Permit CITY OF TIGARD
;,. PLUMBING PERMIT
4 , I'� DEVELOPMENT SERVICES PERMIT #: PLM2005 -00111
��'ll 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 3/18/2005
PARCEL: 2S 110BC -09700
SITE ADDRESS: 14560 SW 120TH PL ZONING: R -7
SUBDIVISION: WALL PARTITION2 /MLP2003 -00001 LOT: 001 JURISDICTION: TIG
Project Description: Installation of backflow prevention device 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
MASTERPIECE CONSTRUCTION INC Description Date Amount
14225 SW 128TH PL.
TIGARD, OR 97224 [PLUMB] Permit Fee 3/18/2005 $36.25
[TAX] 8% State Surchar1 3/18/2005 $2.90
Phone : 503 750 - 5549 Total $39.15
Contractor:
GREENFIL LANDSCAPE IRRIGATION
21667 SW JAY ST REQUIRED ITEMS AND REPORTS
ALOHA, OR 97006 -7072
Phone : 998 - 5708
Reg #: PLM 7214
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 -01 : •ugh OAR 952 - 0001 -0100. You may obtain copies of these rules or direc • - _ •s to OUNC by
calling 50:- 246 -6699 • 1 -: i i-332
Issued B : , _ � A Permittee Signat, •-. ��
Call 503 - 639 -4175 by 7:00 a.m. for an inspection tha 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
Plumi-in Permit Application ., , - FOR OFFICE USE ONLY . " , j
City of Tigard Received
Plan Review Permit No. N4i+nG /1/t // /
13125 SW Hall Blvd., Tigard, OR 97223 Date/By: / ( � QLj �(�leiJ w
Phone: 503.639.4171 Fax: 503.598.1960 4 b / �i�� V � + Date/By: Other Permit No.:
24- Hour Inspection Line: 503.639.4175 al 1 Date Ready /By: . 1 a Q See Page 2 for
Internet: www.ci.tigard.or.us /
;�._:..�,�, .- -;,;'y «., WS , ,. ._ � :3*?'�i� -:�vkt,-&t;� •"�^.*� ,.c€,,. ethod ,.:a � - - m�on: -
Notified/Method: � � Supplemental Infor
v 5�' .,; .n ` = .';-,f"" al .. .irS.a . "'�- rgy:l." ',S'�,. ' ;:xg ',iM :. KO.:a=xt+ It i. . -
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mad,. <.F��3'. -.,�'` ..fix <.�sss em'.,= i:'.',w�'�UC;dsu�. �-, ro €.�h ',-. - �- '.'�'s+:`�sC�Q��Y'�'�sa �'. �a'.' �.�'�'zf�.v9'.���4�".5,�'.�4s.. ,�zsa"�.: 5;. <s�a= : °.•.. �,.M- ,mow., -- ['New construction ❑ Demolition For special information use checklist. .
Description I Qty. I Ea. Total
❑ Addition/alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
- -v�' �-;r �' �`^��� 'fie: >",r '�� % '� , .� = r� s = , .�: � -�.� +ms's r•a.,z' ": v ^- �
'5;4.45 s CA ® 1 C Sge irei'IO N mag a r SFR (1) bath 249.20
'tea, Vi •a� .7,4 flash: 3 ,3 `
[I1- and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 350.00
❑ Accessory building ❑ Multi - family SFR (3) bath 399.00
❑ Master builder Each additional bath/kitchen 45.00
❑ Other:
Fire sprinkler ( sq. ft.) Page 2
t.;" . Iffa. ., �xa t< _ - z} �. : , ,rxa.,.. .. ,� �, Site utilities
�s
Job site address: / . .5.- � 7 r � ) /'0/�
, basin or area drain 16.60
City/State /ZIP: / �;1 � , r p i '? ci Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: J e 2 ., oject name: r (� Footing drain (no. linear ft.: ) Page 2
Manufactured home utilities 110.00
Cross street/directions to job site:
Manholes 1 6.60
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
Tax map /parcel no.: Fixture or item
lip; ._ , valve
Absorption 16 60
1 -4 t ESCRIP'rIO /VO WDR k " ' . P
.4 ; �, ..a . ,.1., , ., _n:s,� � , 'xtr`�.,r� ;.. 3 .it. > � t �,-� Back preventer Page 2.__
Backwater valve I 16.60
Clothes washer 16.60
Dishwasher 16.60
! ° ,R N V4"1!)'?': " Drinking fountain 16.60
<`� ROPER',' O . R- w4 I, , f� TENt'T
