Permit C. ' CITY OF TIGARD
PLUMBING PERMIT
COMMUNITY DEVELOPMENT PERMIT #: PLM2007 -00568
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 12/27/2007
PARCEL: 2S 112C D -16100
SITE ADDRESS: 07953 SW KELSO CT ZONING: R -12
SUBDIVISION: CHURCHILL WOODS LOT: 012 JURISDICTION: TIG
PROJECT: CHURCHILL WOODS
Project Description: Backflow preventer for irrigation.
CLASS OF WORK: ALT 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
WILSHIRE HOMES LLC Description Date Amount
10110 SW N IMBUS
STE B1 [PLUMB] Permit Fee 12/27/2007 $36.25
TIGARD, OR 97223 [TAX] 8% State Surcharl 12/27/2007 $2.90
Phone : 503 -624 -1600 Total $39.15
Contractor:
CONTOUR LANDSCAPING INC
12485 SW TOOZE RD
SHERWOOD, OR 97140 REQUIRED ITEMS AND REPORTS
Contact # : PRl 503 682 - 1302
FAX Same as above
Reg #: LIC 5698
•
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR, Specialty Codes .nd all other applicable laws.
All work will be done in accordance with approved plans. This permit will expire if work is not started \Ai h in 180 day of iss \ ante. or if work is
suspended for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted b , the Oregon tility N tification Center.
Those rules are set forth in OAR 952 - 0001 -0010 through OAR 952 -0001 -0100. You may obtain cock : -. oft ^ese rues or dire t questions to OUNC
by calling 503.246.6699 or 1.800.332.2344.
Issued By Permittee Signatur I
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
BUildi11g Fixtures FOR •OFFICE U ONLY '
City of Tigard Received
Date/By: (y Al 61 CAP Permit No.: ° (,0,07..0ol�Q
lig V 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review (( ((!!
_ - Date /By:
Phone: 503.639.4171 Fax: 503.598.1960 Other Permit No.:
Inspection Line: 503.639.4175 Date Read /B ® See Pa e 2 for
Internet: www.tigard-or.gov gar-or. ov Ready /By:
g
o g Notified/Method: ((� Supplemental Information
' TYPE OF WORK . FEE* SCHEDULE
gNew construction ❑ Demolition For special information use checklist
Description I Qty. I Ea. I Total
El Addition/alteration/replacement ❑ Other: New 1 - 2 - family dwellings (includes 100 ft. for each utility connection)
. • • . CATEGORY OF CONSTRUCTION . ' - . ' SFR (1) bath 249.20
K1- 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
El Master builder ❑ Other:
Fire sprinkler ( sq. ft.) Page 2
- ` JOB' SITE INFORMATION AND LOCATION - ' b ' Site utilities •
Job site address: � 5 :f L " 1. ' Ca tch basin or area drain 16.60
City /State /ZIP: T ( 6-7.6-1---D i� 6 q 7>:, 7 Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: l 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
SubdivisioB MJL42 ,(C( C t.f' ch I Lot no.: rZ- Water service (no. linear ft.: ) Page 2
Fixture or item
Tax map /parcel no.: Absorption valve 16.60
" ' DESCRIPTION OF WORK Backflow preventer ( Page 2
• p vA i /5-i T Backwater valve 16.60
Clothes washer 16.60
��aa Dishwasher 16.60
M- - - PROPERTY OWNER I ID TENANT ° : Drinking fountain 16.60
\ , L' ' ft , ; H CS � ` c Ejectors/sump 16.60
Name: U ` !� C--c-- Expansi on tank 16.60
Address: 1 of ( 0 5C ivi: i/ , Fixture /sewer cap 16.60
City /State /ZIP: l 6 ( 9--e--6 t/ /` - g,.„.0 Floor drain/floor sink/hub 16.60
Phone: 05 („2.__(f /(0-?;) 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
Sink/basin/lavatory 16.60
Phone: ( ) Fax::( )
Tub /shower /shower pan 16.60
E -mail: Urinal 16.60
• CONTRACTOR Water closet 16.60
Business name /V -p7 �/ . - S Water heater 16.60
Address: %- 5'� 1 5r j � % 1� i Other:
City /State /ZIP: � �j� . Z�f �� r L/C' Subtotal
Minimum permit fee: $72.50
Phone: Coe y / 3 (7 r � Fax: ( ) Residential backflow minimum permit fee: $36.25
CCB Liie.: 1 � j e , Plu. . g Lic. no.: Plan review (25% of permit fee)
Authorized signature: [ ��G j ✓� State surcharge -(8% of-permit fee)
777-32/4" TOTAL PERMIT FEE
Print name: PI 04 Date: / 2 __ 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\PLMF- 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' Uti11t1eS'_ Qty. Fee (ea) T otal Square, Footage: Permit Fee: .
Footing drain - IS 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
Storm & Rain Drain - 1st 100' 55.00 Valuation:, . Perm Fee: ,
$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
and including $50,000.00.
specially requested inspections - per hour 72.50
Subtotal: $50,001 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 Plumbing Installations
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
Quantity by (Fixture) Work Performed greater, except systems designed and stamped by licensed
Fixture Type: Replsce engineer.
' Previous Capped Added Existing ❑ 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 ',Isometric_ or Riser Diagram
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
Garbage - Domestic Comments regarding fixture work:
Disposal - Commercial
- Industrial
Ice Mach. /Refrig. Drains
Oil Separator (Gas Station)
Rec. Vehicle Dump Station
Shower . -Gang
-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:
i.\Building\Permits\PLM- PermitApp.doc 12/27/06
CITY OF TIGARD
BUILDING DIVISION PERMIT #: PLM2007-00568
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 12127/2007
0
Phone: (503) 639-4171
Inspection Requests (24 Hrs.): (503) 639-4175 L.
INSPECTION WORKSHEET FOR DATE: 12002007 TIME: .7:00AIVI PAGE: 56
SITE ADDRESS: 07963 SW KELSO CT CLASS OF WORK:
SUBDIVISION: CHURCHILL WOODS LOT #: 012 TYPE OF USE:
PROJECT NAME: CHURCHILL WOODS
DESCRIPTION: Backflow preventer for irrigation.
OWNER: WILSHIRE HOMES LI.C, PHONE #: 503-624.1600
CONTRACTOR: CONTOUR LANDSCAPING INC PHONE #: 503
Inspection Request Scheduled For: Date: 12/2012007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
399 Piumbing final 062254-01 503-1240305
Corrections/Comments/Instructions:
D e1/4)ii-:4 1 ' Tie s-+-e A.
C.ot
PASS PARTIALAPPROVAL JT - 1 CANCEL. fl NO ACCESS
I I FAIL n CALL FOR INSPECTION ADDITIONAL FEES ASSESSED
Inspector: (:) o tfl Date: 1 2-7 I 0 Phone #: (503) 718-