Permit CITY TIGARD PLUMBING PERMIT
,.,* l DEVELOPMENT SERVICES PERMIT #: PLM2005 - 00365
I I 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 8/9/2005
PARCEL: 2S112CD -14800
SITE ADDRESS: 07952 SW CAROL ANN CT ZONING: R -12
SUBDIVISION: REBECCA MEADOWS LOT: 005 JURISDICTION: TIG
Project Description: Installation of 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
KEYSTONE DEVELOPMENT INC
PO BOX 476 Description Date Amount
LAKE OSWEGO, OR 97034 [PLUMB] Permit Fee 8/9/2005 $36.25 •
[TAX] 8% State Surcha 8/9/2005 $2.90
•
Phone : 503- 635 -4736 Total $39.15
Contractor:
NATURESCAPING
10950 S MAPLE GROVE RD
MOLALLA, OR 97038 REQUIRED ITEMS AND REPORTS
Phone : 503- 873 -8407
Reg #: PLM 7075
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: _� Permittee Signature: ( ��� \ (J
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 n �F rv,t�
Plumbing Permit Application F012 O USE 'ONLY
City of Tigard AUG 0 9 2005 Date /By y-9 2:95-,.....--c Permit N0.7.? ' f- &J ?
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598,1960 U -,,.y;dr1r, „-l;,?`\ Date / Other Permit No.:
24- Hour Inspection Line: 503.639. BUILDING DIVISION 41751 Y OF TIGARD , + :1.;111 Date y Jeri
® See for
Internet: www.ci.tigard.or.us
BUI ----- •'_ rr Supplemental Notified/Method: Ti Supplemental Information
TYPE OF WORK, FEE* SCHEDULE
For special in ormarion use checklist.
1,2 New construction ❑ Demolition
• Description I Qty. I Ea. I Total
❑ Addition /alteration/replacement ❑ Other: New 1 dwellings (includes 100 II for each utility connection)
CATEGORY OF ,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
❑ Master builder Each additional bath kitchen 45.00
•
❑ O ther: Fire sprinkler ( sq. ft.) Page 2
•
JOB SITE INFORMATION AND LOCATION Site utilities
Job site address: `75 / t! 3 4 . 4.47 .. ,4N4V G7 Catch basin or area drain 16.60
City /State /ZIP: T4, c _) Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: Project name: AffeccA- jyy Footing drain (no. linear ft.: ) Page 2
• Manufactured home utilities 110.00
Cross street /directions to job site: //�' Manholes 16.60
. 2' e /4//44W +4 Rain drain connector 16.60
Sanitary sewer (no. linear ft.: ) Page 2
Storm sewer (no. linear ft.: ) Page 2
Subdivision: Subdivision:,,--4 �G�1�dvt/S" I Lot no.: /a,3 yr, Water service (no. linear ft.: ) Page 2
t Fixture or item
Tax map /parcel no.: Absorption valve ,16.60
• DESCRIPTION OF WORK Backflow preventer / Page 2
Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
Drinking fountain 16.60
PROPERTY 'OWNER - I ❑ TENANT
Ejectors/sump 16.60
Name: , ' - 'fir ,OSVOG e2e,// J7 Expansion tank 16.60
Address: p,, max 97 Fixture /sewer cap 16.60
City /State /ZIP: � 0 5, w e p p, - 97039 Floor drain/floor sink/hub 16.60
Phone: (�p5 ) 7e y--'=15. ' ax: (5r3) G4794_°7 711/ Garbage disposal 16.60
❑ A PLICANT ❑ CONTACT PERSON Hose bib 16.60
P
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
Phone: ( ) I Fax:: ( )
Sink/basin/lavatory 16.60
Tub /shower /shower pan 16.60
E -mail:
Urinal 16.60
CONTRACTOR Water closet 16.60
Business name: 447 -e Pt: , 6 - „ , f . pJ/va. Water heater 16.60
Address: / 5 /17,f, € • ti.° ® ,,•c ,6.40• Other:
. / lvL,4z.e. 4 p`L 9703 Subtotal
City /State /ZIP: .
/ M permit fee: $72.50
Phone: ( s3) 073 -, ? f' 7 Fax: ( ) Residential backflow minimum permit fee: $36.25
• CCB Lic.: l'ciolaco Plumbing Lic. no.: 7 : 2 75 Plan review (25% of permit fee)
Authorized signature: Xj.. State surcharge (8% of permit fee)
TOTAL PERMIT FEE
Print name: - / 7f L. , 7 3'ET y F� Date: g'__ ?._ J77 ��I
/) This permit application expires if a permit is not obtained within
l" /� C C` 180 days after it has been accepted as complete.
*Fee methodology set by Tri -County Building Industry Service Board.
1:\ Building \Permits\PLMF- PermitApp.doc 06/05 440- 4616T(10 /02/COM/WEB)
Plumbing Permit Application - City of Tigard '
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
-
- Site_Utiliti 2 Qty., ' Fee (ea) Total Square Footage: - Permit "Fee:.
Footing drain - I" 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 Valuations Permit 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
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
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 Review 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.
Quantity by (Fixture) Work Performed ❑ Any new commercial building.
Fixture Type`: Replace CI Any new exterior plumbing site utilities.
Previous Capped Added Existing ❑ 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 El Any new residential building containing three (3) or more
- Domestic dwelling units.
Drinking Fountain
Eye Wash ❑ Any NFPA I 3-D multipurpose fire sprinkler system.
Floor Drain /sink 2" Submit 2 sets of plans with any of the above.
3" a
-4
Car Wash Drain Isometric or Riser, 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
Water Extractor *Note: If the fixture work under this permit results in an
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.
i:\ Building \Permits \PLM- PermitApp.doc 07/06/05
CITY OF TIGARD
BUILDING DIVISION PERMIT #: PLM200S -00366
13125 SW Hall Blvd., Tigard, OR 97223 A DATE ISSUED: 8/9/2005
Phone: (503) 639-4171
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 8/10/2005 TIME: 7 :06AM PAGE: 79
SITE ADDRESS: 07952 SW CAROL ANN CT CLASS OF WORK:
SUBDIVISION: REBECCA MEADOWS LOT #: 005 TYPE OF USE:
PROJECT NAME: REBECCA MEADOWS
DESCRIPTION: Installation of bacidlov+t device.
OWNER: KEYSTONE DEVELOPMENT INC, PHONE #: 503 - 635.4736
CONTRACTOR: NATURESCAPING PHONE #: 503. 873 -8407
Inspection Request Scheduled For: Date: 8/10/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
399 Plumbing final 013217 -10 503 -704 -9506 . N
Corrections /Comments /Instructions:
94,-)
•
•
Egt PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
I FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: (TTh Date: 71/o) n f Phone #: (503) 718-