� .��.�,xw +.mt%*.dc± � s �„�+. �s 4�...�. Ejectors /sump 16.60
Name: N NG-' -- .. P f Q .. - 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
" t z 4 z ' a g � z� Hose bib 16.60
15 ' APPTI:IC'A IrTT' etkV ", ®FQIN A.C P
_ " '� �'� "� ^` � ' �'-�'� " - " I maker 16.60
Business name: n gg Q
'� LAS ( 'f' Interceptor /grease trap 16.60
Contact name: - Medical gas (value: $ ) Page 2
Address: / `6 `/ ) ) 7 ( 54 r rimer 16.60
City/State/ZIP:
Roof drain (commercial) 16.60
j '�- C` ' > /
Phone: ( ) 1 Fax:: ( ) `7`_ Sink/basin /lavatory 16.60
Tub /shower /shower pan 16.60
E -mail:
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Urinal 16.60
�,�, �z ,„ " " G QN C �' ,y : e i.: z,r , t ., rs � r A 1 Water closet 16.60
Business name: j ���� ` L 9 , „ „ - ✓,, --�� Water heater 16.60
Address: / + ` � ` t� Other:
City/State/ZIP: i t� P Q ae34 Subtotal
�� �-� ( Y/ Minimum permit fee: $72.50 2 / �s
�
Phone: ( ) J Fax: ( ) ' Residential backflow minimum permit fee: $36.25 (�(Q
A B Lie.: `t� Plumbing Lic. no.: Plan review (25% of permit fee)
State surcharge (8% of permit fee) -?C) Authorized signature: r
`, __---- �� - _ i . TOTAL PERMIT FEE rj
Print name: / Date: --- awl-- 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 12/03 440- 4616T(10 /02 /COM/WEB)
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
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Fee Schedule: Residential Fire Suppression Systems:
"SIt Vti - T,f S 441 iFee(ea) "fbtal (S itar Foo e
. „ (13,.: L, g._ :. Perm>It Fe e
Footing drain - 1s 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
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Storm & Rain Drain - 1st 100' 55.00 Valuation„ `. Permlt Fee,
$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
uF eC ea '` Total additional $100.00 or fraction thereof, to and
I+'xture ,orItem.': E' XZ p^ .. Q Y• 4
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) 1 27.55 2.21 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.
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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 * .
r* ti .. ; uanttt b` Ftxtpre orl P rformed
Ftx ture ' Cype5 x a R epla ce .
x E # s rhea kl x t� r , a� 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:
i:\Building\Permits\PLM- PermitApp.doc 3/03
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CITY OF TIGARD
BUILDING DIVISION PERMIT #: PLI��200r00111
13125 SW Hall Blvd., Tigard, OR 97223 D ATE ISSUED: 3/18/2005
Phone: (503) 639 -4171 / � � iir a pPiilpi4lPJ11
Inspection Requests (24 Hrs.): (503) 639-4175 `:_.. gd1
INSPECTION WORKSHEET FOR DATE: 3/21/2005 TIME: 7 :10AM PAGE: 9
SITE ADDRESS: 14550 SW 120TH PL CLASS OF WORK:
SUBDIVISION: WALL PARTITION2JMLP2003 -00001 LOT #: 001 TYPE OF USE:
PROJECT NAME: WALL PARTITION 2
DESCRIPTION: Installation of bacldlow prevention device for irrigation.
OWNER: MASTERPIECE CONSTRUCTION INC, PHONE #: 503 - 750 -5549
CONTRACTOR: GREENFIL LANDSCAPE IRRIGATION PHONE #: 998 -5708
Inspection Request Scheduled For: Date: 3/21/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
325 RP/backflow preventer 002330 -01 503- 998 -5708 N
Corrections /Comments/ Instructions:
Tii+ VII — 6(.5 '3A 0--c ( It-G2C2-q_s7
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CJL# 1
WAll fir
S PASS El PARTIAL APPROVAL El CANCEL n NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: 4) Li ( Date: // \ 6 5 Phone #: (503) 718-