Permit S I
r i t ill' ' , 1 CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT
PE
COMMUNITY PLM2007 - 00344
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 8/6/2007
PARCEL: 1S134DB-07700
SITE ADDRESS: 11222 SW FOREST LN ZONING: R - 4.5
SUBDIVISION: STONECHASE LOT: 001 JURISDICTION: TIG
PROJECT: STONECHASE
Project Description: Install residential 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
FOUR D CONSTRUCTION CO.
PO BOX 1577 Description Date Amount
BEAVERTON, OR 97075 [PLUMB] Permit Fee 8/6/2007 $36.25
[TAX] 8% State Surcha 8/6/2007 $2.90
Phone : 503 -590 -0805 Total $39.15
Contractor:
CROWN LANDSCAPE INC
STEPHEN HARMS
22821 BOONES FERRY RD REQUIRED ITEMS AND REPORTS
AURORA, OR 97002
Contact # : PRI 503- 678 -7900
Reg #: LIC 6181
PLM 14939
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 9 2- 0001 -0100. You may obtain copies of
these rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344. \
1
--S)
Issued By A / 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
FOR OFFICE USE ONLY
City of Tigard Received
Date/By: (O/ y: S / ! / S Permit No PI 1
i 1 `7 7M� ��
I
- q 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 Other Permit No.:MSl bo( bout,
Inspection Line: 503.639.4175 Date /By: 10
/ T I G AR D Date Ready /By: Internet: www.ti azd -or. ov pi er., S See Page 2 for
g g Notified/Method: Supplemental Information
TYPE OF WORK FEE* SCHEDULE
❑ New construction ❑ Demolition For special information use checklist
Description Qty. Ea. Total
❑ Addition/alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. 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
Each additional bath/kitchen 45.00
❑ Master builder ❑ Other:
Fire sprinkler ( sq. ft.) Page 2
JOB SITE INFORMATION AND LOCATION. M Site utilities
Job site address: ff 2 22 $W AweS 1/% Catch basin or area drain 16.60
City /State /ZIP: 776"y2,4 , p/L Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: J Project name: S7 s E L. >r Footing drain (no. linear ft.: ) Page 2
Manufactured home utilities 110.00
Cross street/directions to job site: 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 t Page 2 a .15
/(/a,/ Bf- ,DI i4 /L y/pr /,l,Q, sys Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
Drinking fountain 16.60
[P ROPERTY OWNER I ❑TENANT
/ Ejectors /sump 16.60
Name: Cn,4 3 f • Expansion tank 16.60
Address: /� 0 . /SAC /5 7 7 Fixture /sewer cap 16.60
City/State /ZIP: / Aviv t dIL- -/ 707s' Floordrain/floorsink /hub 16.60
Phone: (503 ) 7, ,p - O p 2_ Fax: ( ) Garbage disposal 16.60
❑ APPLICANT ❑ CONTACT PERSON Hose bib 16.60
• 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: Sink/basin/lavatory 16.60
( ) Fax:: ( )
Tub /shower /shower pan 16.60
E -mail: Urinal 16.60
CONTRACTOR . • Water closet 16.60
Business name: GRer..i./. 4 Ps Water heater 16.60
Address: / 13mrvg$ A� Other:
Z 2� Z Subtotal
City/State/ZIP: 1 d d 7 'oo Z
U�p� / Or Minimum permit fee: $72.50
Phone: (67i) ••- 7 Too Fax: ( ) Residential backflow minimum permit fee: $36.25
C ► i Lic.: 6 ! g7 in , , /J?/ 0 ; Plumbing Lic. no.: 14 • 1 Plan review (25% of permit-fee)
State surcharge (8% of permit fee) Z..1 D
Authors. d signature: / 3/ TOTAL PERMIT FEE iq.
Print na;;, .
�. Date � � 0 ' This permit application expires if�a permit is not obtained within
44; 1 8 0 days after it has been accepted as complete.
*Fee methodology set by Tri- County Building Industry Service Board.
I:\ Building \Permits \PLM- 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 '' ' • . Qtr 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 100' 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
Inspection of existing plumbing or each additional $100.00 or fraction thereof, to
specially requested inspections - per hour 72.50 and including O.GG.
Subtotal: $50,001.00 and up $742.00 for the e first rst $50,000.00 and $1.20 for
each additional $100.00 or fraction thereof.
