Permit C ITY OF TIGARD PLUMBING PERMIT
Ali DEVELOPMENT SERVICES PERMIT #: PLM2005 - 00494
'�� II 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 9/28/2005
PARCEL: 2S 109AD -10500
SITE ADDRESS: 12813 SW WINTERVIEW DR ZONING: R -7
SUBDIVISION: ARBOR SUMMIT LOT: 003 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: ; ,� Permittee Signature: A d'
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.
4 .. "
Plumbing Permit Applic • CEIV j FOR OFFICE USE ONLY
A.
City of Tigard SE 28 Date/Bya �_6.5.". . . \ . 2) ' 6Qc/, (y
Q Permit No
13125 SW Hall Blvd., Tigard, OR 97223 ►
1 � � Plan Review
Phone: 503.639.4171 Fax 503.598.1960 // +�. dip. J � 's+� Date/By. Other Permit No
OF TI !'-
24- Hour Inspection Line 503 639 4175 CITY _ ' 1 G I I Date Ready/By /r See Page for
Internet• www.ci.tigard.or.us rho js S l
g RI III DING DNISION Notified /Method IV Supplemental Information
TYPE OF WORK .FEE* SCHEDULE
® New construction ❑ Demolition For special information use checklist.
Description I Qty I Ea. [ 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
Z I- and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 350.00
El 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. ago 51,0 ()YJ7 , V /E1) be, Catch basin or area drain 16 60
City /State/ZIP: TI GaRb. oe 9 7.22 3 Drywell, leach line, or trench drain 16 60
Suite/bldg. /apt. no.: 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 Lot no.. 3
Water service (no linear ft . ) Page 2
Fixture or item
Tax map/parcel no.: Absorption valve 16.60
DESCRIPTION OF WORK Backflow preventer 9 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 Z 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 @wcsthillsdevelopment.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 Lic.: 23847 Plumbing Lic no.: 26 -208PB Plan review (25% of permit fee)
State surcharge (8% of permit fee)
Authorized signature:
v TOTAL PERMIT FEE
Print name Gary Lippold OF Date: 9/26/0S" This permit application expires if a permit is not obtained within
180 days after it has been accepted as complete.
*Fee methodology set by Tn- County Building Industry Service Board
i\ Buildi \Permits \PLM•PennitApp doc 12/03 440.4616T(10/02/COM/WEB)
CITY 0041GARD " PLfr1V) 06464
BUILDING DIVISION : PERMIT #. MST200S-00212
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 7/18/2005
Phone: (503) 639 -4171
Inspection Requests (24 Hrs.): (503) 639 -4175 • `'I L
INSPECTION WORKSHEET FOR DATE: 11/2/2005 TIME: 7:04AM PAGE: 26
SITE ADDRESS: 12813 SW WINTER VIEW DR CLASS OF WORK:
SUBDIVISION: ARBOR SUMMIT LOT #: 003 TYPE OF USE:
PROJECT NAME: ARBOR SUMMIT
DESCRIPTION: New SF detached.
OWNER: WEST HILLS DEVELOPMENT, PHONE #: 503 - 641 -7342
CONTRACTOR: WEST HILLS DEVELOPMENT PHONE #: 503-641-7342
Inspection Request Scheduled For: Date: 11/2/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
1 3226 RP/backflow preventer 020133 -06 t 503-319-6963 N
Corrections /Comments /Instructions: o r °
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11(06 �ci Z� .
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PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Vtt Date: ` �1 0 Phone #: (503) 718-