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Permit C ITY OF TIGARD PLUMBING PERMIT " G i .. DEVELOPMENT SERVICES PERMIT #: PLM2005 -00214 - 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 5/25/2005 PARCEL: 2S 109AD -AS025 SITE ADDRESS: 14810 SW GREENFIELD DR ZONING: R -7 SUBDIVISION: ARBOR SUMMIT LOT: 025 JURISDICTION: TIG Project Description: 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 WEST HILLS DEVELOPMENT Description Date Amount 15500 SW JAY ST BEAVERTON, OR 97006 [PLUMB] Permit Fee 5/25/2005 $36.25 [TAX] 8% State Surchari 5/25/2005 $2.90 Phone : 503 641 - 7342 Total $39.15 Contractor: TRADEMARK LANDSCAPES, INC. 18478W WALKER RD. REQUIRED ITEMS AND REPORTS OREGON CITY, OR 97045 Phone : 503- 631 -3890 Reg #: PLM 6796 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 direct questions to OUNC by calling 503 - 246 -6699 or 1- 800 - 332 -2344. - Issued By: �Q' 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. ., t P1l mbing Permit Ii " CO L�OM L -- • FOR OFFICE USE ONLY ` City of Tigard Received �, g Permit No7 �\\ / 13125 SW Hall Blvd., Tigard, OR 972.2 '( 2005 Date/By: S �� Q� 1 I��vV, Q( � � / 1( •� Plan Review Phone: 503.639.4171 Fax: 503.598.1960 4w l'i� ;u� I 1' I i\ Date /B Other Permit No.: IX- 24 Hour Inspection Line: 503.639.t7 \( OF nGP B _ II Internet: www.ci.hgard.or.us , 111 n1NG DIVISION. ■ ^ -� Notified/Method: J 1 I I/ Supplemental plemental Information See Page 2 for r esw ?`., e'.<A . ^'.z a :Z-N , ^:A ".* ;�' =:.P.'t�^'s:';C++ri . U v4;.!4:g "r "�..m':`: x' .;< r i, ^ '•' :- c+_,4 :: Ni-...s,£ - - ". ^^•w > ^ . . _. .. .,';.�,"»'^±-"`,..u.+.y�.",: ", at':• N . ,-•'n�"` a " <? :t.... ' �t z � i' , 4.. vni: *S��r' ".S° it _, , : -r I'PE,, O : WO , _ ' °FEE :S'GHEDiJi E st' � Vii,- a': .`� », .,G?=^ RK .. <=c z-,,, , :dip ew 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) :Oar - r`,r�,: -Y �'.� ^:a wa u.; �! �'. �<TX j <�;.,a: ; °.: � <ry;s.�mea � . , *� i �°` °s - _`.- : , w ^ i .�,� + ' : �� � a : 61 NS G T,IO N w r =• a . 4 ; 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 WIC (IC FLO Each additional bath/kitchen 45.00 'Other: !T` �; �. �.; .. >".. , ��;�tm >. �;: %x r ..,�e ^ Fire sprinkler ( sq. ft.) Page 2 , " ' OB S TPE ,I N F ORMA1j ON'` =A1 D• OGAETON "> 4 � 1- .�° � - x §h..:, cu.�s /, - vs s� :._ zua „ ., �,,�.- . 1 Site utilities Job site address: 1 ! 3/ (/ t l W V l '1 EE V F1 C (� D Pie. Catch basin or area drain 16.60 City/ State/ZIP: 'nao9 o^ 2� Drywell, leach line, or trench drain 16.60 Suite/bldg. /apt. no.: t , Pr ject name: 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: pclic ,St4 MM I T I Lot no.: 2 5 Water service (no. linear ft.: ) Page 2 Fixture or item Tax map /parcel no.: :y -1 = - M . - , w ::�:,: m : •. fi , = ; : r. Absorption valve 16.60 ) _ wa .' ,., q . 1 , . C RI P T J O N O A W Q RT C, '•x� t a ° - ?`;. , ..„ „,'.; a. , Backflow preventer Page 2 /^ � 3� /CC 4°11/ Pitt Y % Backwater valve 16.60 Clothes washer 16.60 Dishwasher 16.60 r mow. : -K 5r , g, Drinking fountain 16.60 <r R�PERTX ©WNER . , ..*AP a rA4, , m '''`�. .I � .i '. 5 .;.TENAN . 4 w . i �/�R . . Ejectors /sump 16.60 Name: WEST it I Lis D E V C W pm ENT Expansion tank 16.60 Address: /5,56o ,Sh' Vt T (/ s7. Fixture /sewer cap 16.60 City/State/ZIP: .Da V acol OR 97006 Floor drain /floor sink/hub 16.60 Phone: ( 503) 6 Y1' 73 y2 x 2 Fax: ( $13) 6H 1... - MA I Garbage disposal 16.60 > .,:01,>u,.tc -7 M.it,Mitic 6 t war t #40 Hose bib 16.60 1- �r Ice maker 16.60 Business name: W / f l a D W &Ophi our Interceptor /grease trap 16.60 Contact name: ((K V7n/fC1? Medical gas (value: $ ) Page 2 Address: 500 P / 430 VC Primer 16.60 City/State /ZIP: / Roof drain (commercial) 16.60 Phone: ( ) F ax:: ( ) Sink/basin /lavatory 16.60 Tub /shower /shower pan 16.60 E -mail: - .;:. -% : < °'az' - „.., ,. <l; {3. Urinal 16.60 = t _: ° 41, : ited 'w i . ' :t om :.s° RAC7'OR.: „�: � ��:� -�.. 