Permit 11 q CITY OF TIGARD
PLUMBING PERMIT
COMMUNITY DEVELOPMENT PERMIT #: PLM2007 - 00465
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 10/17/2007
PARCEL: 2S 112CD - 16000
SITE ADDRESS: 07975 SW KELSO CT ZONING: R -12
SUBDIVISION: CHURCHILL WOODS LOT: 011 JURISDICTION: TIG
PROJECT: CHURCHILL WOODS
Project Description: Backflow preventer for irrigation. •
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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
WILSHIRE HOMES LLC
10110 SW NIMBUS Description Date Amount
TIGARD, OR 97223 [PLUMB] Permit Fee 10/17/2007 $36.25
[TAX] 8% State Surcha 10/17/2007 $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 # : PRI 503- 682 -1302
FAX Same as above
Reg #: LIC 5698
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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 . in 180 days of
issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law requires you to f+llow rules ado.te• by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 0001 -0010 through OAR 952 - 0001 -0 00. Y.0 may .btai i copies of
these rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
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Issued By: A Permittee Signature: I • 4
i Call 503.639.4175 by 7:00 a.m. for an inspection that busin°ss day.
This permit card shall be kept in a conspicuous place on the job site until c1.mpletion of the project.
Approved plans are required on the job site at the time of each inspection.
:, P!umbin Permit A lice •
Building Fixtures FOR OFFICE USE ONLY
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City of Tigard Or T j E t l r Received``//��
Date /By:IV / 1 /7 /O / 'b 52 Permit N. i�� .2 u 4
V 13125 SW Hall Blvd., Tigard, OR r
Plan Review
Phone: 503.639.4171 Fax: 5j.�3 .{I!F 1r0A1iD Date/By: Other Permit No.:
TI GARD Inspection Line: 503.639.4175tfRDIN,to®p�`[r Date Ready /By: .runs: 0 See Page 2 for
Internet www.tigard- or.gov l � '�� ®� Notified/Method: Supplemental Information
TYPE OF WORK FEE* SCHEDULE
New construction For special information use checklist.
❑ Demolition
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
1141- and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 350.00
❑ Accessory building ID 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 Site utilities
Job site address:
j- S Wl-SU G ? " Catch basin or area drain 16.60
1'Ca ��D U�- '9 9.- Drywell, leach line, or trench drain 16 60
City /State /ZIP:
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
` - ei i k- , e - S v Rain drain connector 16.60
Sanitary sewer (no. linear ft.: ) Page 2
Storm sewer (no. linear ft.: _ ) Page 2
Subdivision: auk I ,t` Lot no.: Water service (no. linear ft.: ) Page 2
Tax map /parcel no.: I�•, f „ Fixture or item
V�3 Absorption valve 16.60
DESCRIPTION OF 1 W ` ORK Backflow preventer ( Page 2
. � e k) 1.. S `-/ S T Backwater valve . ( 16.60
( Clothes washer 16.60
Dishwasher 16.60
ya Drinking fountain 16.60
PROPERTY OWNER
110/463 I . 0 TENANT Ejectors /sump 16.60
Name: ( tjS(' P-- -
Expansion tank 16.60
Address: O H 0 5(.t/ //KA 6t/S e 6 ( Fixture /sewer cap 16.60
City /State /ZIP: /76, 0 - ?*q-(9;-.3 Floor drain/floor sink/hub 16.60
Phone: (5723) Coact /0.00 Fax: ( ) Garbage disposal 16.60
CI 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: / WS Water heater 16.60
Address: la, 1196-- y� 5ct i `7po � � Other:
City /State /ZIP: � `..60.. - ' 47v C '" /'' / / y/ Subtotal
Minimum permit fee: $72.50
Phone: (5.3)6714._ / O a Fax: ( ) ___ / Residential backflow minimum permit fee: $36.25
CCB Lie.: p� q � - 1 b tg Lic- n Plan review %of permit fee)
State surcharge (8% penniYfee)
Authorized signature: A /
TOTAL PERMIT FEE �. � 5
Print name: c�� Date: w'�0 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- PennitApp doe 12/27/06 440- 4616T(I0 /02 /COM/WEB)
Plumbing Permit Application - City of Tigard - :-,
Page 2 - Supplemental Information
Fee Schedule: ' Residential Fire Suppression Systems:_
Site Utilities Qty. Fee (ea) Total Square Footage: - Permit Fee: .
Footing drain - l' 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
and including $50,000.00.
specially requested inspections - per hour 72.50
Subtotal: $50 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) WorkPerformed, greater, except systems.designed•and_stamped.by licensed
Fixture Type: Replace 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 se 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
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CITY OF TIGARD ..‘
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BUILDING DIVISION PERMIT #: pLm2007-00466
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 10/17/2007
Phone: (503) 639-4171
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Inspection Requests (24 Hrs.): (503) 639-4175 V
INSPECTION WORKSHEET FOR . DATE: 11/2/2007 TIME: 7:01AM PAGE: 43
SITE ADDRESS: 07975 SW KELSO CT CLASS OF WORK:
SUBDIVISION: CHURCHILL WOODS LOT #: 011 TYPE OF USE:
PROJECT NAME: CHURCHILL WOODS
DESCRIPTION: Backflow prevents for irrigation.
OWNER: WILSHIRE HOMES LLC, PHONE #: 503-624-1600
CONTRACTOR: CONTOUR LANDSCAPING INC PHONE #: 603-6821302
Inspection Request Scheduled For: Date: in/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
393 Plumbing final 058908-01 603-320-0183
Corrections/Comments/Instructions:
CAre_
Xi PASS ii PARTIAL APPROVAL LII CANCEL 7 NO ACCESS
E] FAIL Ej CALL FOR INSPECTION ADDITIONAL FEES ASSESSED
Inspector: CravKiaA Date: I I 19 1 n , Phone #: (503) 718-