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Permit
C ITY OF TIGARD PLUMBING PERMIT ''r4. DEVELOPMENT SERVICES PERMIT #: PLM2005 -00067 I I 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 2/22/2005 SITE ADDRESS: 12950 SW OXALIS TERR PARCEL: 2S104BC -08500 SUBDIVISION: HILLSHIRE CREST ZONING: R -7 BLOCK: LOT: 007 JURISDICTION: TIG CLASS OF WORK: NEW 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 Remarks: Installation of residential backflow prevention device for irrigation. FEES Owner: Description Date Amount RIDGECREST CONSTRUCTION CO [PLUMB] Permit Fee 2/22/2005 $36.25 6600 SW 92ND AVE SUITE 210 PORTLAND, OR 97223 [TAX] 8% State Surchari 2/22/2005 $2.90 Total $39.15 Phone : 503 246 - 8808 Contractor: CONTOUR LANDSCAPING INC 12485 SW TOOZE RD REQUIRED ITEMS AND REPORTS SHERWOOD, OR 97140 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. Issued y: Permittee Signature: m Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the nex business day y Pluntbine Permit Application rOR orrice: t'sy. O\LV City of Tigard �v� � Permit No.: 'S LH/ ..... 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review Phone: 503.639.4171 Fax: 503.598.1960 . , Date/By: Other Permit No.: 24- Hour Inspection Line: 503.639.4175 Date Ready/By. El See Page 2 for Internet: www.ci.tigard.or.us Notifed/Method I a , Supplemental Information ,�/ TYPE OF WORK FEE* SCHEDULE kl New construction ❑ Demolition For special information use checklist. Description I Qty. I Ea. I Total ❑ Addition/alteration/replacement ❑ Other: - New 1- 2- family dwellings (includes 100 ft. for each utility connection) ,/ CATEGORY OF CONSTRUCTION SFR (I) bath 249.20 2 1- and 2-family dwelling ❑ Commercial /industrial SFR (2) bath 350.00 ❑ Accessory building El Multi-family SFR (3) bath 399.00 ❑ 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: 1 S (&) QY)''L( S Teri Catch basin or area drain 16.60 City /State/ZIP: / f Drywell, leach line, or trench drain 16.60 Suite/bldg./apt. no.: �f Project name: Footing drain (no. linear ft.: ) Page 2 - 7 j if tat G2�si 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 j� i l ` JS i2 I Subdivision: ► I l (,n G �� I Lot no.: Water service (no. linear ft.: ) Page 2 Tax map/parcel no.: Fixture or item Absorption valve 16.60 DESCRIPTION OF WORK Back flow preventer l Page 2 G�C.�Gh.. .S Backwater valve 16.60 Clothes washer 16.60 Dishwasher 16.60 ❑ PROPERTY OWNER I ❑ TENANT Drinking fountain 16.60 Ejectors/sump 16.60 Name: r1< - Expansion tank 16.60 Address: 6 _ (.1,Q,0 (� "'� a/--C Fixture/sewer cap 16.60 City /State/ZIP: 02 Floor drain/floor sink/hub 16.60 Phone: (S63) a-Y6 g g 0 8 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 Phone: ( ) I Fax: : ( ) Sink/basin/lavatory 16.60 Tub /shower/shower pan 16.60 E-mail: Urinal 16.60 CONTRACTOR Water closet 16.60 r Business name: 6 , 0 (J ri , berstiNc ...,,.›esAyl Water heater 16.60 Address: I ) (&V S f 773021E Other: City /State/ZIP: )-1 > (1 4111 0 Subtotal b i © Minimum permit fee: $72.50 2 a S Phone: (Sb3) , f R). - l 3 p Z Fax: ( ) 5 la .,_�,,. e Residential backflow minimum permit fee: $36.25 o CCB Lic.: :5 1 6 Plumbing Lic. no.: Plan review (25% of permit fee) ( I " l C �� Sta surch arge (8% of permit fee) a ;9O Authorized signature: TOTAL PERMIT FEE 01, 15 Print name: f )'t>L /V1 G py( -)u,. yt) I Date: 2.. 1y j 05 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. i:\Building\Permits \PLM- PennitApp.doc 17/03 410.4616T(I0W07JCOM/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 - 1 100' 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 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: Are you capping, moving or replacing existing fixtures? If "yes", please indicate work performed by fixture. Failure to accurately report fixtures could result in increased sewer fees * . Quantity by (Fixture) Work Performed Fixture Type: Replace New Moved Existing Capped Comments regarding fixture work: Baptistry/Font Bath - Tub/Shower - Jacuzzi/Whirlpool Car Wash -Each Stall -Drive Thru Cuspidor /Water Aspirator Dishwasher - Commercial - Domestic Drinking Fountain Eye Wash Floor Drain/sink - 2" - 3" -4" Car Wash Drain Garbage - Domestic Disposal - Commercial *Note: If the fixture work under this permit results in an - Industrial Ice Mach./Refrig. Drains increase of sewer EDUs, a sewer permit will be issued and Oil Separator (Gas Station) fees assessed for the sewer increase must be paid before the Rec. Vehicle Dump Station plumbing permit can be issued. Shower -Gang -Stall Sink - Bar/Lavatory Quantity Total - Bradley - Commercial Isometric or riser diagram is required if fixture quantity - Service total is >9. Swimming Pool Filter Washer - Clothes Water Extractor Plan Review Water Closet - Toilet Plan review is required if fixture quantity total is >9. Urinal Other Fixtures: i:\BuildingWermitAPLM-PermitApp.doc 3/03 CITY OF TIGARD BUILDING DIVISION PERMIT #: PLM2005.00067 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 2/22/2005 Phone: (503) 639 -4171 40,1 — 7Yl I nspection Requests (24 Hrs.): (503) 639-4175 3 / 16/2005 7: 11 AM 2 2-A, 6 INSPECTION WORKSHEET FOR DATE: TIME: PAGE: SITE ADDRESS: 12950 SW OXALIS TERR CLASS OF WORK: SUBDIVISION: HILLSHIRE CREST LOT #: 007 TYPE OF USE: PROJECT NAME: HILLSHIRE CREST DESCRIPTION: Installation of residential bac:ldlow prevention device for irrigation. OWNER: RIDGECREST CONSTRUCTION CO, PHONE #: 503 - 246 -8808 CONTRACTOR: CONTOUR LANDSCAPING INC PHONE #: 682 - 1302 Inspection Request Scheduled For: Date: 3/16/2005 Pour Time: Code # Inspection Description Confirm # Contact # Message 325 RP /baclflow • : -_._ •., • :1 • . ,.-' 5503 682 - 1302 N Co ions /Comme is /Instructions: I - r ii. mo--e 4-e_s-1--,3, 4. ..I. A -■ . --- .N 7::_e -, / /0 (e ❑ PASS ❑PARTIAL APPROVAL ❑ CANCEL El NO ACCESS F AIL U ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: Date: �/ 1 kP / 0 ` Phone #: (503) 718-