Permit CITY TIGARD PLUMBING PERMIT
DEVELOPMENT SERVICES PERMIT #: PLM2006 - 00199
DATE ISSUED: 5/10/2006
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171
PARCEL: 2S 110DC - 90231 .
SITE ADDRESS: 15565 SW 114TH CT 23 ZONING: R -
SUBDIVISION: FOUNTAINS AT SUMMERFIELD CONDO LOT: 023 JURISDICTION: TIG
Project Description: Replace backflow device, Located near the back of Unit 23 near water meter.
CLASS OF WORK: OTR GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: MF 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
HARNS, JAMES R + PATRICIA S
14106 PENNYSTONE DR Description Date Amount
SUN CITY WEST, AZ 85375 [PLUMB] Permit Fee 5/10/2006 $72.50
[TAX] 8% State Surcha 5/10/2006 $5.80
•
Phone : Total $78.30
Contractor:
WILLAMETTE LANDSCAPE SERVICES, INC.
18480 SW PACIFIC DR
TUALATIN, OR 97062 REQUIRED ITEMS AND REPORTS
Contact # : FAX 503- 625 -9714
PRI 503- 625 -9600
Reg #: LIC 6949
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, opies of
these rules or direct questions to OUNC by calling 503 - 246 -6699 or 1- 800 - 332 -2344.
"/ 4 ,0 - 1
Issued By: .- 71) ���� Permittee Signature:
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.
4. Plumbing Permit Api1�ica °tio�n�
City of Tigard '- - - FOR OFFICE USE ONLY
d v Ct \‘''' Received U ^
Permit No.:
-?W\,),/;0(-- )C -_ /99
13125 SW Hall Blvd., Tigard, OR 97223 Q�6 Date/By: �/
KV Pla Review
Phone: 503.639.4171 Fax: 503.598.1960 \A N p��.n lit Date /By: Other Permit No.:
��� �m"ppur
24- Hour Inspection Line: 503.639.4175 • c"'* 07 _ Date Ready /By: Juris El See Page 2 for
Internet: www.ci.tigard.or.us , 11.1V ( .)t _ _y�n��,t Notified/Method: 1/k Supplemental Information
- . TYP. t y41 EEII G HED'ULE� " t .
❑ New construction B Avg ❑ 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 4 _ • SFR (1) bath 249.20
❑ 1- and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 350.00
E] Accessory building ® Multi- family SFR (3) bath 399.00
❑ Master builder ❑Other: Each additional bath /kitchen 45.00
Fire sprinkler ( sq. ft.) Page 2
JOB. ' SITE ,INFORMATION AND LOCATION , 6 •', Site utilities
Job site address: 15565 SW 114 Court Catch basin or area drain 16.60
City /State /ZIP: Tigard, OR 97224 Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: Unit #23 Project name: The Fountains at Summerfield Footing drain (no. linear ft.: ) Page 2
Cross street/directions to job site: Pacific Hwy to Durham Rd to Summerfield Drive. Manufactured home utilities 110.00
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
Replace aged PVB backflow device with DCVA in- ground device. Backwater valve 16.60
Device is located along 114 court nearest the back of Unit #23 next to the curb, Clothes washer 16.60
near the water meter. Dishwasher 16.60
y r - Drinking fountain 16.60
i PROPERTY'- OWNERF'' � ' " "'` � • - ,❑.TENANT "
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
° ''J®' AP_PLICAN'T 'r < - "+, " Hose bib 16.60
'
. ■- CONTACT .PERSON .'_ -_
Ice maker 16.60
Business name: The Fountains at Summerfield Interceptor /grease trap 16.60
Contact name: Bob Young Medical gas (value: $ ) Page 2
Address: 15605 SW 114 Ct. #19 Primer 16.60
City /State /ZIP: Tigard, OR 97224 Roof drain (commercial) 16.60 .
Sink/basin /lavatory 16.60
Phone: (503) 624 - 2046 Fax:: ( )
Tub /shower /shower pan 16.60
'- E -mail:
Urinal 16.60
1 a " ." . . , CONT " . ° " - " Water closet 16.60
1
1%. Business name: Willamette Landscape Services, Inc. Water heater 16.60
Address: 18480 SW Pacific Drive Other:
City /State /ZIP: Tualatin, OR 97062 Subtotal
Minimum permit fee: 2.50 -
. Phone: (503) 625 - 9600 Fax: (503) 625 - 9714 Residential backflow minimum permit fee: .25
CCB Lie.: LC " t < 9 y q Plumbing Lie. no.: Plan review (25% of permit fee)
Authorized signature: / ii c,./....47. State surcharge (8% of permit fee)
/ TOTAL PERMIT FEE 7 ,, IC
Print name: Matthew C. Triplett, VP Date: May 9, 2006 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 \PLM- PemiitApp doe 06/05 440- 4616T( I 0 /02 /COM /WEB)
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Slte Utilities °., t ' _ µhr'c - ' i4 Q ty nFee "(ea) Total
Footing drain - I e 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
Storm & Rain Drain - 1st 100' 55.00 Valuat1611 y , e _ peCITlltee - �, - s ..
$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
a OrItelll a p Qty ; = =F' )1; additional $100.00 or fraction thereof, to and
including $10,000.00.
Commercial Back Flow Prevention Device 1 46.40 GfG,l(O $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: .Plan =Reviewrrr =for Complex,Structures ,`
Are you capping, adding or replacing fixtures? If "yes ", A "complex structure" is defined as an installation of a plumbing
please indicate work performed by fixture. Failure to system that meets any of the following criteria.
accurately report fixtures could result in increased sewer fees *. Please check all that apply.
