Permit rp! CITY OF ..T GARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT PERMIT #: PLM2008 -00428
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 11/12/2008
PARCEL: 2S 102C D -05700
SITE ADDRESS: 13940 SW 95TH AVE ZONING: R -4.5
SUBDIVISION: FLETCHER WOODS LOT: 007 JURISDICTION: TIG
PROJECT: FLETCHER WOODS
Project Description: Backflow 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
C & L PROPERTIES LLC
9279 SW 75TH Description Date Amount
PORTLAND, OR 97223 [PLUMB] Permit Fee 11/12/200E $36.25
[TAX] 12% State Surch 11/12/200f $4.35
Phone : 503- 245 -4944 Total $40.60
Contractor:
PLUMBING SYSTEMS, INC
PO BOX 2056
CLACKAMAS, OR 97015 REQUIRED ITEMS AND REPORTS
Contact # : PRI 503- 658 -2836
FAX 503- 658 -2836
Reg #: LIC 97810
PLM 3 -252PB
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 -000 • SO. You may obtain copies of
these rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
•
Issued By: d , dr - Permittee Signature: ,AJ / ' ,111
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.
Plumbing,Permit Application
Building Fixtures FOR OFFICE USE ONLY `
City of Tigard Received �� o.: /�
-
q 13125 SW Hall Blvd., Tigard, ORD��fl 3 6 ' Plan Review
. DateDate/By: ////01 t�� Pe N / - - Z(J�J�'
'Vtr� � �' '
Phone: 503.639.4171 Fax: 503.598.1960 Other Permit No.:
DateBy: 7;201) OQQ 9/
Inspection Line: 503 CIT OF T9UARb Da te Read /B Ju ris. ® See Page 2 for
TIGARD Ready /By: g
Internet: www.tigard - or. v Notified/Method: 7/6 Supplemental Information
j D.6.VISI ®N
TYP " (3F'• _ . - . . .: . , . .- .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)
:,CATE GORY; O .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
' . SITE - INFORMA . AND LOCATION ..
' .�. ""
JOB ' . ,.. - �,,_ . S ut
Job site address: 1'39 40 C W . CI Catch basin or area drain 16.60
City /State /ZIP: .1 (, ijO ()A.._. c'72,2...4.. 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 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: 'S (.rATGIG 1705 I 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 L, Page 2
Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
, . } 9. . , . Drinking fountain 16.60
❑ PROPERTY OWNER , . . ❑ TENANT . ,
,� Ejectors /sump 16.60
Name: ' Expansion tank 16.60
Address: Fixture /sewer cap 16.60
City /State /ZIP: 1 Floor drain /floor sink/hub 16.60
-Phone:-( ) - Fax: -( ) _ Garbage disposal _ __ _16.60_
. , P
D. A P P , Hose bib • 16.60
`" ❑CONTACT. PERSON
C � � r , 6 '6 � ° "" L( - Ice maker 16.60
Business name: `}/ P l.i Interceptor /grease trap 16.60
Contact name: el u..)Gia Medical gas (value: $ ) Page 2
Address: 9 a 7q S O 75 Primer 16.60
City /State /ZIP: jA0 /2.,7 L -tij 1.l 0 tz, 9 7 . Z3 Roof drain (commercial) 16.60
Sink/basin/lavatory 16.60
Phone: (3) , y5 - L /%y y Fax: : ( )
Tub /shower /shower pan 16.60
E -mail:
Urinal 16.60
'- CONTRAC . _ , , Water closet 16.60
Business name: LUrkB j 5,.. 4..yjc , Water heater 16.60
Address: PD a 0 x at) 51. Other:
Subtotal
City /State /ZIP: G j_,4 -C M 4..S 0 2 9r20 (s Minimum permit fee: $72.50
Phone: ( S03) 6,56 - ay3(. Fax: ( ) Residential backflow minimum permit fee: $36.25 3‘ , 25
CCB Lic.: 9 •2P / 0 Plumbing Lic. no.: 3 -025 2 p� Plan review (25% of permit fee)
State surcharge (12% of permit fee) 3S
Authorized signature: TOTAL PERMIT FEE lea , 60
Print name: 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.
I:\ Building \Permits\PLMF- PermitApp.doc 12/27/06 440- 4616T(10/02 /COM/WEB)
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information 4 , ., :„.
Fee Schedule: Residential Fire Suppression Systems:
F ee ea :Tota r ffi , . a
F',SitesUtilities° ' :. , . ; '�, y Qty:' > ,A. =- 'Square 3 ' '`Permit g< F y. _ , ° ,,�
Footing drain - l' 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 * ,; � '=
Valuati6n; �; - . = ,.Permit Fee:-, t ,., ;a ._" ,, ,,.. _:a�A.a' ,.
