Permit 1.1:011 a CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT PERMIT #: PLM2006 -00565
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 11/21/2006
PARCEL: 2S 111 AD -20600
SITE ADDRESS: 08805 SW SCHECKLA DR ZONING: R -4.5
SUBDIVISION: LADY APPLE LOT: 030 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
BEACON HOMES NW, INC.
12703 SW 67TH AVE Description Date Amount
TIGARD, OR 97223 [PLUMB] Permit Fee 11/21/200E $36.25
[TAX] 8% State Surcha 11/21/200E $2.90
Phone : 503 -570 -8828 Total $39.15
Contractor:
CONTOUR LANDSCAPING INC
12485 SW TOOZE RD
SHERWOOD, OR 97140 REQUIRED ITEMS AND REPORTS
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Contact # : PRI 503- 682 -1302
FAX na
Reg #: L1C 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 or 1.800.332.2344.
� Issued By: / �` Permittee Signature: 4111011101P7
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.
Building Fixtures
Plu Permit AnnliRECE( \/E® rOli, ()Fri.: Iasi, ()N1.V"
City of Tigard Received Permit •
I q 13125 SW Hall Blvd., Tigard, OR�� 32 1 2006
Date/By It 1� y �D h "DO ��J
Plan Review
I C Phone: 503.639.4171 Fax: 50 598.1960 Date/By. Other Permit No.:
- r 1 G A R D Inspection Line: 503.639.417i TY OF rIG�1RD Date Ready/By: ilui 3 See Page 2 for
Internet: www.tigard or.goBUILDING ntvISIoN Notified/Method: Supplemental Information
TYPE OF WORK FEE* SCHEDULE
ta--liew 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
511_Lc and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 350.00
❑ Accessory building ❑ Multi - family SFR (3) bath 399.00
❑ Master builder Each additional bath/kitchen 45.00
❑ O ther: Fire sprinkler ( sq. ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities
Job site address: O' a 05 z er Et Q t el Di e Catch basin or area drain 16.60
City /State/ZIP: 7r. ( , q7 -2�3 Drywell, leach line, or trench drain 16.60
i ` Footing drain (no. linear ft.: ) Page 2
Suite/bldg. /apt. no.: Project name: La.rit A i v le
Manufactured home utilities 110.00
Cross street /directions to job site:
Manholes 16.60
Rain drain connector 16.60
S ZS E tf Art Sanitary sewer (no. linear R: ) Page 2
Storm sewer (no. linear ft: ) Page 2
Subdivision: App ( I Lot no.: Water service (no. linear ft.: ) Page 2
Y Fixture or item
Tax map/parcel no.: Absorption valve 16.60
DESCRIPTION OF WORK Backflow preventer Page 2
J Backwater valve 16.60
.,, k_h.,,)
!' I.r pot Clothes washer 16.60
Dishwasher 16.60
❑ PROPERTY OWNER I ❑ TENANT Drinking fountain 16.60
Ejectors/sump 16.60
Name: g �
a D Art rl P S Expansion tank 16.60
Address: !, 76, 7 S G7 4/4_ A, Jo , Fixture /sewer cap 16.60
City /State/ZIP: •'779 evert tt�t� 7 2Z Ti Floor drain/floor sink/hub 16.60
Phone: ( ) J 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
Business name: C��4 d tn,45Ay t� Water heater . 16.60
Address: / 2 f �u] z,... R o z Other: -
City /State/ZIP: .. J - Subtotal
Minimum permit fee: $72.50
Phone: (5a ) bg2 _ i 3 y Fax: (b to 3) z _/30' Residential backflow minimum permit fee: $36.25
CCB Lic.: O Plumbing Lic. no.: ,56;Fse Plan review (25% of permit fee)
Authorized signature: State surcharge (8% of permit fee) •
4 -. TOTAL PERMIT FEE
Print name: l Uu /.4„t'- I Date: fr_ _ t7 p, This permit application expires if a permit is not obtained within
,y 180 days after it has been accepted as complete.
*Fee methodology set by Tri -County Building Industry Service Board.
I: BuildinglPennits\PLMF- PemnitApp.doc 04/06/06 410.4616T(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 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
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
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 a, . 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 Complex Structures
Are you capping, adding or replacing fixtures? If "yes ", A "complex structure" is defined as an installation of a plumbing
please indicate work performed by fixture. Failure to system that meets any of the following criteria
accurately report fixtures could result in increased sewer fees *. Please check all that apply.
Quantity by (Fixture) Work Performed ❑ Any new commercial building
Fixture Type: Replace ❑ Any new exteriot plumbing site utilities. ,
Previous Capped Added Existing ❑ A commercial building with installation, alteration or addition
Baptistry/Font of nine (9) or more new or relocated plumbing fixtures.
Bath - Tub /Shower ❑ Medical gas and vacuum systems for health care facilities
- Jacuzzi/Whirlpool providing services to human beings.
Car Wash - Each Stall ❑ Plumbing installations, alterations or additions to food service
- Drive Thru facilities where new plumbing fixtures, including interceptors,
Cuspidor/Water Aspirator are being installed for the food service area.
Dishwasher - Commercial ❑ Any new residential building containing three (3) or more
- Domestic dwelling units.
Drinking Fountain ❑ Any NFPA 13 -D multipurpose fire sprinkler system.
Eye Wash •
Floor Drain /sink - 2" Submit 2 sets of plans with any of the above.
-3"
-4"
Car Wash Drain Isometric or Riser Diagram
Garbage - Domestic ❑ Isometric or riser diagram is required for new buildings
Disposal -Commercial three (3) or more stories in height.
- Industrial •
Ice Mach./Refrig. Drains
Oil Separator (Gas Station) Comments regarding fixture work:
Rec. Vehicle Dump Station
Shower -Gang
-Stall
Sink - Bar/Lavatory
- Bradley •
- Commercial
- Service
Swimming Pool Filter .
Washer - Clothes
Water Extractor -
*Note: If the fixture work under this permit results in an
Water Closet - Toilet increase of sewer EDUs, a sewer permit will be issued and
Urinal fees assessed for the sewerincrease must be paid before the
Other Fixtures: , plumbing permit can be issued.
i:\Building\Pennit \PLM- PennitApp.doc 07/0405
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CITY OF TIGARD
BUILDING DIVISION PERMIT #: PLM2006.00565
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 11/21/2006
Phone: (503) 639 -4171
A ,
Inspection Requests (24 Hrs.): (503) 639 -4175 �'!+� °
INSPECTION WORKSHEET FOR DATE: 1/31/2007 TIME: 7 :02AM PAGE: 14
SITE ADDRESS: 08$05 SW SCHECKLA DR CLASS OF WORK:
SUBDIVISION: LADY APPLE LOT #: 030 TYPE OF USE:
PROJECT NAME: LADY APPLE
DESCRIPTION: Bacldlow preventer for irrigation.
OWNER: BEACON HOMES NW, INC., PHONE #: 503- 570.8820
CONTRACTOR: CONTOUR LANDSCAPING INC PHONE #: 503- 682 -1302
Inspection Request Scheduled For: Date: 1/31/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
395 Misc. impe ion 042754 -02 503 - 320.0183 N
Corrections/C mments Ins ructions:
;F/M S — d
7 �-
4SS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: L / Date: I /l / Phone #: (503) 718 - 24 1