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Permit
114 a CITY OF TIGARD PLUMBING PERMIT COMMUNITY DEVELOPMENT PE COMMUNITY PLM2009 -00035 TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 2/20/2009 PARCEL: 2S 103AD -07500 SITE ADDRESS: 12683 SW 108TH TERR ZONING: R -4.5 SUBDIVISION: MILESBROOK LOT: 006 JURISDICTION: TIG PROJECT: MILESBROOK Project Description: Backflow for irrigation. CLASS OF WORK: NEW GARBAGE DISPOSALS: MOBILE HOME SPACES: TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS: 1 OCCUPANCY GRP: 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 BUENA VISTA CUSTOM HOMES 5665 SW MEADOWS RD. #150 Description Date Amount LAKE OSWEGO, OR 97035 [TAX] 12% State Surch 2/20/2009 $4.35 [PLUMB] Permit Fee 2/20/2009 $36.25 Phone : 503- 443 -6033 Total $40.60 Contractor: TRUSCAPES INC 21600 NW ANBERWOOD DR. HILLSBORO, OR 97124 REQUIRED ITEMS AND REPORTS Contact # : PRI 503- 969 -2144 FAX 503 -531 -9216 Reg #: LIC 7962 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: ,c1(( \ ftQJkJ\ Permittee Signature n(t 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 A City of Tigard R eceived ++'�� ^ 1 Permit No.: (, W 13125 SW Hall Blvd., Tigard, OR 97223 Date /By: pJ' a c UCl p l �� 1 y y� l2 '� = Phone: 503.639.4171 Fax: 503.598.1960 Plan Review Other Permit No.: [y �Sl 2\ 1t II (y �1 Date/By: 1' v co Inspection Line: 503.639.4175 Date Read /B luris: 0 See Page 2 for Internet: www.tigard-or.gov I G A R D g T ICI Supplemental Information ard -or. ov No tified/Method: T TYPE OF WORK FEE* SCHEDULE [l New construction 1 ❑ 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 a1- and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 350.00 El 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: i,`� 't'„c 3 ,. c _,., )�+ " t -14 VV Catch basin or area drain 16.60 ---c- v G ` t , r City/State /ZIP: ,r C, r Q 2_2-‘1 - Drywell, leach line, or trench drain 16.60 Suite/bldg. /apt. no.: U Project name: 1 Footing drain (no. linear ft.: ) Page 2 Manufactured home utilities 110.00 f�C Cross street/directions to job site: (l q � T� Manholes 16.60 - _ (� � l Jo t 1 - t_ . I T ` c�] ` �Qy l (10± ✓ L L ) T tD Rain drain connector 16.60 t o cK T iA • Sanitary sewer (no. linear ft.: ) Page 2 Storm sewer (no. linear ft.: ) Page 2 Subdivision: L A 1 1 P S �3 ter, 1 Lot no.: Water service (no. linear ft.: _) Page 2 �+ Fixture or item fax map /parcel no.: 2_ s i©?..) AD_ L� -) 5 c Absorption valve 16.60 DESCRIPTION OF WORK Backflow preventer i Page 2 � U- e t . x) c 3 - u 12 d 5 - Backwater valve 16.60 e Clothes washer 16.60 Dishwasher 16.60 ❑ PROPERTY OWNER , ❑ TENANT Drinking fountain 16.60 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 ❑ 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: ( ) I Fax:: ( ) Tub /shower /shower pan 16.60 E-mail: Urinal 16.60 CONTRACTOR Water closet 16.60 Business name: -i--- U ' ? - C Water heater 16.60 Address: �� s� Y'� c� Other: City/State /ZIP: i f 12 Subtotal \∎ �lgb� co n C" 12 - \ Minimum permit fee: $72.50 / - Phone: (c,�� B-2 ( _ t17 A ! _ Fax: ( ) Residential backflow minimum permit fee: $36.25 3 Lp • z5 CCB Lie.: L c S - 1 Q� � Plumbing Lic. no.: Plan review (25% of permit fee) 1 1 State surcharge (12% of permit fee) 4 , Authorized signature: TOTAL PERMIT FEE 140 ' �` Print name: Date: This permit application expires if a permit is not obtained with 180 days after it has been accepted as complete. *Fee methodology set by Tri -County Building Industry Service Board. I:\BuildingTermits\PLMF- 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 Square Footage: Permit 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 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 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 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 a CITY OF TIGARD COMMUNITY DEVELOPMENT_ , TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 Plumbing Signature Form IMPORTANT PERMIT NOTICE TRUSCAPES INC 21600 NW ANBERWOOD DR. HILLSBORO, OR 97124 Permit #: PLM2009 -00035 Date Issued: Parcel: 2S103AD -07500 Site Address: 12683 SW 108TH TERR Subdivision: MILESBROOK Lot: 006 Jurisdiction: R-4.5 Zoning: TIG Project Name: MILESBROOK Description: Backflow for irrigation. Your company has been indicated as the plumbing contractor for the permit 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 form to: City of Tigard, Building Division, 13125 SW Hall Blvd., Tigard, OR 97223, or you may fax the form to: 503.624.3681. If you have any questions please call 503.718.2433. No plumbing inspections will be authorized until this completed form is received OWNER: PLUMBING CONTRACTOR: BUENA VISTA CUSTOM HOMES TRUSCAPES INC 5665 SW MEADOWS RD. #150 21600 NW ANBERWOOD DR. LAKE OSWEGO, OR 97035 HILLSBORO, OR 97124 Phone #: 503 - 443 -6033 Phone #: 503 - 969 -2144 Reg #: LIC 7962 AN INK SIGNATURE IS REQUIRED ON THIS FORM Signature of Authorized Plumbe Name (printed)