Permit i y CITY OF TIGARD PLUMBING PERMIT
i DEVELOPMENT SERVICES PERMIT #: PLM2005 -00129
DATE ISSUED: 3/30/2005
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171
PARCEL: 1 S 135AA -07400
SITE ADDRESS: 10260 SW 90TH AVE ZONING: R -4.5
SUBDIVISION: PACIFIC CREST PARTNERS LOT: 002 JURISDICTION: TIG
Project Description: 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
BEACON HOMES NW, INC
12703 SW 67TH AVE Description Date Amount
TIGARD, OR 97223 [PLUMB] Permit Fee 3/30/2005 $36.25
[TAX] 8% State Surcha 3/30/2005 $2.90
Phone : 503 -570 -2282 Total $39.15
Contractor:
CONTOUR LANDSCAPING INC
12485 SW TOOZE RD
SHERWOOD, OR 97140 REQUIRED ITEMS AND REPORTS
Phone : 682 -1302
Reg #: LIC 5698
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 Permittee Signature:
M
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.
Building Fixtures
Plulnbin2 Permit Application FOR OFFICE USE ONLY
City of Ti and Received �_ ,
13125 SW Hall Blvd., Tigard, OR 97223 DateBy: �3 U u Permit No: \ O au 4. 9
Plan Review 1
Phone: 503.639.4171 Fax: 503.598.1960 //#iii /Nisi 1 W` �`r� Date/By: Other Pe t No.:
24- Hour Inspection Line: 503.639.4175 , Al I
p �_ Date Ready/By: Juris: j See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method: 1 1 . ' Su Information
.? } w r =sue r $, k r -_' q , ° y ,c �' 3 " 4 a € . ?. } x °s.. a
a fl ' FE SCHEATJI E`
U l Iew construc 1=1 Demolition For special information use checklist
Description I Qty. I Ea. I Total
❑ Addition/alteration/replacement ❑ Other: New 1 - 2- family dwellings (includes 100 ft. for each utility connection)
om �l � � ` t SFR (1) bath 249.20
.E11 - and 2- family dwelling El Commercial/industrial SFR (2) bath 350.00
El Accessory building El Multi-family SFR (3) bath 399.00
❑ Master builder Each additional bath/kitchen 45.00
❑ Other:
Fire sprinkler ( sq. ft.) Page 2
7 � a 1 0 g f$ 8 � 8 1 0 g
,, t = .. Site utilities
Job site address: (00 S c U C Catch basin or area drain 16.60
City/State/ZIP: 1(647 ) pa Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no,: I Project name: Footing drain (no. linear ft.: _) Page 2
Manufactured home utilities 1 10.00
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: I Lot no.: a- Water service (no. linear ft.: _) Page 2
Fixture or item
Tax map /parcel no.: Absorption valve 16.60
zt
1 . - �'" t k - t � � ® , �� . - r � . Backflow preventer Page 2
S ' J Cif -,-� Backwater valve 16.60
Z - l.f. �� +��iG - Clothes washer 16.60
Dishwasher 16.60
+� niMkin fountain 16.60 21
gym° '- Ejectors /sump 16.60
Name: Expansion tank 16.60
Address: Fixture /sewer cap 16.60
City/State /ZIP: Floor drain/floor sink/hub 16.60
Phone: ( ) Fax: ( ) Garbage disposal 16.60
r a r Hose bib 16.60
= Ice maker 16.60
Business name: (:',0- � Q U a. C, �_� Il 7)G Interceptor /grease trap 16.60
, c.- 1'1 Contact name: i� Caw j o� 1, Medical gas (value: $ ) Page 2
Address: 1 a G f5 S ) - 7, o - Primer 16.60
City/State/ZIP: S f ye, 0 2 / q '- / t Z/0 Roof drain (commercial) 16.60
Phone: ( j3) (J - l 3 p I Fax:: -73 ) 6�d - 1302.
Sink/basin/lavatory
16.60
Tub /shower /shower pan 16.60
E-mail: Urinal 16.60
-I d :. ' - . ,r Water closet 16.60
Business name: Water heater 16.60
Address: Other:
Subtotal
City/ State/ZIP: Minimum permit fee: $72.50
Phone: ( ) Fax: ( ) Residential backflow minimum permit fee: $36.25
CCB Lic.: 6 Plumbing Lic. no.: Plan review (25% of permit fee)
State surcharge (8% of permit fee)
Authorized signature:
TOTAL PERMIT FEE 39 r i 5-
Print name: Vu 6 ) Date:3/30 /05 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 Serv Board.
440- 4616T(10 /02/COM/WEB)
r.\ Building \Pernits\PI,tv�- PermitApp.doc 12/03
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
%'t tfr ,.F. Qt Tva1ti Squaa�Footae P ermit Fee:
Footing drain -1 100' 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
Permit' F ee:
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
t _ s additional $100.00 or fraction thereof, to and
a taf 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: $50,001.00 and up $742.00 for the first $50,000.00 and $1.20 for
each additional $100.00 or fraction thereof.
Fixture Work:
Are you capping, moving or replacing existing fixtures? If
"yes ", please indicate work performed by fixture. Failure to
accurately report fixtures could result in increased sewer fees * .
gym¢ ti s ,au ».., e''
�r; < #A:� i Comments regarding fixture work:
Baptistry /Font
Bath - Tub /Shower
- Jacuzzi/Whirlpool
Car Wash -Each Stall
-Drive Thru
Cuspidor/Water Aspirator
Dishwasher - Commercial
- Domestic
Drinking Fountain
Eye Wash
Floor Drain /sink - 2"
-3"
-4"
Car Wash Drain
Garbage - Domestic -
Disposal - Commercial *Note: If the fixture work under this permit results in an
- Industrial
Ice Mach. /Refrig. Drains increase of sewer EDUs, a sewer permit will be issued and
Oil Separator (Gas Station) fees assessed for the sewer increase must be paid before the
Rec. Vehicle Dump Station plumbing permit can be issued.
Shower -Gang
-Stall
Sink - Bar /Lavatory
Quantity Total
- Bradley
Commercial Isometric or riser diagram is required if fixture quantity
Service total is >9.
Swimming Pool Filter
Washer - Clothes
Water Extractor Plan Review
Water Closet - Toilet Plan review is required if fixture quantity total is >9.
Urinal
Other Fixtures:
is' Building 'Penmts'PLM•PemtitApp.doc 3/03
CITY OF TIGARL
BUILDING DIVISION PERMIT #: PLM2005 00129
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 3/30/200a
Phone: (503) 639 -4171 A, 14 gp
Inspection Requests (24 Hrs.): (503) 639 -4175 1
INSPECTION WORKSHEET FOR DATE: TIME: PAGE:
5/11/2005 7:12AM 8
SITE ADDRESS: 10260 SW 90TH AVE CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PACIFIC CREST PARTNERS 002
PROJECT NAME: PACIFIC CREST PARTNERS
DESCRIPTION:
Backflow device.
OWNER: PHONE #:
CONTRACTOR: BEACON HOMES NW, INC PHONE #: 503.570-2282
CONTOUR LANDSCAPING INC 682 -1302
Inspection Request Scheduled For: Date: 5/11/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
325 RP /backflow preventer 006613 -01 503. 407 -0580 N
Corrections /Comments/ Instructions:
F'/
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: 12 3V Date ,I Phone #: (503) 718-
/