: 505 Sanitary sewer
498 Grading final 595 Misc. inspection:
499 Final inspection 599 Final inspection
I: \Building \Inspection Cards \Forms\AOP - InspCard - Blank.doc 12/09/2005
11/30/2006 15:50 5036846087 B B WILSON & ASSOC PAGE 01/03
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- 1 Phone: 503.639.4171 Fax: 503.598.10 Permit No.
►� CITY OF TIGARD Date/By:
i' 1 6 ak . n t(' i .. ) fns Inspection Line 503.639.4175 p Ready/By: y. Other Per curie: !d See Page 2 for
Y a Internet; www.tigard-or.gov • i 1 ION Supplemental of
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❑ New construction ❑ Demolition For special information use checklist
- Description 1 Qty. r E. I Total
® Addition/alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 R for each utility connection)
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'a!/,ii rA tfiRi , y ''1 �Afi,"!, /, ?. .; :216/:: 'giO.[�'r;.&lif i''V.::, ;., 1,'2:4'r ,Ne, r, {Nr,,,,.,.✓.n, r,.,rr.S
_® 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
tx 7” %tF Pr 2 , w t r a aax, \ �'o r u, o „ 'a;ai � ,� i lea � ;,,,r Fire sprinkler (,_ sq. ft.) Page 2
s , **P!ti'r 4A $w �' Y, ".'IPT.'A.'..1 C13,' 0 a r �� ;' , ;,,^" T ;:i , , 1. ;746 456'z r r7 /rill e.%>, i2 e;fti ,0i
Site utilities
Job site address: 9875 SW Serena Way Catch basin or area drain 16.60
City /State /ZIP: Tigard, OR 97224 Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: Project name: Sprinkler system Footing drain (no. linear ft.: _ _ ) Page 2
Manufactured home utilities 110.00
Cross street/directions to job site: Durham & Serena Ct
Manholes 16.60
Rain drain connector 16.60 —
Sanitary sewer (no- linear ft.: ) Page 2
Storm sewer (no. linear ft.: 1 Page 2
. water service (no. linear ft.: ) Page 2
Subdivision: Pick's Landing No. 2 Lot no.: 136
Fixture or item
Tax map /parcel no.: sorption ..
s n t»:7), ri r K /T∎P(" n rr y r,( rt ,r m- n N: rory 8� i '" ; "'r F ?4 ( T % F;F, .,' rq
ry ,r } x `r h � M r�°�> S( :; : :.4�} d < y s�•SI' , / : a x P v $ ns, ,.
+° �W (Me 7 .tF e, ��,, + A yk(, �,' x ?n Jrt -, 1,»'+'� +,xKa^,r r 1KU,. }2,w,t,. �t,',u'�� 2 ,�� ,,r. , $� 1 . 1 Page 2 36.25
�t'�31 *��'�.^,9�r.%�iSn9n,_:.55s4n., ,. :'�k { , ,wr ( ,. , 1 r, I a+,:, ,a 9,r�rx+�.C
Installation of Backflow Prevention Device in landscape sprinkler system. Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
.4Yp r a ;'' twrr bs h( '�k ''I ,. d" r Y,t''C r/ ✓ �„' r' . ',T r( .,w a� a r rv,' P &'7 zg s N : G sK A rc Dnuktrtg 09untain 16.60
N. vi ,ar4 Y�zS,q� . s. 00. r7s :t'rlH,�'l!044, ; ✓ti c ? g K I rf .1, / ;, J ,1x / ,dIx.,tkgoN..,"
Ejectors /sump 16.60 -
Name: Wilson Revocable Trust, Bonnie B Wilson, Trustee Expansion tank 16.60
Address: 9875 SW Serena Way Fixture /sewer cep 16.60
City /State /ZIP: Tigard, OR 97224 Floor drain /floor sink/hub 16.60
Phone: (503)684 -6087 _ Pax: (503)684 -6087 Garbage disposal 16.60
rJxfr `, .^d y '+h•kr t,V ,�( rS §t$? , Ha S lt 1 M,fi'r �'rinJ Mc'•Cn!i F SW K g 3:: . 1rrr. r, rr c T Hose bib 16.60
,� �°cM "� +, Y., t, a��s �� j �4�i t ��3Hc,S,t 7 �A), .f�,fi1J,� Itj v't �✓, �, '� ���, , )rrd�t r {
. sr n 11. r7 a ,.r ilg, /, a; %�ri ,� „ f?ej ., rrr r, h r. ,., , l ,r C? 11, , Ss, ?• ice maker 16.60
Business name: Interceptor /grease trap 16.60
Contact name: Bonnie B. Wilson Medical gas (value: $ ) Page 2
Address: 9875 SW Serena Way Primer 16.60
City /State /ZIP: Tigard, OR 97224 Roof drain (commercial) 16.60
Phone: (S03) 684 -6087 I Fax:: (S03) 684 -6087 Sink/basin/lavatory 16.60
Tub /shower /shower pan 16.60
E -mail: bbwassoc @comcast.net ' Urinal 16.60
''�m n,�ra � 'IS, 4:5,e rr O ,. ,,r,o,S i1 r" rr�m �t'!VAN''t ' ' . /�",, "7 �{ L (�
��� !da � q ty�l `+ t' Y M 4�' ,R� �r�r S� / r d 7,14 „),2 r {i � M 1 /�� Water • closet 1.6 60
wnd w, }eia$4,; '� :14 ftt.FAN.1Y,,,NS'',A 111' } ;Sr r /,,k, ,,?+ ,:Nliomiswif.Iterr ,,.,:d P704, r r,..e,Nr�: l ;o ,thr �, -
Business name: none Water heater -^ „ 16.60
Other:
Address:
Subtotal 36.25
City /State /ZIP: Minimum permit fee: $72.50
Phone: ( ) Fax: ( ) Residential backflow minimum permit fee: $36.25 36,25
• CCB l ic.: Plumbing Lie. no.:
review (25% of permit fee)
State surcharge (8% of permit fee) 2.90
Authorized signature: TOTAL PERMIT FEE 39.15
Print name: Bonnie B. Wilson Date: 11/30/06 I This permit application expires if a permit is not obtained wiitbin
180 days after it has been accepted as complete.
*Fee methodology set by Tri County Building Industry Service Board.
1. \Building\ Permits\ PLM- Pcr 06/26/06 d40- 46167(10 /0Z/COMfWPB)
CITY OF TIGARD L g12tnn".'5
BUILDING DIVISION PERMIT #:
13125 SW Hall Blvd., Tigard, OR 97223 D ATE ISSUED:
Phone: (503) 639-4171 e rym�ii��ll � .
Inspection Requests (24 Hrs.): (503) 639 -4175 �JJ�" _.L
INSPECTION WORKSHEET FOR DATE: TIME: PAGE:
SITE ADDRESS: Lots F.GJ. 1 SS •€ CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME:
DESCRIPTION:
•WNER M4 5`rp}�/4 L 1? W/ 0 L PHONE #:
CONTRACTO °: PHONE #:
Inspection Request Scheduled For: Date: Pour Time:
Code # Inspection Description Confirm # Contact # Message
1 ;q 4 1 5c-dez--- 6u0 )4 Le. 4 _,', ‘4L .A.
Corrections /Comments/ Instructions:
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I I PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
Ill FAIL I I CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED
Inspector: V Date: Phone #: (503) 718-