Permit CI TY OF TIGARD PLUMBING PERMIT
DEVELOPMENT SERVICES PERMIT #: PLM2005 -00653
11 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 11/2812005
PARCEL: 2S 104BC -09200
SITE ADDRESS: 14010 SW KARLEY CT ZONING: R -7
SUBDIVISION: HILLSHIRE CREST LOT: 014 JURISDICTION: TIG
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
RIDGECREST CONSTRUCTION CO INC
6600 SW 92ND AVE # 100 Description Date Amount
PORTLAND, OR 97223 [PLUMB] Permit Fee 11/28/200E $36.25
[TAX] 8% State Surcha 11/28/200E $2.90
Phone : 503- 246 -8808 Total $39.15
Contractor:
CONTOUR LANDSCAPING INC
12485 SW TOOZE RD
SHERWOOD, OR 97140 REQUIRED ITEMS AND REPORTS
Phone : 682 -1302
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:
L , �
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.
>,.. Building Fixtures
Plumbing Permit Application_
� ic { a.ti.on , FOROFFFICE' USE ONLY
City of Tigard J +
U iI� ReceiDateB vey / r t�J� - Permit No.? 1 \
L , v y
13125 SW Hall Blvd., Tigard, OR 97223 n , Plan Review
Nov Phone: 503.639.4171 Fax: 503.598.1960 „a.Nr „ 'x Other Permit No.:
24- Hour Inspection Line: 503.639.4175 5 / � ' 200 UH ,' . - "i i 1 Date/ By.
Internet: www.ci.tigard.or.us • ,, "� - Date Ready/By: luris: S3 See Page 2 for
g r rT" Notified/Method: /I ,� Supplemental Information
4-01 . 1 t Wit t l d'S?1L) -
TYPO OFW�O RK D � tt � F _ FEE* SCHEDULE
New construction ❑ Demolition For s ecial in ormation 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
' Z 1 - and 2 -family dwelling ❑ Commercial /industrial SFR (2) bath 350.00
CI Accessory building ID Multi-family SFR (3) bath 399.00
1:1 Master builder Each additional bath/kitchen 45.00
❑ Other:
Fire sprinkler ( sq. ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities •
Job site address: ' Li 010 . w le A IL( ,,,` T , 6 9 7 - , Catch basin or area drain 16.60
j j
City /State /ZIP: . 641,--P Drywell, leach line, or trench drain 16.60 •
Suite/bldg. /apt. no.: I Project 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: 41 lb I) t D C 0 Q .-5r I Lot no.: i L. Water service (no. linear ft.: ) Page 2
1 Fixture or item
Tax map /parcel no.: Absorption valve 16.60
DESCRIPTION OF WORK Backflow preventer Page 2
S TYw�� ,S e c.v...., Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
Drinking fountain 16.60
: . PROPERTY OWNER . - ' ■ "TENANT
II -- Ejectorslsump 16.60
• Name: pdi_e•mc,5r C1r'v e$ Expansion ta 16.60
Address: 00 SL q), -c . Fixture /sewer cap 16.60
City /State /Z[P: 0 PL. Floor drain /floor sink/hub 16.60
L'
Phone: ( o3 ) Lj b - ga U Fax: ( ) Garbage disposal 16.60
PPLICANT . • ' Hose bib 16.60
❑ A
❑_ CONTACT PERSON '
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: Urinal 16.60
- CONTRACTOR. - ' ; , • Water closet 16.60
Business name: �-✓t t4 (,''(L /* IUD 5c . p i i Water heater 16.60
Address: 144 iS 100 b0� Z( Other:
Subtotal
City /State /ZIP: 0 (� 11 I/ 0
t Minimum permit fee: $72.50
Phone: (S 68 ). -i ( 3 '1+7y Fax: ( ) 5-1fys--'- Residential backflow minimum permit fee: $36.25
CCB Lic.: 5 6 g e , ,,: ' /5Ye _Plumbin Lic.. no.:_ . __ _ .. _ Plan review (25% of permit fee)
State surcharge (8% of permit fee)
Authorized signature: Tt � TOTAL PERMIT FEE 3 1 Js
• Print name: 'P�-UL i --, \ � i -p j *) Date: i i t i a i 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.
is \Building\ Permits\ PLMF - PermitApp.doc 06/05 440-4616T(10/02/COM/WEB)
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
�
''� Site ,Utilities , , ` ` - -Qty. 1 Fee (ea) ` Total Square Footage; Permit Fee;, - ,
.,Footing drain - 1 100' 55.00 0 to 2,000 / $115.00
F Ling drain - each additional 100' 46.40 2,001 to 3,600 / $160.00
3,601 to 7,200 / $220.00
Sewe 1st 100' 55.00 7,201 andgreatFr $309.00
Sewer - • :, h additional 100' 46.40
Water Service - 1st 100' 55.00 Medica Gas Systems:
Water Service - -: ch additional 100' 46.40
Storm & Rain Drain 1st 100' 55.00 Valuate l n: ' ', Permit fee: - .
