Permit i-
z) M r CITY OF TIGARD
�:� a +: PLUMBING PERMIT
COMMUNITY DEVELOPMENT PERMIT #: PLM2007 - 00063
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 2/15/2007
PARCEL: 2S 111 AD -19300
SITE ADDRESS: 14811 SW JONAGOLD TERR ZONING: R -4.5
SUBDIVISION: LADY APPLE LOT: 017 JURISDICTION: TIG
PROJECT: LADY APPLE
Project Description: Backflow preventer 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
BEACON HOMES NW. INC
12703 SW 67TH AVE Description Date Amount
TIGARD, OR 97223 [PLUMB] Permit Fee 2/15/2007 $36.25
[TAX] 8% State Surcha 2/15/2007 $2.90
Phone : 503 -570 -8828 Total $39.15
Contractor:
CONTOUR LANDSCAPING INC
12485 SW TOOZE RD
SHERWOOD, OR 97140 REQUIRED ITEMS AND REPORTS
Contact # : PRI 503- 682 -1302
FAX na
Reg #: LIC 5698
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: 16J-0 6 " 4 ,
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.
,I
',/ Plumbing Permit Application i ,.. : IOR 0F: ICE JSLOiLY ' .1, ,::.'
City of Tigard � � ® "� / .S �J � permit NoI)\ML 1/�0 1'000(, 3
v 13125 SW Hall Blvd, Ti � " ./ '�' DaleBy
°I� Tigard, OR 97223
P lan Review
Phone: 503.639.4171 Fax: 503.598.119 Date/By.
Permit No.:
Inspection Line: 503.639.4175 r L B fl 2007
Ti G A R D - Date Ready/By: Juris: ® See Page 2 for
i Internet: www ttgard or.gov CITY OF i Notifi�Method Supplemental Information
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' `ate'' ,R.,°,(TYPE OF WO e i : ° FEE'S SCHEDULE ?+t " ' °
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New construction ❑ Demolition For special information use checklist -
Description I Qty. Ea. I Total
❑ Addition /alteration/replacement ❑ Other: New 1 dwellings (includes 100 ft. for each utility connection)
� Y� * a a r `tC #4,9019 NSTRUC CION 5i 0 � k'� R ,
�"`� �"� _. w� � �; ; , �.., Nn ��:��. �� �„��.�.��..< -,� � -� di . � � � SFR (1) bath 24920
19 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
❑ Other: Fire sprinkler ( , sq. ft.) Page 2
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Job site address:
/1 S to 1 • $/ -reiL Catch basin or area drain 16.60
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City /State/ZIP: 'I X ' c. /L Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: l Project name: L,�.�• �7 Footing drain (no. linear ft.: ) Page 2
L Manufactured home utilities 110.00
Cross street /directions to job site: f `e' J� Manholes 16.60
S A : ca �i't�'1_ Rain drain connector 16.60
Sanitary sewer (no. linear ft.: ) Page 2
Storm sewer (no. linear ft.: ) Page 2
Subdivision: I Lot no.:
/ -1 Water service (no. linear ft.: _) Page 2
Fixture or item
Tax map /parcel no.:
Absorption valve
..1; :. w . X ...-,;., .� ,. „, .,,,, sore a e 16.60
icl t .,, '` DE_SCRPTION oFA r v
, » M=41, Back flow preventer I Page 2
3p...., ��' � � �.�N�f +,r�._ .., .:,�,vh���� �W,ORK�:, � $,.�v. ���n , �' °�'. o,�r�,
L ,..- / . _jd t... SO ,�,,■ Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
i,� r� hr ai a , e°° ; w, Drinking fountain 16.60
�'��t"(PROPERTY, ttOWNER � } }�° ®�'fENANT�'���'
n ..ri, t h ..i ,.n. •,u Ejectors/sump 16.60
Name: • '
j� •�.fl- r�rti' -) � .,..,, -rn i i\-/v'` ) Expansion tank 16.60
Address: t r.) p . S LO 6 '7 i- _€ Fixture /sewer cap 16.60
City /State/ZIP: . 1 l e l -a•, �' , Q. '7 - 3 Floor drain/floor sink/hub 16.60
Phone: (-Sb)) U? L'3 % 3 Fax: ( ) Garbage disposal 16.60
y "" • p :s, �+ �:�r� s -r i . xx,- e roc x Hose bib 16.60
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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: ( ) Fax:: ( ) Sink/basin/lavatory 16.60
