Permit III s s� ., PLUMBING PERMIT
�a
COMMUNITY DEVELOPMENT PERMIT #: PLM2007 -00345
TI 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 8/6/2007
PARCEL: 1S134DB-07800
SITE ADDRESS: 11198 SW FOREST LN ZONING: R - 4.5
SUBDIVISION: STONECHASE LOT: 002 JURISDICTION: TIG
PROJECT: STONECHASE
Project Description: Install residential backflow device,
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
FOUR D CONSTRUCTION
PO BOX 1577 Description Date Amount
BEAVERTON, OR 97075 [PLUMB] Permit Fee 8/6/2007 $36.25
[TAX] 8% State Surcha 8/6/2007 $2.90
Phone : 503 -590 -0805 Total $39.15
Contractor:
CROWN LANDSCAPE INC
STEPHEN HARMS
22821 BOONES FERRY RD REQUIRED ITEMS AND REPORTS
AURORA, OR 97002
Contact # : PRI 503- 678 -7900
Reg #: LIC 6181
PLM 14939
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 -01Q0. 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 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.
,Pinan:bing Permit. Application
w a �'FOR O F 6,6v iJSE . o , 4. c a7 _ ``'
7 10i C ity of Tigard Received y� Permit No.: /J , w ���/[�
� ., Date /By: ��1 iv r I" �-+ / <w/ ^Q� 3495
n 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
''. 'i, . ; Phone: 503.639.4171 Fax: 503.598.1960 Date /B : Other Permit No.: M cT2 7 Z , O � 0
f?n Inspection Line: 503.639.4175 y J' �`'
Z T1 G A ^RD: �lur � ®See Page 2 for
to er .4660 Internet: www.ti Date Ready /By:
gard or.gov Notified/Method: / / V Supplemental Information
TYPE OF WORK - ' FEE* SCHEDULE .
❑ New construction ❑ Demolition For special information use checklist
Description I Qty. 1 Ea. I Total
❑ Addition/alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (1) 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: /// 98' 5 e -, -- 1 Catch basin or area drain 16.60
City /State /ZIP: '7ifp/!'t® p 2, Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: Project name: 5 7a* e sZ Ze• 2 Footing drain (no. linear ft.: ) Page 2
Manufactured home utilities 110.00
Cross street/directions to job site:
Manholes 16.60
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.:
Absorption valve 16.60
DESCRIPTION. OF WORK Backflow preventer / Page 2 34, ZS'
/ SiC Pewc /7,04_ y.frrW j sys Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
%PROPERTY OWNER I 0 TENANT . Drinking fountain 16.60
Ejectors/sump 16.60
Name: i . 7) e sr Expansion tank 16.60.
Address: 1� p • /577 Fixture /sewer cap 16.60
City /State /ZIP: / Floor rain/floor sink/hub 16.60
Phone: (5-493 ) 720 - 0 0 /z 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: $ ) Page 2
Address: Primer 16.60
City /State /ZIP: Roof drain (commercial) 16.60
Sink/basin/lavatory 16.60
Phone: ( ) Fax: : ( ) Tub /shower /shower pan 16.60
E -mail: Urinal 16.60
CONTRACTOR Water closet 16.60
Business name: eteeui J / vAa5 Water heater 16.60
Address: 2 2- 8 Soaves 040 Other:
Subtotal
City /State /ZIP: Q, ®1t 970,
/4,v/ea/EA Minimum permit fee: $72.50
Phone: ( )G 7Y' - 7900 Fax: ( ) Residential backflow minimum permit fee: $36.25
CC Lic.: 6,/ / Plumbing Lic. no.: Plan review (25% of permit fee)
State surcharge (8% of permit fee) 2 .70
Authors. d signature: TOTAL PERMIT FEE !S
Print n ice✓ A . .._ Date: • ` > -7 This permit application expires if a permit is not obtaine within
- -Now ` 180 days after it has been accepted as complete.
*Fee methodology set by Tri- County Building Industry Service Board.
1:\ Building \Permits \PLM- PermitApp.doc 12/27/06 440- 4616T(10/02/COM/WEB)
. ,
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site: Utilities . Qty.. Fee (ea) ,Total q Foota e:
q g . Permit Fee:
Footing drain - 1 100' 55.00 0 to 2,000 $I 15.00
Footing drain - each additional 100' 46.40 2,001 to 3,600 $160.00
3,601 to 7,200 $220.00
Sewer - 1st 100' 55.00 7,201 and greater $309.00
Sewer - each additional 100' 46.40
Water Service - 1st 100' 55.00 Medical Gas Systems:
Water Service - each additional 100' 46.40 •
Valuation: Permit Fee:
Storm &Rain Drain - 1st 100' 55.00 $1.00 to $5,000.00 Minimum fee $72.50
Storm & Rain Drain - each additional 100' 46.40 $5,001.00 to $10,000.00 $72.50 for the first $5,000.00 and $1.52 for each
Qty.: . 'Fee (ea) . Total additional $100.00 or fraction thereof, to and
Fixture' Or Item including $10,000.00.
Commercial Back Flow Prevention Device 46.40 $10,001.00 to $25,000.00 $148.50 for the first 510,000.00 and $1.54 for
Residential Backflow Prevention Device . each additional $100.00. or fraction thereof, to
(minimum permit fee $36.25) 27.55 and including $25,000.00.
Rain Drain, single family dwelling 65.25 $25,001.00 to $50,000.00' $379.50 for the'first $25,000.00 and $1.45 for
•
Inspection of existing plumbing or each additional $100.00 or fraction thereof, to
and including $50,000.00.
specially requested inspections - per hour 72.50
Subtotal: $50,001.00 and up $742.00 for the first 550,000.00 and $1.20 for
each additional $100.00 or fraction thereof.