6.60 � , - .� g ;:)` <,� �. �.. �„ :t,�;a;. ^�,- _s�.�.. :_ ......�:. ,,r�: <-�:: ,��; C � � � � h . � .��:x�°� �- ; �:.; : ,.. � �,...., W ater closet 1 Business name: TR LANb S�PZ Water heater 16.60 Address: Po 'Ox 7.!/ /O Other: _/ j Subtotal City/State /ZIP: ORE CiTT' Oaf ( J 7a9JC' Minimum permit fee: $72.50 Phone: (S -03) Je-a y - Zo 1 3 Fax: ( ) Residential backflow minimum permit fee $36.25 CCB Lie.: I 1 35 Plumbing Lic. no.: Plan review (25% of permit fee) / - State surcharge (8% of permit fee) Authorized signature: ' TOTAL PERMIT FEE Print name: RiCk G4„1wre,t" Date: 5 2 5 0s- 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 \PLM- PermitApp.doc 12/03 440- 4616T(10 /02/COM/WEB) Plumbing Permit Application - City of Tigard ,, Page 2 - Supplemental Information ' Fee Schedule: Residential Fire Suppression Systems: S 1 te1M. AP A P,s -. 0 r Q e� r eC a} : I: " ; S q uare.: , •'„ -• of rmit1 . 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 ,' ;,' < ° itr'-' 7'4::• ,, ' ?.' ' e , :,: v n l Vaue' ion. 'L' P rmit 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 ;•<_ � • �a;T,, ; 1 ; -�;,r: > ;3F; " w ; " additional $100.00 or fraction thereof, to and w F xture or Item " _ Qty el ) m otet" u,_ . x_;��.a �=.. ��... � �q ��� �. * �...�:v% � 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 5 $25,001.00 to $50,000.00 $379.50 for the first $25,000.00 and $1.45 for Ins ection of existing plumbing or each additional fraction thereof, to P g p g and 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: . .. • . . . • 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*. . . . ' �Quan1�ty�by Frxdi e) oc�lcPerformed , - Fiitti Type 4 a 0 "`` ; a R l e 4 ,.; 3 g iv- A t 4,1,:1:', . o e a , x i c 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 r 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 increase of sewer EDUs, a sewer permit will be issued and Ice Mach. /Refrig. Drains 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 Isometric or riser diagram is required if fixture quantity - Commercial 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- PemtitApp doc 3/03 V CITY OF TIGARD BUILDING DIVISION ' v PERMIT #: PLM2005 -00214 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 5/25/2005 Phone: (503) 639 -4171 ./Af 1plpi�l1'�hl Inspection Requests (24 Hrs.): (503) 639 -4175 .���■ INSPECTION WORKSHEET FOR DATE: 6/27/2005 TIME: 7 :10AM PAGE: 44 SITE ADDRESS: A4810 SW GREENFIELD DR CLASS OF WORK: SUBDIVISION: ARBOR SUMMIT LOT #: 025 TYPE OF USE: PROJECT NAME: ARBOR SUMMIT DESCRIPTION: Backflow device. " OWNER: WEST HILLS DEVELOPMENT, PHONE #: 503 -641 -7342 CONTRACTOR: TRADEMARK LANDSCAPES, INC. PHONE #: 503 -631 -3890 Inspection Request Scheduled For: Date: 5/27/2005 Pour Time: Code # Inspection Description Confirm # Contact # Message 325 RP /backflomt preventer 007916 -01 503 - 319 -7664 N Corrections /Comments /Instructions: 1 q-e V.jL{3 C' .e-----20 C/ (S k)) - 30f CI i 7 l (iv K PASS n PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS ❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES - ASSESSED " �` Inspector: ' " Date: �/27/& Phone #: (503) 718-