Permit C ITY OF TIGARD PLUMBING PERMIT
PERMIT #: PLM2005 -00498
DEVE H BM r S O RV 2CES - 639 - 4171 DATE ISSUED: 9/28/2005
PARCEL: 2S 109AD -10800
SITE ADDRESS: 12755 SW WINTERVIEW DR ZONING: R -7
SUBDIVISION: ARBOR SUMMIT LOT: 006 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
WEST HILLS DEVELOPMENT
15500 SW JAY ST Description Date Amount
BEAVERTON, OR 97006 [PLUMB] Permit Fee 9/28/2005 $36.25
[TAX] 8% State Surcha 9/28/2005 $2.90
Phone : 503- 641 -7342 Total $39.15
Contractor:
WOLCOTT PLUMBING CONTRACTORS
1075 W HISTORIC COLUMBIA RIVER
TROUTDALE, OR 97060 REQUIRED ITEMS AND REPORTS
Phone : 503- 667 -1781
Reg #: LIC 23847
PLM 26 -208PB
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: -0 / Z Permittee Signature:
Call 503 - 6394175 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.
iir
Plumbing Permit AppREGEIVED FOR OFFICE USE ONLY
City of Tigard CEP 2 8 2005,4000 Date/By: 9 v� /. / /U" Permit No? ��.2.Q)'(6bV93
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone 503 639.4171 Fax 503.598.1960 r Date/By Othei Permit No:
24- Hour Inspection Line 503 639 4175 CITY OF TIGA -, :. - IL' Date Ready /By Jur s See Page 2 for
Internet• www.ci.tigard or.us Bu 11 nwr rlrvlRlnN Notified/Method S pp
Su Icmentallnformntion
TYPE OF WORK FEE* SCHEDULE
® 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
® 1- 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
0 Fire sprinkler ( sq ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities
Job site address: I _7SS SW woo1TE /eVI e 1.J Dr. Catch basin or area drain 16.60
City /State/ZIP: TI GaRD Old 9 7 2.Z 3 Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: I Project name: Footing drain (no linear ft • ) 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. Arbor Summit I Lot no.: 6 Water service (no linear ft ) Page 2
Fixture or item
Tax map /parcel no.: Absorption valve 16 60
DESCRIPTION OF WORK Backflow preventer 0 Page 2
NEW CONSTUCTION Backwater valve 16 60
Clothes washer 16 60
Dishwasher 16 60
® PROPERTY OWNER ❑ TENANT Drinking fountain 16.60
Ejectors/sump 16.60
Name. West Hills Development
Expansion tank 16 60
Address: 15500 SW Jay ST. Fixture /sewer cap 16.60
City /State/ZIP: Beaverton, OR 97006 Floor drain /floor sink/hub 16.60
Phone. (503)641 -7342 Fax: (503)641 -7661 Garbage disposal 16 60
® APPLICANT ® CONTACT PERSON Hose bib 16 60
Ice maker 16.60
Business name: Same As Owner.
Interceptor /grease trap 16.60
Contact name: Jed Dairy Medical gas (value $ ) Page 2
Address Primer 16 60
City/State/ZIP: Roof drain (commercial) 16 60
Phone (503 ) 641 -7342 Fax:: ( )
Sink/basin/lavatory 16 60
Tub /shower /shower pan 16 60
E -mail. jdairy@westhillsdevelopment.com
westhillsdevclopment.com Urinal 16 60
CONTRACTOR Water closet 16.60
Business name: Wolcott Plumbing Water heater 16 60
Address. 1075 W Historic Columbia River HWY. Other.
City /State /ZIP: Troutdale, OR 97060 Subtotal
Minimum permit fee $72 50
Phone: (503) 667 -1787 Fax. (503) 667 -9891 Residential backflow minimum permit fee $36.25
CCB Lrc.• 23847 Plumbing Lic. no. 26 -208PB
Plan review (25% of permit fee)
State surcharge (8% of permit fee)
Authorized signature:6 ano. L l _ p , _ 9 j TOTAL PERMIT FEE 39, /,"
Print name: Gary Lippold Ilr¢ Date: g / / This permit application expires if a permit is not obtained within
180 days after it has been accepted as complete.
*Fee methodology set by Tr1- County Building Industry Service Board
i \Budding\Permns\PLM•Penn,App doc 12/03 440 -4616T(10 /02/COM/WEB)
CITY gF TIGARD
BUILDI DIVISION
,t PERMIT #: PLM2005.00498
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 9/28/2005
Phone: (503) 639 -4171 A M �
Inspection Requests (24 Hrs.): (503) 639 -4175 `'I ..
INSPECTION WORKSHEET FOR DATE: 11/14/2005 TIME: 7:12AM PAGE: 105
SITE ADDRESS: 12755 SW WINTERVIEW DR CLASS OF WORK:
SUBDIVISION: ARBOR SUMMIT LOT #: 006 TYPE OF USE:
PROJECT NAME: ARBOR SUMMIT
DESCRIPTION: Backflow preventer for irrigation.
OWNER: WEST HILLS DEVELOPMENT. PHONE #: 503 -641 -7342
CONTRACTOR: WOLCOTT PLUMBING CONTRACTORS PHONE #: 503- 667 -1781
Inspection Request Scheduled For: Date: 11/14/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
325 RP /bacl4l preventer 021101 -04 503 - 319 -6963 N
Corrections /Comments /Instructions: •
‹
v4‹ ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
� �
Inspector: Date: V Phone #: (503) 718 -