_ ` 'd ",=.'%
.. iQya itiiy,by (Fixture) WorkPerfornied° ❑ Any new commercial building.
n new exterior plumbing
FxtureTYPe1 " ms s- Re ce ❑ Any i P site utilities.
a w ,, , Previous; , Capped= Added , .1F is r ❑ A commercial building with installation, alteration or addition
Baptistry/Font of nine (9) or more new or relocated plumbing fixtures.
Bath - Tub /Shower ❑ Medical gas and vacuum systems for health care facilities
- Jacuzzi /Whirlpool providing services to human beings.
Car Wash - Each Stall ❑ Plumbing installations, alterations or additions to food service
- Drive Thru facilities where new plumbing fixtures, including interceptors,
Cuspidor /Water Aspirator are being installed for the food service area.
Dishwasher - Commercial ❑ Any new residential building containing three (3) or more
- Domestic
dwelling units.
Drinking Fountain
Eye Wash ❑ Any NFPA 13 - D multipurpose fire sprinkler system.
Floor Drain /sink - 2"
3 „ Submit 2 sets of plans with any of the above.
-4 "
Car Wash Drain IS 'metric or Rises' Diagram
Garbage - Domestic ❑ Isometric or riser diagram is required for new buildings
Disposal - Commercial three (3) or more stories in height.
- Industrial
Ice Mach. /Refrig. Drains
Oil Separator (Gas Station) Comments regarding fixture work:
Rec. Vehicle Dump Station
Shower -Gang
-Stall
Sink - Bar /Lavatory
- Bradley
- Commercial
- Service
Swimming Pool Filter
Washer - Clothes *Note: If the fixture work under this ermit results in an
Water Extractor p
Water Closet - Toilet increase of sewer EDUs, a sewer permit will be issued and
Urinal fees assessed for the sewer increase must be paid before the
Other Fixtures: plumbing permit can be issued.
is \Building \ Permits \PLM- PermitApp doc 07/06/05
CITY OF TIGARD ,.. ._
,..
BUILDING DIVISION
A, PERMIT #: PLM2006-00199
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 5/1012006
Phone: (503) 639-4171
Inspection Requests Requests (24 Hrs.): (503) 639-4175 .., 11-
.INSPECTION WORKSHEET FOR DATE: 912412007 TIME: 7:00AM PAGE: 46
SITE ADDRESS: 15565 SW 114TH CT 23 CLASS OF WORK:
SUBDIVISION: FOUNTAINS AT SUMMERFIELD COND LOT #: 023 TYPE OF USE:
PROJECT NAME: FOUNTAINS AT SUMMERFIELD
DESCRIPTION: Replace backflow device, Located near the back of Unit 23 near water meter. Plumber paid
reinspection fee and has 30 days to complete work and get final inspection. SLN
OWNER: HARNS, JAMES R + PATRICIA 3, PHONE #:
CONTRACTOR: WILLAME. 1 I E LANDSCAPE SERVICES, INC. PHONE #: 503-625-9600
Inspection Request Scheduled For: Date: 9/24/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
399 Plumbing final 056160-01 503-572-8427 Y
Corrections/Comments/Instructions:
D t . ..Ac e... 1 C g-e-tpd/
r-exit-c v./4)U p
PASS I I PARTIAL APPROVAL n CANCEL I I NO ACCESS
I FAIL CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED
Inspector: cra v‘,...A..../4 ,41\--,_ Date: 9 \ -24 Jo T? Phone #: (503) 718-
. _ . .
Inspections Required for: PLM2006 -00199
✓ Code Inspection Description 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 drain 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 PLM - Plumbing Permit
910 Sprinkler rough -in 305 Plumbing underslab
915 Fire alarm rough -in 310 Crawl drain
920 Suppression trip test 315 Post/beam plumbing
995 Misc. inspection: 320 Plumbing rough -in
998 Alarm final 322 Shower pan
999 Sprinkler final 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 0 11D - 110 - 7 OA/
210 Foundation walls
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 \Inspection Cards \Forms \AOP- InspCard- Blank.doc 12/09/2005
CITY TIGARD PLUMBING PERMIT
i DEVELOPMENT SERVICES PERMIT #: PLM2006 -00199
� n DATE ISSUED: 5/10/2006
�--- - - -- ` Y- 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 PARCEL: 2S110DC 90231
SITE ADDRESS: 15565 SW 114TH CT 23 ZONING: R -25
SUBDIVISION: FOUNTAINS AT SUMMERFIELD CONDO LOT: 023 JURISDICTION: TIG
Project Description: Replace backflow device, Located near the back of Unit 23 near water meter.
CLASS OF WORK: OTR GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: MF 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 I
HARNS, JAMES R + PATRICIA S Description Date Amount
14106 PENNYSTONE DR
SUN CITY WEST, AZ 85375 [PLUMB] Permit Fee 5/10/2006 $72.50
[TAX] 8% State Surcha 5/10/2006 $5.80
Phone : Total $78.30
Contractor: r
WILLAMETTE LANDSCAPE SERVICES, INC.
18480 SW PACIFIC DR
' t TUALATIN, OR 97062 REQUIRED ITEMS AND REPORTS
ZI''
Contact # : FAX 503- 625 -9714 _ 11
PRI 503- 625 -9600 r i`` E
Reg #: LIC 6949 l O O
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 '' . _re !„ ,_,� Permittee Signature: ,. '.
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.