Loading...
Permit a CITY OF TIGARD PLUMBING PERMIT COMMUNITY DEVELOPMENT PERMIT #: PLM2009 -00033 TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 2/19/2009 PARCEL: 2S112CC SITE ADDRESS: 15663 SW 81ST AVE ZONING: R -12 SUBDIVISION: GAGE FOREST LOT: 026 JURISDICTION: TIG PROJECT: GAGE FOREST Project Description: Backflow for lawn sprinklers. CLASS OF WORK: NEW 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 CEDAR MILL TOWNHOMES II, LLC 12670 SW 68TH AVE SUITE 400 Description Date Amount TIGARD, OR 97223 [PLUMB] Permit Fee 2/19/2009 $36.25 [TAX] 12% State Surch 2/19/2009 $4.35 Phone : 503- 639 -3104 Total $40.60 Contractor: FOREST LANDSCAPE, INC 40437 NW VERBOORT RD FOREST GROVE, OR 97116 REQUIRED ITEMS AND REPORTS Contact # : PRI 503- 357 -3808 FAX 503- 359 -1908 Reg #: PLM 8253 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: c ' J,1, < 4 Permittee Signatu e: 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. Plumbing Permit Application RECEIVE , Building Fixtures FOR OFFICE USE ONLY City of Tigard FEB 19 2009 R eceiPlateBve Permit • 13125 SW Hall Blvd., Tigard, OR 97223 y: �. 4' . Q� �I ` �•t / �4' , 0 003 3 II Plan Review C Phone: 503.639.4171 Fax: 503.598 1960 TIGAR Date/By: Other Permit No.: Inspection Line: 503.639.4175 CITY a te Read /B mt;5: ® See Pa e 2 for T t G R D Internet: www.tigard - or.gov BUILDING DIVISIC I y yd g otifie 4 Supplemental Information TYPE OF WORK FEE* SCHEDULE • New construction ❑ Demolition For special information use checklist Description I Qty. I 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 249.20 141- 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: 75-'4 „_ 5:;.:03,),; Z-7 Catch basin or area drain 16.60 City /State /ZIP: l�c j _ Drywell, leach line, or trench drain 16.60 �._:�.�y� y � s Footing drain (no. linear ft.: ) Page 2 Suite/bldg. /apt. no.: I Project name: ` / 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: /� y ,.� 7 L I Lot no.: Water service (no. linear ft.: ) Page 2 f J Fixture or item Tax map /parcel no.: Absorption valve 16.60 DESCRIPTION OF WORK Backflow preventer l Page 2 3 (O.25 Backwater valve 16.60 Clothes washer 16.60 Dishwasher 16.60 ❑ PROPERTY OWNER I ❑ TENANT Drinking fountain 16.60 Ejectors /sump 16.60 Name: ,,�_--,77,` l2 ;, `Z Expansion tank 16.60 Address: IAG7 ✓ vim _ Fixture /sewer cap 16.60 City/State /ZIP: � Floor drain/floor sink/hub 16.60 Phone: (5 ) 4. -•'j.' Fax: (e .- Garbage disposal 16.60 ❑ APPLICANT ❑ CONTACT PERSON Hose bib 16.60 Ice maker 16.60 Business name: Interceptor /grease trap 16.60 Contact name: Yid o e> Le ..._- Medical gas (value: $ ) Page 2 Address: Primer 16.60 City/State/ZIP: Roof drain (commercial) 16.60 Sink/basin/lavatory 16.60 Phone: (d7 c ..- . .3 > Fax: : ( ) Tub /shower /shower pan 16.60 E -mail: Urinal 16.60 CONTRACTOR Water closet 16.60 Business name:/,..,.. ,4� Sri Water heater 16.60 Address: ,#.-„,,,,,4- 7t ) 4 _ Other: Subtotal City/ State/ZIP: ��� ` d Minimum permit fee: $72.50 3(0 25 Phone: (105TH _,Fe r... ..„7y--J Fax: ( ) Residential backflow minimum permit fee: $36.25 CCB Lic.: Plumbing Lic. no.: 2r Plan review (25% of permit fee) _ State surcharge (12% of permit fee) 4 ) Authorized signature: 1 / TOTAL PERMIT FEE Op .1 Prin • :, . - .- . � 6 /. Date: 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. 1:\ Building \PermitsWLMF- PermitApp.doc 12/27/06 440- 4616T(I0 /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 Square Footage: Permit Fee: Footing drain - I' 100' 55.00 0 to 2,000 $115.00 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 Fixture or Item Qty. Fee (ea) Total additional $100.00 or fraction thereof, to and including $10,000.00. Commercial Back Flow Prevention Device 46.40 $10,001.00 to $25,000.00 $148.50 for the first $10,000.00 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 specially requested inspections - per hour 72.50 and including $50,000.00. Subtotal: $50 and up $742.00 for the first $50,000.00 and $1.20 for each additional $100.00 or fraction thereof. Commercial Fixture Work: Plan Review for Plumbing Installations Are you capping, adding or replacing fixtures? If "yes", Plan review is required for any of the following. please indicate