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Permit CITY TIGARD PLUMBING PERMIT • COMMUNITY DEVELOPMENT PERMIT #: PLM2007 -00366 TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 8/14/2007 PARCEL: 2S109DD -09700 SITE ADDRESS: 15617 SW RAPHAEL LN ZONING: R -7 SUBDIVISION: BELLA VISTA LOT: 027 JURISDICTION: TIG PROJECT: BELLA VISTA Project Description: Install residential backflow prevention device 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 RIVERSIDE HOMES INC Description Date Amount 1925 NW AMBERGLEN PKWY #200 BEAVERTON, OR 97006 [PLUMB] Permit Fee 8/14/2007 $36.25 [TAX] 8% State Surcha 8/14/2007 $2.90 Phone : 503- 645 -0986 Total $39.15 Contractor: STREAMLINE PLUMBING 2505 , OR 97006 AUGUSTA DR. ALOHA, REQUIRED ITEMS AND REPORTS ALO Contact # : PRI 503- 888 -6657 FAX 503- 379 -9543 Reg #: LIC 142111 PLM 34 -370PB 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 Notific • nter. Those rules are set forth in OAR 952 - 0001 -0010 through OAR 952 - 0001 -0100. You may obtain copies of these es or direct qu to OUNC by calling 503.246.6699 or 1.800.332.2344. Is ed By: �l �. Permittee Signature: 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 • FOR OFFICE. USE ONLY City of Tigard Received / / L, 1114 D 7 Permit No. l (ge 2 --e03d4 a 1 3125 SW Hall Blvd., Tigard, OR 97223 Date By ( ``�� Phone: 503.639.4171 Fax: 503.598.1960 Plan Review Date/By: Other Permit No.: TIGARD Inspection Line: 503.639.4175 Date Ready /By: �Jur � ® See Page 2 for Internet: www.tigard - or.gov Notified/Method' / !f, Supplemental Information ' TYPE OF WORK _ " FEE* SCHEDULE ❑New construction ❑ Demolition For special information use checklist Description 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 (1) bath 249.20 ❑ 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 LOCATION ' ," '. . " Site utilities Job site address: I S to - SW pk, e . I L N Catch basin or area drain 16.60 City /State /ZIP: T ri �!`a, G K 77 19 7-224 Drywell, leach line, or trench drain 16.60 Suite/bldg. /apt. no.: Project name: t( a Footing drain_ (no. linear ft.: ) Page 2 a �t ' S �- 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: Lot.no.: 27 Water service (no. linear ft.: ) Page 2 Fixture or item Tax map /parcel no.: Absorption valve 16.60 • DESCRIPTION° OF WORK preventer Page 2 6aG k 1p tn.) P re ve,44 - 0 4' Backwater valve 16.60 Clotheswasher 16.60 Dishwasher 16.60 L_ PROPERTY OWNER ' - Drinking fountain 16.60 ❑� TENANT' Ejectors /sump 16.60 Name: R`JerS ) )O i Expansion tank 16.60 Address: (I Z S NIA) 4i,Abei', lr% f kw V # 2eO Fixture /sewer cap 16.60 City/State /ZIP: &t vef'Jvyl ©g, 9 7e0 et) Floor drain/floorsink/hub 16.60 Phone: (6 ) gig- 6I g6 Fax: ( ) Garbage disposal 16.60 Hose bib 16.60 0. APPLICANT , ' ❑ . 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: S-Fr ai, lale, Qj 14 Water heater 16.60 Address: 2. �}vJ uJa► Dr Subtot CO So S S vi 54- Other: City /State /ZIP: �IO dz Q� lv . � Minimum permit fee: $72.50 - Phone: (Sp3) gg g - 6 6 .7. Fax: ( ) Residential backflow minimum permit fee: $36.25 (,(J CCB L,ic.: I y 2 i 1 j Plumbing Lic. no.: -370 pe Plan review (25% of ,l iew permit fee) State surcharge (8% of permit fee) a . / V� Authorized signature: TOTAL PERMIT FEE g Print name: J G�. � Date: g / /07.- This permit application expires if a permit is not obtaif�d ithi 5 r , v' 180 days after it has been accepted as complete. *Fee methodology set by Tri- County Building Industry Service Board. 1:\Building \Permits \PLM- 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 S stems: Site. Utilities - • • Qty. Fee (ea) Total. ' 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: Permit 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 Future or Item , ° Qtyi 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 and up $742.00 for the first $50,000.00 and $1.20 for each additional $100.00 or fraction thereof. Fixture Work: Are you capping, adding or replacing fixtures? If "yes ", Plan Review for Plumbing Installations, - please indicate work performed by fixture. Failure to Plan review is required for any of the following. accurately report fixtures could result in increased sewer fees Please check all that apply. ` Quantity bf (Fixture) - Work Performed" ❑ Any new commercial building with water service 2" and Fixture Type: - Replace. greater, except systems designed and stamped by licensed Previous Capped Added 'Existing engineer. Baptistry/Font - Tub/Shower ❑ New exterior plumbing site utilities for any complex structure Bath - hower Tub /S -Jacuzzi/Whirlpool as defined in OAR918- 780 -0040. ❑ Medical gas and vacuum systems for health care facilities. Car Wash -Each Drive Stall ❑ Any multipurpose fire sprinkler system. Cuspidor /Water Aspirator ❑ Any complex structure as defined in OAR918- 780 -0040. Dishwasher - Commercial Domestic Submit 2 sets of plans with any of the above. Drinking Fountain • Eye Wash Isometr,'ic.or Riser Diagram • Floor Drain/sink - 2" ❑ Isometric or riser diagram is required for new buildings 3„ that meet the qualifications above. - 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: is \Building\Permits \PLM- PermitApp doc 12/27/06 • , CITY OF TIGARD BUILDING DIVISION PERMIT #: PLM2007-00366 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 81/4/2007 Phone: (503) 639 -4171 41 �tii�Il�1l Inspection Requests (24 Hrs.): (503) 639 - 4175 ±x- _.. INSPECTION WORKSHEET FOR DATE: 8/15/2007 TIME: 7 :00AM PAGE: 22 SITE ADDRESS: 15617 `SSW RAPHAEL LN CLASS OF WORK: SUBDIVISION: BELLA VISTA LOT 027 TYPE OF USE: PROJECT NAME: BELLA VISTA DESCRIPTION: Install residential backflow prevention device for irrigation. OWNER: RIVERSIDE HOMES INC, PHONE #: 503 -6455 -0986 CONTRACTOR: STREAMLINE PLUMBING PHONE #: 503-888.6657 Inspection Request Scheduled For: Date: 8/15/2007 Pour Time: Code # Inspection Description Confirm # Contact # Message 399 Plumbing final 054043 -01 971 -246 -1996 N Corrections/Comments/Instructions: , � . e,AJ: c.� � "-e-4 S o .t t- -0`c,L�dl F \ c Q V1 Ca �r �.•4 9Adi n. PASS I I PARTIAL APPROVAL I CANCEL ❑ NO ACCESS I I FAIL I I CALL FOR INSPECTION I I ADDITIONAL FEES ASSESSED Inspector: `. U k'1 ti l I � � �-�� r - Date: ?7 ,I S 7 O Phone #: (503) 718-