. -
$1.00 to $ ,000.00 Minimum fee $72.50
Storm & Rain Drain - • . • additional 100' 46.40 $5,001.01 to $10,000.00 $72.50 for the first $5,000.00 and $1.52 for each
' Fixture or I tenl' ' ' 'Qty. Fee (ea), Total additional $100.00 or fraction thereof to and
including $10,000.00.
Commercial Back Flow Prevent : Device 46.40 $10,00 .00 to $25,000.00 $148.50 for the first $10,000.00 and $1.54 for
Residential Back flow Prevention De 'ce each additional $100.00 or fraction thereof, to
I (minimum permit fee $36.25) 27.55 and including $25,000.00.
Rain Drain, single family dwelling 65.25 $25,1.11.00 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 $50,000.00.
Subtotal: $5 1 and up $742.00 for the first $50,000.00 and $1.20 for
each additional $100.00 or fraction thereof.
Fixture Work: Plan, Review for .Complex'Structures
Are you capping, adding or replacing fixtures? If "yes ", A "complex structure" is defined as an installation of a plumbing
please indicate work performed by fixture. Failure to system that meets any of the following criteria.
accurately report fixtures could result in increased sewer fe s ' Please check all that apply.
Quantit by (Fixture) Work Performed ❑ Any new commercial building.
Fixture :Type: Replac ❑ Any new exterior plumbing site utilities.
Previous 'Capped" Added, Existi • A commercial building with installation, alteration or addition
Baptistry/Font of nine (9) or more new or relocated plumbing fixtures.
Bath - Tub /Shower ❑ edical gas and vacuum systems for health care facilities
' - Jacuzzi/Whirlpool • •viding services to human beings.
Car Wash -Each Stall ❑ Pl • bing installations, alterations or additions to food service
-Drive Thru facili s where new plumbing fixtures, including interceptors,
Cuspidor /Water Aspirator - - are bei installed for the food service area.
Dishwasher - Commercial - El Any new -sidential building containing three (3) or more
- Domestic dwelling un s.
Drinking Fountain El Any NFPA Submit 2 1 D multipurpose
wi fire any spriof nkler the system.
Eye Wash
Floor Drain /sink - 2"
s e fi h r
above .
-3"
-4
Car Wash Drain . Isoinetri or.Riser Diagram' - . '
Garbage - Domestic El Isometric or riser dia a.s m is required for new buildings
Disposal - Commercial M,- three (3) or more storie 'n height.
- Industrial
Ice Mach. /Refrig. Drains
Oil Separator (Gas Station) Comments regarding fixtu e work:
Rec. Vehicle Dump Station
/
Shower -Gang •
-Stall
Sink -Bar/Lavatory /
- Bradley
- Commercial
- Service
Swimming Pool Filter
Washer - Clothes / *Note: If the fixture work under this permit results in an
Water Extractor/
Water ClosetdToilet increase of sewer EDUs, a sewer permit will be issued and
Urinal fees assessed for the sewer increase must be paid before the
Other Fixtures: plumbing permit can be issued.
i:\ Building \Pemiits\PLM- PermitApp.doc 07/06/05
I - ' . - - - ■ , ■ -.- - _
CITY OF TIGARD .
BUILDING DIVISION PERMIT it: PLM200500653
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 11/28/2006
Phone: (503) 639-4171 . / A
N411 li?\
Inspection Requests (24 Hrs.): (503) 639-4175 ,,, : J.11• -.... •
INSPECTION WORKSHEET FOR DATE: 12 TIME: 7:18AM PAGE: 1
SITE ADDRESS: 14010 SW KARLEY CT CLASS OF WORK:
SUBDIVISION: HILLSHIRE CREST LOT #: 014 TYPE OF USE:
PROJECT NAME: HILLSHIRE CREST
DESCRIPTION: BacHlow preventer for irrigation.
OWNER: RIDGECREST CONSTRUCTION CO INC, PHONE #: 503-246-8808
CONTRACTOR: CONTOUR LANDSCAPING INC PHONE #: 682-1302
Inspection Request Scheduled For: Date: 12/2/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
325 RP/backflow preventer 022862-01 503-320-0183 N
Corrections/Comments/Instructions:
r a4( 5
•
•
j :Ass EI PARTIAL APPROVAL El CANCEL 0 NO ACCESS
I I FAIL I I CALL FOR INSPECTION 0 ADDITIONAL FEES ASSESSED
, Inspector: Date: 4" Phone #: (503) 718-