work performed by fixture. Failure to Please check all that apply. accurately report fixtures could result in increased sewer fees *. ❑ Any new commercial building with water service 2" and Quantity by (Fixture) Work Performed greater, except systems designed and stamped by licensed Fixture Type: Replace engineer. Previous Capped Added Existing ❑ New exterior plumbing site utilities for any complex structure Baptistry/Font as defined in OAR918- 780 -0040. Bath - Tub /Shower ❑ Medical gas and vacuum systems for health care facilities. - Jacuzzi/Whirlpool ❑ Any multipurpose fire sprinkler system. Car Wash -Each Stall ❑ Any complex structure as defined in OAR918- 780 -0040. -Drive Thru Cuspidor/Water Aspirator Submit 2 sets of plans with any of the above. Dishwasher - Commercial - Domestic Drinking Fountain Isometric or Riser Diagram Eye Wash ❑ Isometric or riser diagram is required for new buildings Floor Drain/sink - 2" that meet the qualifications above. -3" 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 - Bradley *Note: If the fixture work under this permit results in an - 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: i:�Building \Permits\PLM- PermitApp.doc 12/27/06 . 13 114267 A -- ..... _ , OM b3�r 'ONEW . PNWS-AWWA 1 13 EXISTING ,. BACKFLOW ASSEMBLY TESTREPORT ❑ REMOVED PROPERTY / �1 CI REPLACEMENT . OWNER: 7 o ii A / ,i/'1 e go i77 e PHONE: NA J r /f 1�J ( p °,- - - MAILING A DDRFSS: / �7 b /5 3 5 W 3 / S r 4 v e CITY 7/ Q g r4 STATE OR ZIP 97 3 ASSEMBLY G / ADDRESS: ✓ 2 YYI P STREET ❑ R.P.B.A. Q. D.C.V:A. ❑ R.P.D.A. ❑ D.C.D.A. ❑P.V.B.A. ❑ S.V.B.A. ❑-A.V.B. ❑AIR GAP SIZE: I 1/1.1/X4 MAKE: 1Cg iv.. ,/) MODEL: � . p 5O PURVEYOR: / / 4,8r•5 J NUM (-/ R: R l 3 0 a LOCATION: 1.-- 4 T a' / &I ` / Yl Try /'YI 5/ a.47 _' i-e • REDUCED PRESSURE ASSEMBLY P.V.B.A / S.V.B.A INITIAL TEST • aI CHECK � DOUBLE CHECK ? AIR CHECK PASSED CI • PRESS DROP ( A), CHECK ul INLET FAILED ❑C INITIAL RELIEF VALVE TIGHT ❑ /1 s OPENED AT: PRESS DROP TEST OPENED AT ( B )� DATE: RESULTS BUFFER MIN 2 PSID ,LEAKED Q, PSID rjj ze /O 9 A - B = I CHECK #2 PSID PSID MIN 7 PSI RELIEF VALVE (TIGHT D, J, DID NOT FAILED SYSTEM PASS ❑ FAIL ❑ ,I LEAKED ❑ PsD OPEN El ❑ ` PSI #/ c h ec,& 1/811/e . j J t c , /n o /d )111'vl C N 1 Ps /D. D1 yr/ n - /.'� 1 rer>"®'i�/ Tc f /o yr AND/OR ' j ' � p .ar I , i /5,6!.11 /Ted./ s o Flu 5l1 -e.d � 1�e as ' ,Se d.. r ef s, T 70 , REDUCED PRESSURE ASSEMBLY • P.V.B.A. /S.V.B.A. AFTER REPAIRS N I CHECK (A) ( D .CV A DATE: • TEST PRESS DROP CHECK #1 2,1/ -RELIEF ( ; OPENED AT PRESS DROP -� ^ AFTER OPENED (B) TIGHT © PSID .� /l�J�O / REPAIRS BUFFER '�'°� ( CHECK H2 / . Z . . � A - B - MINIM (TIGHT Q, PSID PSID PSID PASSED 7"� IN'COMPLETING AND SUBMITI1NG HIS TEST REPORT, THE TESTER CERTIFIES THAT THE ASSEMBLY HAS BEEN TESTED AND MAINTAINED IN ACCORDANCE WITH ALL APPLICABLE • RULES AND REGULATIONS OF THE WATER SYSTEM, AND STATE REGULATIONS. • GAUGE CALIBRATION DATE 3,/7 01 METER READING 4 r7 I •, NATUR E . o e..-4 e ? t). R p � / ./i�rA RJ, i.- :.. 3/� l -IIll5 her.) * 4X 9712 3/ 3- ,- r= - 3 7s/ TE TS ? DRESS / .1 C-Z 45 3E p l Zdar COMPANY NAME 'I:J SERVICE RESTORED REPORT RECEIVED BY: (REPRESENTATIVE OF OWNER) / i WHITE - Water System Copy . PINK - Customer Copy YELLOW - Tata Copy CITY ��������������� ��nu n OF nm����nm�� BUILDING DIVISION PERMIT pERM|T#: M.M2009'O0033 13125 SW Hall Blvd.,-Tigard, OR 97223 DATE ISSUED: 2113/2008 Phone: (503) 639-4171 Inspection Requests (24 Hrs.): (503) 639-4175 INSPECTION WORKSHEET FOR DATE: 2y23/2009 TIME: 7:OOXm PAGE: 20 SITE ADDRESS: 16663 SW 81ST AVE CLASS OF WORK: SUBDIVISION: GAGE FOREST LOT #: 025 TYPE OF USE: PROJECT NAME: GAGFFDREST DESCRIPTION: BVc:kDmw for lawn sprinklers. OWNER: CEDAR MILL TOWNHOMES l, LLC, PHONE #: 503-630-3104 CONTRACTOR: FOREST LANDSCAPE, INC PHONE #: 603'367-3808 Inspection Request Scheduled For: Date: 2123/2809 Pour Time: Code # Inspection Description Confirm # Contact # Message 399 Plumbing final 080727.01 603-639-4530 N Corrections/Comments/Instructions: ^ Q,C .0 PARTIAL APPROVAL El CANCEL ri NO ACCESS | 1 FAIL 0 CALL FOR INSPECTION 11 ADDITIONAL FEES ASSESSED �" /--��/ '���' �/�'�i/ Inspector: 7 Oa�a� c-~( �~ ~'/ �� / Phone #: (503) 718- `''� ~/�z