Permit C ITY OF TIGARD PLUMBING PERMIT
DEVELOPMENT SERVICES PERMIT #: PLM2005 -00495
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 9/2$/2005
PARCEL: 2S 109AD - 10600
SITE ADDRESS: 12797 SW WINTERVIEW DR ZONING: R -7
SUBDIVISION: ARBOR SUMMIT LOT: 004 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 97223 [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.
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Issued By: 7 r��� Permittee Signature: .4 4,1/-
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.
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Plumb Permit Ap FOR OFFICE USE ONLY
City of Tigard SEP 2 ry [[ Received M
g 2UDJ Date/By: ��.,� 10,-.1.:01,_ Pennn No'? 1 1 5 do vg. 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax. 503.598 19 Ail.„, ,,,,,t A Othei Permit No:
24- Hour Inspection Line 503.639.4175L 1TY OF TIGARD ■ .i i Dat Date/By.
'' --". Ready /By inns El See Page 2 for
Internet www.ci.dgard onus BUILDING DNISI �-1- � Notified /Method - f / l r " Supplemental Information
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
® l- 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: /2 7 SW (A)IATe,e /C/t) D Catch basin or area drain 16.60
City / State/ZIP: TIGARD De 17213 Drywell, leach line, or trench drain 16 60
Suite/bldg. /apt. no.: Project name:
Footing drain (no. linear ft.. ) Page 2
Manufactured home utilities 1 10.00
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.:
Water service (no linear ft.: ) Page 2
Fixture or item
Tax map /parcel no.: Absorption valve 16 60
DESCRIPTION OF WORK Backflow preventer 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@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 Lic.: 23847 Plumbing Lic. no.: 26 -208PB Plan review (25 % of permit fee)
State surcharge (8% of permit fee)
Authorized signature: 6 a no _
Lippitej TOTAL PERMIT FEE
Print name: Gary Lippold Date: G, /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 Trt -County Building Industry Service Board
i\Buiiding'J'ermus\PLM•PermiiApp doe 12/03 440 -4616T(I0 /02/COM/WEB)