Permit MI CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT PERMIT #: PLM2007 -00512
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 11/20/2007
PARCEL: 1 S125CA -04000
SITE ADDRESS: 07410 SW CEDARCREST ST ZONING: R - 4.5
SUBDIVISION: BOULEVARD HEIGHTS LOT: 016 JURISDICTION: TIG
PROJECT: PACIFIC HOMES
Project Description: 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
PACIFIC HOMES
6770 SW ALFRED ST Description Date Amount
TIGARD, OR 97223 [PLUMB] Permit Fee 11/20/2007 $36.25
[TAX] 8% State Surcha 11/20/2007 $2.90
Phone : 503- 975 -6560 Total $39.15
Contractor:
REDWOOD LANE NURSERY
8222 BROADACRES RD
. WOODBURN, OR 97071 REQUIRED ITEMS AND REPORTS
Contact # : PRI 503- 678 -3242
Reg #: LIC 7009
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 /
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 /f /0 D 7 Permit No.: GHJo0 7- -60.57
II 13125 SW Hall Blvd., Tigard, OR 97223
Phone: 503.639.4171 Fax: 503.598.1960 Plan Review
- Other Permit No.:
Date /By:
Inspection Line: 503.639.4175
TIGARD Ready /By: � Date Read /B y,r+� HI See P a g e 2 for
Internet: www.tigard- or.gov Notified/Method:
Supplemental Information
TYPE OF WORK 'FEE* 'SCHEDULE .
❑ New construction ❑ Demolition For special information use checklist.
Description I Qty. I Ea. Total
❑ Addition/alteration/replacement Othe
P z ,5' YST.� New 1- 2- family dwellings (includes 100 ft. for each utility connection)
.CATEGORY OF CONSTRUCTION . . SFR (1) bath 249.20
01- and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 350.00
111 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: 7L / /lJ 44". Cg 7/ L/zAs7-"' sT- Catch basin or area drain 16.60
City /State /ZIP: Drywell, leach line, or trench drain 16.60
i iZ - - ,4/2- j e€2, . g 7Z -0-3
Suite/bldg. /apt. no.: Project name: �f��..� Footing drain (no. linear ft.: ) Page 2
Manufactured home utilities 110.00
Cross street/directions to job site: =ird,G,�-T «�,
Manholes 16.60
Rain drain connector 16.60
7''/ 7*- - re 0�A.-z. Gir t<'$ - 57 -3- Sanitary sewer (no. linear ft.: _) Page 2
Storm sewer (no, linear ft.: _) Page 2
Subdivision: J 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 I Page 2
- /rili6AT� -S" I.-- y c. - Backwater valve . 16.60
Clothes washer 16.60
Dishwasher 16.60
•
-- PROPERTY OWNER I ❑ TENANT ' .
Drinking fountain 16.60
Ejectors /sump 16.60
Name: /�/3GiG 4 CZ; 4 .. .Le ,e.,..- e- 4g2.__-.) Expansion tank 16.60
Address: G 774, .5-,4,,,,,
,�L,e2.� s T. Fixture /sewer cap 16.60
City /State /ZIP: / GAS) /49/2 7�.Z- F Floor drain/floor sink/hub 16.60
Phone: ,>3 ) 4 75 - 6 c 4 p Fax: ( ) Garbage disposal 16.60
APPLICANT ❑ CONTACT PERSON Hose bib 16.60
Ice maker 16.60
Business name: 0091.60 0, j
Interceptor /grease trap 16.60
Contact name: Medical gas (value: $ ) Page 2
Address: s / Primer 16.60
City /State /ZIP: ,i Roof drain (commercial) 16.60
Sink/basin/lavatory 16.60
Phone: ( ) ✓ Fax:: ( )
Tub /shower /shower pan • 16.60
E -mail: Urinal 16.60
CONTRACTOR. Water closet 16.60
Business name:
£ Water heater 16.60
r�wov� I..AN�i 14 L,,cS - Y �Hlr -
Address: ,S'L Z Z-- a"c41.4',i"./fL�ff / ?z' . Other:
Subtotal
City /State /ZIP: / 7 ram j' ' c ) 7e 7 / Minimum permit fee: $72.50
Phone: (5 ) 6 7j- 5 .5/ Zi Fax: ( ) Residential backflow minimum permit fee: $36.25
CCB Lic�ps��.o -7pa 9 Plumbing Lic. no.: Plan review (25% of permit fee)
7\
Authorized signature: State surcharge (8% of permit fee)
TOTAL PERMIT FEE 39 _ 15
Print name: Gw -,ci ��y� g .- 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.
1.\Building\Permits\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 1 00' 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
g Y g
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.
Fixture Work: Plan Review for Pl 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 (Fixtur`e) Work Performed, greater, except systems designed and stamped by licensed
Fixture Type: Replace engineer.
Previous Capped ' Added Editing _ ❑ 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"
-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: •
i.\ Budding \Permits\PLM- PermitApp.doc 12/27/06
CITY OF TIGARD
BUILDING DIVISION
PERMIT #: PL.M2007-00512
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 11/20/2007
Phone: (503) 639-4171 &OVA
Inspection Requests (24 Hrs.): (503) 639-4175 ‘ ,44, ■ IL
INSPECTION WORKSHEET FOR DATE: 12/5/2007 TIME: 7:01AM PAGE: 40
SITE ADDRESS: 07410 SW CEDARCREST ST CLASS OF WORK:
SUBDIVISION: BOULEVARD HEIGHTS LOT #: 016 TYPE OF USE:
PROJECT NAME: PACIFIC HOMES
DESCRIPTION: Bacl4low prevention device for irrigation.
OWNER: PACIFIC HOMES, PHONE #: 503-975-6560
CONTRACTOR: REDWOOD LANE NURSERY PHONE #: 503-678-3242
Inspection Request Scheduled For: Date: 12/5/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
399 Plumbing final 060833-01 5034375-6560
• Corrections/Comments/Instructions:
Ccvt 9
•
PASS 0 PARTIAL APPROVAL fl CANCEL 0 NO ACCESS
0 FAIL 0 CALL FOR INSPECTION 0 ADDITIONAL FEES ASSESSED
Inspector: (To 1 44- 4 - 41 ( 114-1 - - Date: l(2--1 trio Phone #: (503) 718-
•