Permit ir CITY 'OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT PERMIT #: PLM2007 -00333
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 7/27/2007
PARCEL: 2S 104DC -04600
SITE ADDRESS: 13529 SW CLEARVIEW PL ZONING: R -4.5
SUBDIVISION: BENCHVIEW ESTATES LOT: 046 JURISDICTION: TIG
PROJECT: GRAY
Project Description: Install 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
RYAN GRAY
13529 SW CLEARVIEW PL. Description Date Amount
TIGARD, OR 97223 [PLUMB] Permit Fee 7/27/2007 $36.25
[TAX] 8% State Surcha 7/27/2007 $2.90
Phone : Total $39.15
Contractor:
SOUTHWEST LANDSCAPE LLC
11654 SW PACIFIC HWY #9
TIGARD, OR 97223 REQUIRED ITEMS AND REPORTS
Contact # : PRI 503- 620 -0149
FAX 503- 620 -0590
Reg #: LIC 8516
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 B ti ALL i i. it '1.1, .. Permittee Signature: Sp 4 i f 60
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.
07/2642007 THU 9:54 FAX 5036200590 SW Landscape LLC Z002/004
Plumbing Permit Application REC FOR OFFICE USE ONLY
City of Tigard JUL 2 6 2007 RcO /H iVCa
te
q 13125 SW Ball Blvd., Tigard, OR 97223 PcrmtNo.t PL / i , tl
j : Phone; 503.639.4171 Fax: 503.598.1960 C� ' ''- `' ^ t" �� b� Pla Rcvicw Other Permit No.:
639
Inspection Line: $03. 4175 U�R p �i �-q
TIGAR'D �V Q�iv i.r�i�® �Da
Internet: www_tig ir - or.gov
See PilKe 2 for
„..,.., +, b , 5 ....:,., : ...,._,.:,... r.4; ...ter, w::•_.. rr: oa r,,p,:.. y;,_:.. ' OA S APlem Information
a , 4 r a w t C tlt 41r tt A ° "C 1 s v �� of dl hod kl,'r li k`° roru rwa a • :_1..,. eotvl 1 war
lY :,....:...:_r .:`_ 1 :t ratl ash t .. 46.7 *. f �i� : .af ( _ , . 1T ° it ' - 'c / t � A MPA ky' I CTHP�D r d= r y .*, ig
, 'x •x.N A. J
❑ New construction ❑ Demolition Furspecial ra ormarion use checklist-
El Description 1 Qty. ! Ea. I Total
Other:
Addition/alteration/replacement New 1- 2- famtil dwellin •s i
. �r�9wµl�,a� xxx , _ ., � wr,,.,r. - •ter_ rwa acrmE:� ; eft ° :•.x Y dwellings 100 R. for each utility connection)
(includes Y,M41r 0,[ }�A'�wy Y�kti V M", iii y, }y,�q�.(�.i �r b `bl'r^_f.o . S�I�,�1 . tie I !,
. fi , r : ..,,,w°f . :1 . ut:A ...41' . ,,, tin kit to 'IP: a a'.\ ze 1 w h 't{ pf.AK
_ L, � :. . s» ,�t{l�, e:: I; ,� .. -i:� .a�,u;:„+�c� SFI ( 1) bat 24920
❑ 1- 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 '0 Other:
� -,. pe l,. � , 4 , 1 .�: �::• r ."' oO�,w.•m"ti,,.. i r : , , vaa x,, , ,.. r 1 ,�i " r: : .: ,, Fire Sptunklttr ( sq. ft.) Page 2
�.' 9 ) , �i ., .,.i. ,• ,f . 11 :1. '.:::.r(n CF1' i)k ` i a
�'riw a r - Site utilities
Job site address ;'\ > -� ^ �`--Q..._,O■ck,i-`,et ..)...4,2)\ Catch basin or area drain J 16,60
City /State/ZIP: - C 4 '-'f' .. Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: Project name; - Footing drain (no. linear ft.: _ ) Page 2
Cross street/directions to job site: Manufactured home utilities 110,00
� a ` 1� � Manholes 16.60
-
\--\ `�
\ ? ) C • '\ �fti�ti� c-1 '\ Rain drain connector 16.60
Sanitary sewer (no. linear ft.: ) Page 2
Stone sewer (no. linear ft.: ) Page 2
Subdivision: l Lot no : Water service (no, linear ft.; _) Page 2
Tax reap /parcel no.;
Fixture or item
� a ro 4 , : _'. :a ? + ''x f; x: y S . i '• rc s"FAfn��., N ur Cf iyr 4 r: n t . ,� , M;a ,;: k , pxr , Absorption valve 16.60
. ..:. G_.t:W�Pt4ifi f�Yi..,!f1;1�t'l Y t', , , ,. 0.n o ,. 4nP , t r ., - g , ',
<'T W, ,rr . q t y { - t Back-flow pteventer 1 Page 2
Backwater valve 16.60
Clothes washer 16,60
Dishwasher 16.60
w Pis.., I, '''.t','"0 r , n
i, ..HH, ��'��t�ss(�! �� �i 4 ' x,;. <, g,A �} , , ..4 , h , "..2% , ( „ Drinking fountain 16,60 • ''�" t. .v.1 ��� "Pr `�fA °J'nkb`.'fetreC: � rb �.' -' ur3Ao. � � >• er 1 . . , n,(Ahra,r�+' #w`At= r-t�ty "S 7ir`tiw;"retr,'W • : ,•*• CRi %: r : �.