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 (e _ Total= additional $100.00 or fraction thereof, to and
Fiithie; ' u -i :; ' " - �_ r 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
. each additional $100.00 or fraction thereof, to
Inspection of existing plumbing or and including $50,000.00.
specially requested inspections - per hour 72.50 $50,001.00 and up $742.00 for the first $50,000.00 and $1.20 for
Subtotal: each additional $100.00 or fraction thereof.
Commercial Fixture Work: -,Plan Revw ie for: Plumbing Instal sr ,
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 tiy- (Fizttire)'Wo k`Performed *'- greater, except systems designed and stamped by licensed
_` -, , -,, ry , engineer.
;? Fiatnce Type: -� , �, .: ., Replace
.. w . • 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 R1ser,Dlagram . . , . r.
. Eye Wash ❑ Isometric or riser diagram is required for new buildings
Floor Drain /sink - 2" 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
- 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:
i1Bui1dmg\Permits\PLM- PermitApp doc 12/27/06
Nov 12 08 04:22p Scott Southwick 503 658 -8655 p.1
CITY OF TIGARD
9 COMMUNITY DEVELOPMENT
t r< •� K [? 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
• RECEIVED
Plumbin Signature Form NOV 1 3 2008
CITY OF TIGARD
IMPORTANT PERMIT NOTICE BUILDING DIVISION
PLUMBING SYSTEMS, INC
PO BOX 2056
CLACKAMAS, OR 97015
Permit #: PLM2008 -00428
Date Issued: 11/1212008
Parcel: 2S102CD -05700
Site Address: 13940 SW 95TH AVE
Subdivision: FLETCHER WOODS
Lot: 007
Jurisdiction: R
Zoning: TIG
Project Name: FLETCHER WOODS
Description: Backflow for irrigation.
Your company has been Indicated as the plumbing contractor for the pe it referenced above. In order for the
plumbing permit to be valid, please have the appropriate individual from your company sign below and return this
Plumbing Signature Form prior to the start of the work. Please mail the orm to: City of Tigard, Building Division,
13125 SW Hall Blvd., Tigard, OR 97223, or you may fax the form to: 543.624.3681.
If you have any questions please call 503.718.2433.
No plumbing inspections will be authorized until this dompleted fo Is received
OWNER: PL MBING CONTRACTOR:
C & L PROPERTIES LLC PL MBING SYSTEMS, INC
9279 SW 75TH PO BOX 2056
PORTLAND, OR 97223 C • CKAMAS, OR 97015
Phone #: 503 - 245 -4944 Ph. ne #: 503 -658 -2836
eg #: LIC 97810
PLM 3 -252PB
,'x 50.:3 - 6 5P— 2 d'J
AN INK SIGNATURE IS REQUIRE ' ON THIS FORM
X • n - r
Signature of Authorized Plumber Name (.rutted)
WatrdrAletricsWesst
o- >- BACKFLOW ASSEMBLY W 9466
TEST REPORT N
! 0
•
•
,....... ..
PROPERTY .
OWNER: 4 .'' f ;Y"I; (��.''�^ PH
MAILING
ADDRESS: 1:39440 j 9 th Av
CITY - {53aPd STATE CP' ZIP 97224
ASSEMBLY
ADDRESS: 1 1F.. Satitt P.6th ,s3/4:,...g.! T Iovz"il
STREET
R.P.B.A.? 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: B t 0 t+ MAKE: V. I. gep, S MODEL: 3 SO
WATER SERIAL
PURVEYOR: T ■r.At:i I°`'r,,• hF NUMBER: ?�( c,.- O 3
ASSEMBLY
LOCATION: g``4 ,'�: th tJVI.: 0''?Qm iTiS.121'
,REDUCED PRESSURE ASSEMBLY P.V.B.A. / S.V.B.A. INITIAL TEST
#1 CHECK DOUBLE CHECK AIR CHECK PASSED
PRESS DROP (A) CHECK #1 INLET FAILED
RELIEF VALVE ‘/
INITIAL OPENED AT (B) TIGHT "` OPENED AT: PRESS DROP
TEST MIN 2 PSID G:. ' DATE:
BUFFER LEAKED — PSID
RESULTS A _ B = PSID PSID 9 111 8/2008
MIN 3 PSI CHECK #2
RELIEF VALVE TIGHT 2 V DID NOT FAILED SYSTEM �t�
PASS FAIL LEAKED PSID OPEN — PSI
IPrLo =- I n
COMMENTS
REPAIRS
AND / OR
PARTS