Fixture Work:
Are you capping, adding or replacing fixtures? If "yes ", Plan Review for Plumbing Installations
please indicate work performed by fixture. Failure to Plan review is required for any of the following. , •
•
accurately report fixtures could result in increased sewer fees ' Please'check all that apply. ,
Quantity by(Fixture).Work.Performed. ❑ Any new commercial building with water service 2" and
Fixture Type: Replace greater, except systems designed and stamped by licensed
Previous Capped Added Existing engineer.
Baptistry/Font
Bath - Tub /Shower ❑ New exterior plumbing site utilities for any complex structure
as defined in OAR918- 780 -0040.
- Jacuzzi/Whirlpool .
Car Wash Each Stall ❑ Medical gas and vacuum' for health care facilities.
Drive tall ❑ Any multipurpose fire sprinkler system.
Cuspidor/Water Aspirator ❑ Any complex structure as defined in OAR918- 780 -0040.
Dishwasher - Commercial
Domestic Submit 2 sets of plans with any of theabove. - •
Drinking Fountain
Eye Wash , ' Isometric or Riser Diagram '
Floor Drain/sink - 2" 0 Isometric or riser diagram is required for new buildings
that meet the qualifications above.
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 •
T I. _ .
-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: -
is \Building\Permits\PLM- PermitApp doe 12/27/06
IZ 004/004
08/06/2007 14:03 FAX 5036787901
R,Lt
'
1I:4 FJj
i LITY OF Tlits'ARt"'
vm --
kdOMMUNITY DEVELOPMENT
i i m m v , 4 7 0 0 ; -
u rri Form
INIPORTANT PERMIT NOTICE
CROWN LANDSCAPE INC
STEPHEN HARMS
22t32.1 OONES PER RD
AURORA, OR 97002
....... _
PE:rmt PU41200700344
I.,Dae issued:
Pa'-c=l: 151340a-07700
Site Address: 11222, SW FOREST LN
S so' STONECHASE
001
Jurisdiction:
- nc
STONECHARE
Cescr0,-.: residentlai bc
s Y our cic <es her7 indici: se the: oc;nii r.hr referenced above. lb 0i r for the
plumbing berrnIt fc) please hove the =ip‘;. ;bor company sign below end return this
Plumping Sgnvu r1,)fin Pri01 to the sta; work, f:.:4 to: City of P,bik,ing Division,
13'125 SW Het E.3.ve'{pen, 05 57223, ;bw
If
yCq, haVE, g:_;estic, cal! 003,
N plumbing inspections wIll be authorized until this form ]ss rSeekted
CONTRACTOR:
FOUR 0 CONSTRUCTION 00, SHOWN LANDSCAPE INC
PO BOX '1577 ',: HARMS
BEAVERTON, OR 57070 22821 F300NES FERRY RD
:f)13RORA, OR 97002
503-590-0805 ;1: 5036787900
'TM ;
AN MK SIG NATU 'RE ',); ON THIS FORM
x
Sinatuf of Authcrize:, piumuer
. ;;;.r:'it',3(1)
p.--= -
s -
CITY OF TIGARD
BUILDING DIVISION PERMIT #: PLIV2007-00:344
13125 SW Hall Blvd., Tigard, OR 97223 i • A DATE ISSUED: 8/6/2007
Phone: (503) 639-4171, heolo
Inspection Requests (24 Hrs.): (503) 639-4175 Ant- 77 E.
INSPECTION WORKSHEET FOR DATE: 8/29n007 TIME: 7:00AM PAGE: 14
SITE ADDRESS: 1 1222 SW FOREST LN CLASS OF WORK:
SUBDIVISION: STONECFIASE LOT #: 001 TYPE OF USE:
PROJECT NAME: STONECHASE
DESCRIPTION: Install residential bacidlovv device.
OWNER: FOUR 0 CONSTRUCTION CO., PHONE #: 503.590.0806.
CONTRACTOR: CROWN LANDSCAPE INC PHONE #: 503-678-7900
Inspection Request Scheduled For: Date: 812912007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
399 Plumbing final 054830-01 503-720-7445 Y
Corrections/Comments/Instructions:
fr
PASS PARTIAL APPROVAL fl CANCEL n NO ACCESS
FAIL El CALL FOR INSPECTION 0 ADDITIONAL FEES ASSESSED
Inspector: CIO Vvr■--)1\ 1) ,-^— Date: g-0 10-7 Phone #: (503) 718-
•