Tub /shower /shower pan 16.60
E -mail:
y '.' r ;
rv8 ,. . . t ,, z ,. . , ; _ . ; r s„ Urinal 16.60
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�.i`.'3�r�3f�'. >��,, 4,,n� -a'u" Water closet 16.60
Business name: C.O 1 In.� Water heater 16.60
Address: , c'} t-/ SLJ To 1.-3 ( Other:
City /State /ZIP: S 0- ') "1 t`-? C3 Subtotal
Minimum permit fee: $72.50
Phone: (S0 3 6,s93 - / 3 p 'e- Fax: ( ) `S o•,y`q-- Residential backflow minimum permit fee: $36.25
CCB Lic.: , 9 X Plumbing Lic. no.: Plan review (25% of permit fee)
' � n State surc (8% of permit fee)
,t 6,...,,,,,o,...,„..) Authorized signature: Y t l
TOTAL PERMIT FEE Wig, f,]
Print name: Ipt/� j`-- 6,5-1,_.) 0 .--1/4i Date: 2/ /5107. 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 \PLM- PamitApp.doc 06/26/06 440.4616T(10l021COM/WEB)
Plumbing Permit Application - City of Tigard `
•
_
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Slte Utlifies r� �_q Qty ` as Fee (a) Total r s r =
, iS.quare aPermrtu]Fee ��� .
Footing drain - l a 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 axi xry x yF
Storm & Rain Drain - 1st 100' 55.00 .:aluation.;Perm><tFee ;t'..,.
$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
zFagtur&or Item r iat `Qty fir' zyce(eaj Total' additional $100.00 or fraction thereof to and
,' ;^ • kx ' . 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 Back Bow 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
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,,Rev><ew..for�• k umtiing�Instaliahons,u
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
greater, except s stems designed and stamped 8� Y des gn s by licensed
-•a ., :� 3 �; '�OoaotitY. tiy'(Fixtirre)`�Work' PeFf'ormed'..V'
E F.t. s en neer.
•Future T u Rea
..•.: )' A Previiius . capped s- `;i4dded E isnnq.#. ❑ 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 ' � IsO netnc, Ot RlSer m � ,
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 Comments regarding fixture work:
Garbage - Domestic
Disposal - Commercial
- Industrial
Ice Mach./Refrig. Drains
Oil Separator (Gas Station) -
Rec. Vehicle Dump Station
Shower -Gang
- Stall *Note: If the fixture work under this permit results in an
Sink - Bar/Lavatory increase of sewer EDUs, a sewer permit will be issued and
- Bradley fees assessed for the sewer increase must be aid before the
- Commercial p
Service plumbing permit can be issued.
Swimming Pool Filter
Washer - Clothes
Water Extractor
Water Closet - Toilet
Urinal •
Other Fixtures: •
is�Bwlding \ Permits \PLM- PermitApp.doc 09/22/06
CITY OF TIGARD
BUILDING DIVISION PERMIT #: PLM2007 000163
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 2/15/2007
Phone: (503) 639 -4171 ���WjmP )i
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 41/7/2007 TIME: 7:0'1AM PAGE: 2
SITE ADDRESS: 14811 SW JONAGOLD TERR CLASS OF WORK:
SUBDIVISION: LADY APPLE LOT #: 017 TYPE OF USE:
PROJECT NAME: LADY APPLE
DESCRIPTION: Backtiow preventer for irrigation.
OWNER: BEACON HOMES NW. INC; PHONE #: 503 - 570 -8828
CONTRACTOR: CONTOUR LANDSCAPING INC PHONE #: 603 - 682 - 1302
Inspection Request Scheduled For: Date: 4/17/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
395 Misc. inspection 046642-01 503 - 320.0183 N
Corrections /Comments /Instructions:
ce .,rc1
PASS ❑ PARTIAL APPROVAL ❑ CANCEL n NO ACCESS
FAIL I I CALL FOR INSPECTION f l ADDITIONAL FEES ASSESSED
Inspector: Date: clinic Phone #: (503) 718-
, t