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Permit
P 4 CITY-OF- T-IGARE5 PLUMBING PERMIT ° COMMUNITY DEVELOPMENT PERMIT #: PLM2007 -00398 TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 8/31/2007 PARCEL: 1S133CD-02200 SITE ADDRESS: 11786 SW SWENDON LP ZONING: R -25 SUBDIVISION: COTSWALD MEADOWS LOT: 020 JURISDICTION: TIG PROJECT: LUSK Project Description: Installation of 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 JANICE L. LUSK 11786 SW SWENDON LOOP Description Date Amount TIGARD, OR 97223 [PLUMB] Permit Fee 8/31/2007 $36.25 [TAX] 8% State Surcha 8/31/2007 $2.90 Phone : 503 -524 -9686 Total $39.15 Contractor: RAIN COUNTRY GARDEN 19093 S BEAVERCREEK RD. SUITE #334 REQUIRED ITEMS AND REPORTS OREGON CITY, OR 97045 Contact # : PRI 503 -631 -4738 FAX 503 -631 -4739 Reg #: LIC 6337 PLM 12249 • 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 rul r direr • - estions • o UNC by calling 503.246.6699 or 1.800.332.2344. Issu By: 1f /' (/ / ' 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 v. r FOR OFFICE USE ONLY • R eceived / 39 S City of Tigard Q' Permit No.: „1,07 V 13125 SW Hall Blvd., Tigard, OR 97223 Da Re C Phone: 503.639.4171 Fax: 503.598.1960 Plan Review Date/By: Other Permit No.: T I G A R D Inspection Line: 503.639.4175 Date ReadyBy: ® See Page 2 for Internet: www.tigard - or.gov Notified/Method: ` lop Supplemental Information TYPE OF WORK FEE* SCHEDULE ❑ New construction ❑ Demolition For special information use checklist Description I Qty. 1 Ea. 1 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 p9 t 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 ❑ Other. Fire sprinkler ( sq. ft.) Page 2 JOB SITE INFORMATION AND LOCATION Site utilities Job site address: r 1 0 C v j ,...5, M L J .,p, Catch basin or area drain '. 16.60 City/State /ZIP: I 1 f CA.,- Drywell, leach line, or trench drain 16.60 Footing di linear Suite/bldg. /apt: no.: J Project name: g ran (no. neaz ft.: _) 2 Page - Manufactured home utilities 110.00 Cross street/directions to job site: f. e ; J I Manholes 16.60 Rain drain connector 16.60 Sanitary sewer (no. linear ft.: ) Page 2 • • Storm sewer (no. linear ft.: ) . Page 2 Subdivision: I Lot no.: Water service (no. linear ft.: - ) Page 2 Fixture or item Tax map /parcel no.: • Absorption valve 16.60 DESCRIPTION OF WORK Backflow preventer 1 Page 2 b e tIf 34 .511r 1 . (Q4- P pray.) Backwater valve 16.60 Clothes washer 16.60 ' Dishwasher 16.60 'PROPERTY OWNER I ❑ TENANT Drinking fountain 16.60 Ejectors /sump 16.60 • Name: ; T�1 ∎c 1 La 5 1 Expansion tank , 16.60 -, `"' Address: `, 1/ u 5 � 6,, o Fixture/sewer cap 16.60 City/State/ZIP: -6 X11 o p_ Floor drain/floor sink/hub 16.60 - Phone: (,5b3) 57 - Q b CiiP 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: (1 ;")`v■-c /_ A t � G� Water heater 16.60 Address: VI n �. { �&M n A_ 1 t ` 33 I Other: . City/ State/ZIP: ` C d ! Y OIL °4 Subtotal © V / r I Minimum permit fee: $72.50 p (f Phone: ( ' b 31 •`( 31 Fax: ( (j 1 .-- 1 T5 I Residential backflow minimum permit fee: $36.25 '• 0 - ( CCB Lic.: 6 3 Plumbing Lic. no.: Plan review (25% of permit fee) Authorized signature: S State surcharge (8% of permit fee) a , 9 ' • • TOTAL PERMIT FEE ,3?, /5 Print name: 5 s 0 J■.i , e- Date: 15 1 This permit application expires if a permit is not obtained within V 180 days after it has been accepted as complete. *Fee methodology set by Tri -County Building Industry Service Board. I :\ Building \Permits\PLM- PermitApp.doc 12/27/06 440- 4616T(10 /02/COM/WEB) r • r) 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 - l' 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 and including $50,000.00. . specially requested inspections - per hour 72.50 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 by (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 ❑ New exterior plumbing site utilities for any complex structure Bath. -Tub/Shower /Whirlpool as defined in OAR918 780 - 0040. Car Wash Each Stall ❑ Medical gas and vacuum systems for health care facilities. Drive tall ❑ 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 . Isometric or Riser Diagram Floor Drain/sink - 2" ❑ Isometric or riser diagram is required for new buildings 3„ that meet the qualifications above. Car Wash Drain Garbage - Domestic Co regarding fixture work: Disposal - Commercial • - Industrial • Ice Mach./Refrig. Drains ; Oil Separator (Gas Station), Rec. Vehicle Dump Station . Shower -Gang • • -Stall Sink Bar/Lavatory *Note: If the fixture work under this permit results in an - Bradley . - 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- PermitApp.doc 12/27/06 • CITY OF TIGARD - - . -. f . BUILDING DIVISION PERMIT #: PLM2007 -00398 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 8/31/2007 Phone: (503) 639 -4171 �,om Inspection Requests (24 Hrs.): (503) 639 -4175 _.. `:_ INSPECTION WORKSHEET FOR DATE: 9/5/2007 TIME: 7:00AM PAGE: 49 SITE ADDRESS: 11786 SW SWENDON LP CLASS OF WORK: SUBDIVISION: COTSWALD MEADOWS LOT #: 020 TYPE OF USE: PROJECT NAME: LUSK DESCRIPTION: Installation of residential backflow prevention device for irrigation. OWNER: LUSK, JANICE PHONE #: 503 - 524 -9686 CONTRACTOR: RAIN COUNTRY GARDEN PHONE #: 503- 631 -4738 Inspection Request Scheduled For: Date: 9/5/2007 Pour Time: Code # Inspection Description Confirm # Contact # Message 399 Plumbing final 056085-01 503 - 516 -4878 Y Corrections /Comments /Instructions: CA rt. ctt —c xW X PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS ❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: CFO ko-A- --1 n I J)-�a Date: ) 1 S)o ? Phone #: (503) 718-