Permit I � ' CITY OF TIGARD PLUMBING PERMIT
-, - `. COMMUNITY DEVELOPMENT PERMIT #: PLM2007 -00573
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 12!27/2007
PARCEL: 2S 112C D -15400
SITE ADDRESS: 07992 SW KELSO CT ZONING: R -12
SUBDIVISION: CHURCHILL WOODS LOT: 005 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 NIMBUS AVE STE B1
TIGARD, OR 97223 [PLUMB] Permit Fee 12/27/2007 $36.25
[TAX] 8% State Surchart 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 # : 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 within 180 days of iss,uajce, or if work is
suspended for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utili . Notification Center.
Those rules are set forth in OAR 952 - 0001 -0010 through OAR 952 -0001 -0100. You may obtain copie of these rules , r direct ` uestions to OUNC
by calling 503.246.6699 or 1.800.332.2344.
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Issued By: 1C Permittee Signature: i k ,,
Call 503.639.4175 by 7:00 a.m. for an inspection that buiness 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
]I''7bli Rtures FOR OFFICE USE ONLY
ter.
'City Of Tigard Received /A- n /� 7 O? Permit No.: AV 7.60573
. Date
V 13125 SW Hall Blvd., Tigard, OR 97223 Plan Re :
I
Phone: 503.639.4171 Fax: 503.598.1960 Plan Review
M Date /By: Other Permit No.:
T I G A R D Inspection Line: 503.639.4175 Date Ready /By Ju ®See Page 2 for
Internet: www.tigard - or.gov Notified/Method: �� Supplemental Info
TYPE OF WORK • ' . FEE* SCHEDULE - ,
N 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)
CATEGORY OF CONSTRUCTION - - a.' , • " SFR (1) bath 249.20
i -1- 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
❑ Master builder ❑ Other:
Fire sprinkler ( sq. ft.) Page 2
` . JOB SITE INFORMATION' AND LOCA ION Site utilities
Job site address: S ' e , if Catch basin or area drain 16.60
City /State /ZIP: 7 )5) 0 Z- et-i,,s 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
<�� Water service (no. linear ft.: ) Page 2
n
Subdivisio (�. �S Lot no.: J
Fixture or item
Tax map /parcel no.:
Absorption valve 16.60
DESCRIPTION OF WORK
e l Backflow preventer / Page 2
3 -19 ' NI _(__1 _ _ ST't--/A, Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
Drinking fountain 16.60
PROPERTY OWNER ❑ TENANT
g � Ejectors /sump 16.60
l
Name: ' ' LS I �
!`� 6-1-- - Expansion tank 16.60
Address: 17 Ll� j� l` r I` 4_, V v S Fixture /sewer cap 16.60
City /State /ZIP: '71 6 1 9 f/1) V q , •-- (9-)- -'3 Floor drain /floor sink/hub 16.60
Phone: ( �. 5(0? -4 /ei� Fax: ( ) Garbage disposal 16.60
'y ��/JJ e'
❑ APPLICANT Hose bib 16.60
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❑ 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: ( ) f Fax:: ( ) Sink/basin/lavatory 16.60
Tub /shower /shower pan 16.60
E -mail:
Urinal 16.60
CONTRACTOR Water closet 16.60
Business name: C L Water heater 16.60
Address: 5 --- G, 6,,, � � / v - Other:
GL/` (f y �� / Subtotal
City /State /ZIP:
�r Minimum permit fee: $72.50
Phone: (..-- Q Fax: ( ) Residential backflow minimum permit fee: $36.25
CCB Lie.: i ir„,, AM Plumbi y Lic b o.: Plan review (25% of permit fee)
Authorized signature:
Ar ,/ f State surc (8 % -of- permit fee)
vY TOTAL PERMIT FEE
Print name: '4 / � -7J
Da te: 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.
C\ 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 Utilities Qty. Fee (ea) Total -- Footage: Permit Fe:
Footing drain - 1S 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
specially requested inspections - per hour 72.50 and including $50,000.00.
Subtotal: $50,001.00 and up $742.00 for the first $50,000.00 and $1.20 for
each additional $100.00 or fraction thereof.
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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: 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 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- PermiIApp.doc 12/27/06
CITY OF TIGARD
BUILDING DIVISION PERMIT #: PLM2007-00573
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 12/27/2007
Phone: (503) 639 -4171 / pu� f i
I Requests (24 Hrs.): (503) - 639 -4175 -
INSPECTION WORKSHEET FOR DATE: . 2113/2008 TIME: 7:01Am PAGE: 59
SITE ADDRESS: 07992 SW KELSO CT CLASS OF WORK:
SUBDIVISION: CHURCHILL WOODS LOT #: 005 TYPE OF USE:
PROJECT NAME: CHURCHILL WOODS
DESCRIPTION: Backflow prevernter for irrigation.
OWNER: WILSHIRE HOMES LLC, PHONE #: 503.024- 1000
CONTRACTOR: CONTOUR LANDSCAPING INC PHONE #: 503 -882 -1302
Inspection Request Scheduled For: Date: 2/13/2008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
399 Plumbing final 0&190&02 503-724-0306 N •
Corrections/Comments/Instructions:
i P.;/ k e:17.ec See T r- R2.eo✓ 7
c art. 4
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X PASS _ ❑ PARTIAL APPROVAL ❑ CANCEL NO ACCESS
I FAIL CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED
Inspector: c/1k v A-s: \'t' -- Date: 2j (, ?, :pc) Phone #: (503) 718-