Permit ,- K.,.
Il . CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT PERMIT #: PLM2007 -00009
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 1/12/2007
PARCEL: 1S125CD-09000
SITE ADDRESS: 07516 SW RED CEDAR WAY ZONING: R -4.5
SUBDIVISION: JACKSON WOODS LOT: 005 JURISDICTION: TIG
Project Description: Backflow preventer 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
NORTH STAR DEVELOPMENT
223 NE RUSSEL Description Date Amount
PORTLAND, OR 97212 [PLUMB] Permit Fee 1/12/2007 $36.25
[TAX] 8% State Surcha 1/12/2007 $2.90
Phone : 503- 262 -6938 Total $39.15
Contractor:
IN VISION LLC
897 WOODMANSEE CT.
SALEM, OR 97302 REQUIRED ITEMS AND REPORTS
Contact # : PRI 1503 -507 -4777
Reg #: PLM 11264
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 or 1.800.332.2344.
Ai_
Issued By: Permittee Signature: _ !r!- ! _ —
A
Call 503.639.4175 by 7:00 a.m. for an inspection that business da
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.
RECEIVED
Plumbing Permit Application FOR OFFICE LSE ONLY
City of Tigard JAi i 1Z 1007 � / i - o 7 h/� Permits .LM p7 - uo "" •
N a 13125 SW Hall Blvd, Tigard, OR 97 6 F TIGARD Plan Retie -
Phone: 503.639.4171 Fax: 503.598h Dale/By. Other Permit No.:
TIGARD Inspection Line: 503.639.4175 BUILDING DIVISION 1» Ready/By. e Ready/By. tuns: El See Page 2 for
Internet: www.tigard- or.gov Notified/Method Supplemental Information
TYPE OF WORK FEE* SCHEDULE
et N w 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 (1) bath 249.20
erl- and 2 -famly dwelling ❑ Commercial/industrial SFR (2) bath 350.00
13 Accessory building ❑ Multi-family SFR (3) bath 399.00
El Master builder Each additional bath/kitchen 45.00
❑ Fire sprinkler ( sq. ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities •
Job site address: 7 57 4. e..e4,-- 14.4 GI Catch basin or area drain 16.60
City /State/LIP: --77(.7 . ,_o( ,1/.-_. Drywell, leach line, or trench drain 16.60
Suite/bldg /apt. no.: I Project name: � k�yt �s F drain (no. linear R: _) 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
Subdivision: Lot no.:
Water service (no. linear ft.: _) Page 2
Tax map/parcel no.: Future or item
Absorption valve 16.60
• DESCRIPTION OF WORK / Back flow preventer - / Page 2
/
rc i y ,iii O't�r ht f//e k gi i v a Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
❑ PROPERTY OWNER l ❑ TENANT Drinking fountain 16.60
‘,f.21 Ejectors/sump 16.60
Name: %moo y Expansion tank 16.60
Address: 7g'/ Z. /moo( L f.//e of Fixture/sewer cap 16.60
City/State/Z1P:` )71.-i r ___,.e aye._ Floor drain/floor sink/hub 16.60
Phone: (233) 1/ " 8 1,;° / Fax: ( ) Garbage disposal 16.60
El APPLICANT I ❑ CONTACT PERSON Hose bb 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 V Water closet 16.60
Business name: / v ! 5% / OGt � 4C_ 014.. 1flt ^jater heater 16.60
Address:
el 7 �oof fit 4 .5".. C7 ` < Otha:
b Subtotal
CitylStatelLlP: ��yft 73 Z Minimum permit fee: $72.50
Phone: (d3) 5 7 -it-7 7 7 Fax: ( , ) Residential backflow minimum permit fee: $3625 `�(p•�5
.7 7 6 � / 7/ Zl � . 9 x t71 Plan review (25% of permit fee)
CCB Lic.: Plumbing Lic. no.: '7 I
Authorized signatu `� State surcharge (8% of permit fee) ��
■!� TOTAL PERMIT FEE V
Print name: 7 q / / I Date: / -/2 - D71 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:\B ldinglPermitr\PLM- PamiuApp.doc 0626'06 440- 4616T(I0'02/COMIWEB)
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 e 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
Stone & Rain Drain - Ist 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
Fixture or Item Qty. Fee (ea) Total additional $100.00 or fraction thereof; to and
including $10,000.00.
Commercial Badc 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
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
Quaotitb 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 Comments regarding fixture work:
Garbage - Domestic
Disposal -Commercial
-1 ndustrial
Ice MachiRefrig. Drains
Oil Separator (Gas Station)
Rec. Vehicle Dump Station
Shower -Gang
-Stall *Note: If the fixture work under this permit results in an
Sink - Bar/Lavatory increase of sewer EDUs, a sewer permit will be issued and
o rnmadal fees assessed for the sewer increase must be paid before the
- Service plumbing permit can be issued.
Swimming Pool Filter
Washer - Clothes
Water Extractor
Water Closet - Toilet
Urinal -
Other Fixtures:
i:u wmg\a,ixs\PLM -rr mnApp.doc o
CITY OF TIGARD
BUILDING DIVISION PERMIT
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: T 21/2006
Phone: (503) 639 -4171 1
Inspection Requests (24 Hrs.): (503) 639 -4175 r F•I 1I
INSPECTION WORKSHEET FOR DATE: 2/1212007 TIME: 7:05AMyl PAGE: t3
SITE ADDRESS: 07516 SW RED CEDAR WAY CLASS OF WORK:
SUBDIVISION: JACKSON WOODS LOT #: 005 TYPE OF USE:
PROJECT NAME: JACKSON WOODS
DESCRIPTION: SF
OWNER: NORTH STAR DEVELOPMENT, PHONE #: 503 - 252 -693a.
CONTRACTOR: NICOLE EMILY YVt1ITESELL_ PHONE #: 503-914 8434
Inspection Request Scheduled • • Date 9 12/2007 Pour Time:
Code # pection Descriptio. Co • # ■ - tact # Mess
3 Plumbing final ' 043282 -02 503.3 0295 6
orrections /Comments /Instructions:
PLel 2e o 7 - Ococa.0 "e1c-
•
'dri,
\ f l it . PASS n PARTIAL APPROVAL ❑ CANCEL El NO ACCESS
FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: e,-/Hi Date: Z i /7 Phone #: (503) 718 - ZS*7