Name: C YD.� _ Ei�torsJsuatp t 6.60
Expansion tank 16.60
Address: \ J� 1� \.e (\ \ „•.�\ , Fixture/sewer cap 16.60
City /Staie/ZiP 7 ..--D-' y1� Floor drain/floor sink/hub 1 16.60
Phone: ( ) Fax; ( ) Garbage disposal 16.60
,.,r.-r .. " � V lilt ° a l . t: ; ',O i! ; i t' aAV
; "ii 7 ., r
. r l ,� V ,r Hosc 16.60
r , „t �w�tt >� t: Ice maker 16.60
Business name:
Altera ob. I, T . ,, Interceptor /grease trap 16.60
Contact name: ._ Medical gas (value: S ) Page 2
Address: Primer _ 16.60
City /State/ZIP: Roof drain (commercial) 16.60
Phone: ( ) Fax:: ( ) Sink/basin/lavatory -. 16.60
E -mail;
Tub/shower/shower pan 16.60
i
: : { !],vii` ....� & i. ` igi r. ° ,Sj IS -0M'ti � ' ''N ` a d l t x an;.ly °m ltrnc .t, . .,; r •* i : >, 4i' ,44' r}? d in - r.. r,,�, �, Urinal
r ; � .. Urit 1 16 GO
S rtti... _ , v:.W11y .. , ..
t,;:44,„,„.,42,4=4,,,,.,,,,,,,, :, wr. r mrixa , 141, =.� ,I .,rr� i > ? '}' '�, =: ':::P
' � ..nxxn'.... I,{ nA�'m� - �� � � r i �� ..J
.:.,..,,.. �I YP�,n• ros "' $� „ •W,�,it�! 1; l�m�I;re;;7a Water closet 16.60
Business name , \ 401. -. lik ik Water hatter 16.60
Address: . �r�i. c • , W • Other.
City/State /ZIP: • • _ ale �, Subtotal
Phone: Minim m permit fee: $72.50 2
� ) l --£�C _ �\L--" _ Cy r )� u ......46. R minimum permit fee: $36.25 -RC • 25
CCB Lie.: r 5 4, 4. 3 V a Plumbing Lie. no,; _ Plan review (25% of permit fee)
Authorized signature '' r _✓ State surcharge (8% of permit fee) Z • 9A
TOTAL PERMIT FEE T.al
I t, � N Print name: $ y �_ 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•Couniy Building Industry Service Board.
I: \IIuilding ermits\PLM- Permirnpp 06/26/06 440.4616T(IWW02/(^4)m/wEti)
07/26/.2007 THU 9 :55 FAX 5036200590 SW Landscape LLC Z003/004
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
•
Fee Schedule: Residential Fire Suppression S'stcros:
xf y... -_f V .. is. ...._. L,. ,r, tlfs' n , idkkdie%ii' '' f .! MA v i ^^9 n.
_ _ M: A �4..R_.�/'�.; ;:tit;:, ''il.' I' - Ri i i" 1{ - t'i'i`e "w "' -i 1�" }t'w 1W 4 daPtAdavl;µwrausrism;r ; .i , i � ".�ESSf')Y'.!*
i
kl _. t,Y.;S;S;I.'W3itE diftWll'
.... $�d .�-.- ..�:;= :.....- „- � ,�trta�:::: tatldu ' �,:. , �� „ a ��ii B �s;;���ct+��l:��a _-. tt� .43��. m � � ' ,��e;�,..
i :i + 'ii... iR.., , p�..,..
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
S - 3,601 to 7,200 $220.00
Sewer 1st 100'
55.00 7,201 and greater $309.00 •
Sewer - each additional 100' 46.40
Water Service - 1st 100' 55.00 Medical Gas S stems:
Water Service - each additional 100' 46.40 ...,r-, .� M, / O�1I�� `
- ...r : -... ,u rST i i I' ,R
- sYllla �TiD 3 Y :�:1:$SMSIiW;OtitN }tA+ 1, :Pa`)SI�J �',".1Fil %µ % sit Gil.' t�31' ';�lir4iMZi. {,IAIA'.,A-, :.