Fixture Work:
Are you capping, adding or replacing fixtures? If "yes", Plan Review 'for PlumbmgInstallations •
please indicate work performed by fixture. Failure to Plan review is required for any of the following.
accurately report fixtures could result in increased sewer fees * . .. Please check all that apply. -
'Quantitr by(Fixture) Work Performed ❑ Any new commercial building with water service 2" and
Fixture Type;_ Replace greater, except systems designed and stamped by licensed
Previous Capped. Added . Existing engineer.
Baptistry/Font
Bath - Tub /Shower ❑ New exterior plumbing site utilities for any complex structure
-Tub/Shower as defined in OAR918- 780 -0040. •
Car Wash Each Stall ❑ Medical gas and vacuum systems for healthcare facilities.
Drive Thru ❑ Any multipurpose fire sprinkler system:
Cuspidor/Water Aspirator ❑ Any complex structure as defined in 0.AR918- 780 -0040.
Dishwasher -Commercial Submit 2 sets of plans with any of the above:
- Domestic P Y
Drinking Fountain
Eye Wash Isometric or Riser Diagram
Floor Drain/sink - 2" ❑ Isometric or riser diagram is required for new buildings
that meet the qualifications above.
-4"
Car Wash Drain
Garbage - Domestic Comments regarding fixture work:
Disposal - Commercial
- Industrial
Ice Mach. /Refrig. Drains
Oil Separator (Gas Station)
Rec. Vehicle Dump Station
Shower. -Gang ' •
-Stall
•
Sink - Bar/Lavatory *Note: If the fixture work under this permit results in an
- Bradley er p
- Commercial increase of sewer EDUs, a sewer permit'will be issued and
- Service fees assessed for the sewer increase Must be'paid before the
Swimming Pool Filter plumbing permit can be issued.
Washer - Clothes
Water Extractor
Water Closet - Toilet •
Urinal •
Other Fixtures:
is\ Building \Permits\PLM- PermitApp.doc 12/27/06
08/06/2007 14:03 FAX 5036787901 Z003/004
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COMMUNITY DEVELORNIEN'Y
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IMPORTANT PERMIT NOTICE
c ROWN LANDSCAPE !NC
ST EPHE k HARMS
22821 ROONES FERRY RD
AURORA, OR 27302
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..z'rrtitil i4: PLA.12007-00345
DE-i.te 55Ued ,
Pa 10e r I S134D B-07800
site Acidre:::=3: 11198 SW FOREST L.N
Subdivisibb SIONECHASE
Lot: 002
jurloictioni Ri--4,5
IsiC3
Project Jiiria: STONECHASE
Description: tist;,:i0 residentiai bacicfickiv , ',1•:n. , '1.r.: , :',.,
You company nas Lieen inclionten i7:.F.i.i tn.:, pii.ii•ip Giii iii-iii i.i: i. p:srinit retereneed above. I- order for ii..ne
plumbing 301 n ' ;,- - va ,i c i i pi,-in.; ii. t ar ;.:, in t.; .. ii,,, i i2ii. / our company sign beilayv and re[um this
ph,rnbng s ic i ina t i.i ii e Fo pr,or to tj-v, _S :. r.;' .'n v0!., ::'!:',.,,,!..,- .!.,., ' - orin lo. City of 1 Building Division,
ir:il.il 25 SV`I Ha! Bkic„ 7 igariiil (i)il?, 97223 or :,:-,_ m. Hi,- ,-, :-•' :-:. :7,0:?.. 024.3681.
if you nave . cuestions pi 1:.': a e cal;
No plumbing inspections w!ll of.) authorized unt;I 'i=i.:i,; .ix.epis:,,:i form , received
UM B N C.; CONTRA\ CTr's
FOUR D CONSTRUCTiON , : - .),Ro ,, ,N1 , 4 LANDSCAPE INC
RO BOX 1577 CTEPHEN HARMS
BEAVERTON 0F? 97075 22821 BOONES FERRY RD
i.. OR 97002
Pr 4 503-590-0805 'iTorio #: 503-678-7900
Lit 61;i1
AN 'NIK SIGNATURE IS "'Zi.:E i''<ED ON THIS FORM
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CITY OF TIGARD
BUILDING DIVISION PERMIT #: p)7.)345
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: E?1v�10i�7
Phone: (503) 639 -4171 . °-' Aliin
Inspection Requests (24 Hrs.): (503) 639 -4175 _��
INSPECTION WORKSHEET FOR DATE: 10/1W2007 TIME: 7:0.1AM PAGE: ri=
SITE ADDRESS: 11198 SW FOREST LN CLASS OF WORK:
SUBDIVISION: STONEC1 - E LOT #: (3O TYPE OF USE:
PROJECT NAME: STONECHASF
DESCRIPTION: I riciail residential basidlow device,
OWNER: FOUR D CONSTRUCTION, PHONE #: 503 - 690 -0806
CONTRACTOR: CROWN LANDSCAPE INC. PHONE #: 503 - 6/0 - 7900
Inspection Request Scheduled For: Date: 10/18/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
399 Plumbing final 057837 -01 503 -720 -0012 N
Corrections /Comments /Instructions:
Of2V,Ge, :es - reek Ste, Te RR e c -T
ca,.e c‘%,r ,
X PASS n PARTIAL APPROVAL n CANCEL n NO ACCESS
1 1 FAIL n CALL FOR INSPECTION ADDITIONAL FEES ASSESSED
Inspector: :TO h r7 W; 1 I; A.N., Date: j'01 I T (c ) Phone #: (503) 718-