REDUCED PRESSURE ASSEMBLY .,`I #1 CHECK P.V.B.A. / S.V.B.A, AFTE IfEPAIRS
(A
TEST PRESS DROP I D . C . V .A
CHECK #1 OPENED AT PRESS DROP DATE:
AFTER RELIEF
ED (B) ; TIGHT PSID - t ,!'4 -
REPAIRS BUFFER MIN 2 PSID ; CHECK #2 l k / y ® ,
A B = MIN 3 PSI 'TIGHT PSID PSID , PSID PA ED
IN COMPLETEING AND SUBMITTING THIS TEST REPORT, THE TESTRR CERT``IyIy'''IES THA HE U
ASSEMBLY HAS BEEN TESTED AND MAINTAINED IN ACCORDANCE WITH A APPLI BLE
RULES AND REGULATIONS OF THE WATER SYSTEM, AND STATE REGU TIT
GAUGE CALIBRATION D TE� - /'1m� s DETECTOR METE READING ' I l
TESTER SIGNATURE �- _,,,�1 I ?2T4#
TESTERS NAME PRINTED \ /GAUGE #
16120 SW 72ND, PORTLAND, 97224 (50'3) 603 -9988
TESTERS ADDRESS ‘ PHONE #
WATER METRICS CO. WEST
WWW.WATERMETRICS.COM
COMPANY NAME
❑ SERVICE RESTORED
REPORT RECEIVED BY: (REPRESENTATIVE OF OWNER)
WHITE - WATER SYSTEM COPY PINK - CUSTOMER COPY YELLOW - TESTER COPY
1■ - .
. -
CITY TIGARD
.6.
13bIEDIIN DIVISION , , ,,... PERMIT #: PLM2008-00428
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 11/17P008
Phone: (503) 639-4171
Inspection Requests (24 Hrs.): (503) 639-4175
INSPECTION WORKSHEET FOR DATE: 11/13/2008 TIME: 7•00AM PAGE: 11
SITE ADDRESS: 13940 SW 95TH AVE CLASS OF WORK:
SUBDIVISION: FLETCHFR WOODS LOT #: 007 TYPE OF USE:
PROJECT NAME: FLFTCHER WOODS
DESCRIPTION: B ack fl ow f i rr i ga ti on.
OWNER: C & L PROPERTIES LLC, PHONE #: 503-245-4944
CONTRACTOR: PLUMBING SYSTEMS, INC PHONE #: 503-658-28'36
Inspection Request Scheduled For: Date: 11/13/2008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
395 Misc. inspection 078040-03 503-939-2310 Y
Corrections/Comments/Instructions:
•
•
• .,
t
1 i
th *ASS 0 PARTIAL APPROVAL 0 CANCEL Ft NO ACCESS
0 FAIL CALL FOR INSPECTION 11 ADDITIONAL FEES ASSESSED
Inspector:
0---.. Date: U/3/b0 r
Phone #: (503) 718- akiDy
.,,
INSPECTOR'S SIGNATURES ARE NOT
Inspections Required for: /'L _,ZQ,/ 'DD /02f REQUIRED ON GREEN INSPECTION CARD.
✓ Code 1 Inspection Description I 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 dram 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
•
910 Sprinkler rough -in PLM - Plumbing Permit
915 Fire alarm rough -in 305 Plumbing underslab
310 Crawl drain
920 Suppression trip test 315 Post /beam plumbing
995 Misc. inspection:
998 Alarm final 320 Plumbing rough -in
999 Sprinkler final 322 Shower pan
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 I
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 \Forms \InspCard- AOP- Blank.doc 02/02/07
UPI n
CITY OF TIGARD
PLUMBING PERMIT
COMMUNITY DEVELOPMENT PERMIT #: PLM2008 - 00428
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 11/12/2008
PARCEL: 2S 102CD -05700
SITE ADDRESS: 13940 SW 95TH AVE ZONING: R -4.5
SUBDIVISION: FLETCHER WOODS LOT: 007 JURISDICTION: TIG
PROJECT: FLETCHER WOODS
Project Description: Backflow 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
C & L PROPERTIES LLC
Description Date Amount
9279 SW 75TH p
PORTLAND, OR 97223 [PLUMB] Permit Fee 11/12/200€ $36.25
[TAX] 12% State Surch 11/12/200€ $4.35
Phone : 503- 245 -4944 Total $40.60
Contractor:
PLUMBING SYSTEMS, INC
PO BOX 2056 .
CLACKAMAS, OR 97015 REQUIRED ITEMS AND REPORTS
Contact # : PRI 503- 658 -2836
FAX 503- 658 -2836
Reg #: LIC 97810 •
PLM 3 -252PB
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 -000 -el 0. You may obtain copies of
these rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By: r � 6 ' i� " Permittee Signature: r r\ `l4
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.