Storm & Rain Drain - I st 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
i ' :3t;i+ � i i:;. :ti :;i,A = ic.::i:.l 0 : : ;xc::; I :. 3 tt •'-'. y u 100.00 or faction thereof, to and
'}� �r , p y� T IC bh+,y�� yy y; �� y �y y ll!,y �y y�� � ��� p j �}r, x { gamma 1j .L,L i'1':.1M ::: .4R „� a 1AHl YlYf.V,V.{AMN1Pl11Ml iN RW {{ '�; it A :!.T�.'!1?¢y% iliear.,rdlf[M {ff� ∎1i,a ,. f�dA {d V.t�1.A1i1 additional $
- 1 1
" including $I0,000.00.
Commercial Back Flow Prevention Device 46.40 $ 10,001.00 to 525,000.00 $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
g
_specially requested inspections - per hour 72.50 and includira $50,000.00.
Subtotal: $50.001,00 and up $742.00 for the first $50,000.00 and 51.20 for
• each additional $100 -00 or fraction thereof.
•
FRN ,RA I RIA
Fixture Work: r
1 � ��11��� ��, .... -,.. ......:::- .�.._;,,n ar
� � -�� �� bta�a�
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 re , ort fixtures could result in increased sewer fees*. ❑ Any new commercial building with water service 2" and
n
tnrgd "�+.f ,; ;?fidvf v i ° � 4,tb _d Mi . '- �. ° " n _ . " � "; .... f greater, except systems designed and stamped by licensed
, ryW "- � i Yr, ' i:.:..; �' , ;:.... ;>" .. /! . �' � )P''1'!11Y�tlndivii
...f._,a'. ,tit C �1� aSs� a ki { F'ia�1�i .A.
p ■Y }, p.,
at engineer.
4T
; .. A dllt!]p r S v_ vxf , i fEfµ9l; �Cr x 'IV ... ".i i ' �.' i�tt� +1`S4f1'���' b
FMit:.;......�:.:,- „r_.l.r , . +NinrE�At:,::::�APP/tdlr,” tb� ' d� #d:.�,;. _':��'tri�r�T:l!. ❑ Any new exterior plumbing site utilities.
Baptistry/Font ❑ Medical gas and vacuum systems for health care facilities.
Bath -Tub /Shower ' ❑ Any multipurpose fire sprinkler system.
- 3acurci/Whirlpool ❑ Any complex structure as defined in OAR918 -780 -0040_
Car Wash -Each Stall
- Drive Tluu Submit 2 sets of plans with any of the above.
GuTidor /Watcr Aspirator ,
Dlsltwasher' - Commensal
r ,,., - µG; .: 4; y R..4..i.!vFs U i, 1 [ I IO11EA91�J'JM121NI5(IJ�;II,
�6 +intlt''1 z ta>ru
x -: _- :.- ::.:,.:Y,:. . . ....::........ l r i •Q! g,' ..1....... �i#ra4rfi�;r�rs -;; ��: =�:
Drinking Fountain U Isometric or riser diagram is required for new buildings
Eye Wash that meet the qualifications above.
Floor Drain/sink - 2•'
-3 „
4 Comments regarding fixture work:
Car Wash Drain
Garbage - Domestic
Disposal - Commercial
- Industrial
Ice Mach. /Refrig. Drains
Oil Separator (Gas Station)
Rec. Vehicle Dump Station
Shower - Gang *Note: If the fixture work under this permit results in an
Siva increase of sewer EDUs, a sewer permit will be issued and
Sink Bar /Lavatory fees assessed for the sewer increase must be paid before the
- Bradley P
-Commercial plumbing permit can be issued.
- Service
Swimming Pool Filter
Washer - Clothes
Water Extractor _
Water Closet - Toilet
Urinal
Other Fixtures:
is\ Building \E'knnia\I'LM- ra 09/22/Ot
CITY OF TIGARD
BUILDING DIVISION PERMIT #: PLM2007 -00333
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 712712007
Phone: (503) 639 -4171
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 7/30/2007 TIME: 7:02AM PAGE: 35
SITE ADDRESS: 13629 SW CLEARVIEW PL CLASS OF WORK:
SUBDIVISION: BENCHVIEW ESTATES LOT #: 046 TYPE OF USE:
PROJECT NAME: GRAY
DESCRIPTION: Install backflow device.
OWNER: GRAY, RYAN PHONE #:
CONTRACTOR: SOUTHWEST LANDSCAPE LLC PHONE #: 503.620- 0149
Inspection Request Scheduled For: Date: 7/30/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
395 Misc. inspection 052964 -01 503 -620 -0149 N
Co /Comments / Instructi y' P Re
c- c( a- a. I.e z{ Y
PASS PARTIAL APPROVAL I I CANCEL NO ACCESS
I I FAIL n CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED
Inspector: �lU 1 / � ^� Date: 74(407 Phone #: (503) 718 -
r