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Permit CITY TIGARD PLUMBING PERMIT PERMIT #: PLM2005 -00497 DATE ISSUED: 9/28/2005 DEVELOPMENT SERVICES 13125 SW Hall Blvd., Tigard, OR 97223 503- 639 -4171 PARCEL: 2S 109AD -10700 SITE ADDRESS: 12781 SW WINTERVIEW DR ZONING: R -7 SUBDIVISION: ARBOR SUMMIT LOT: 005 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- 647 -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: f'��jj Permittee Signature: G�-- 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. • i , ... *4+. Plumbing Permit REMIVED FOR OFFICE USE ONLY City of Tigard R / ' Permit No : ` 13125 SW Hall Blvd., Tigard, OR 971�Q� 2005 Date/By. Review _ V _,_4. - (,�jy Phone 503.639 4171 Fax 503.598 S J 44,7 a 1.01 Date/By y Other Permit No • 24- Hour Inspection Line 503.639 4175 A I� Internet www.ci.tigard.or.us CITY OF TIGARD Note Ready/By. . "r)(� S See Page l Information Notified/Method: I Supplementalnformation 1R1 ) f aC I IRie 10N FEE* SCHEDULE Z 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 E I- 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: ) 179 1 so w )N7Yftw 4(), Catch basin or area drain 16 60 City /State/ZIP: 71 Gl4RD O12 17 2.2 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 Water service (no. linear ft.: ) Page 2 Subdivision Arbor Summit I Lot no.: S Fixture or item Tax map /parcel no.: Absorption valve 16 60 DESCRIPTION OF WORK Backflow preventer V Page 2 NEW CONSTUCTION Backwater valve V 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 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 $36.25 CCB Lic.: 23847 Plumbing Lic. no.: 26 -208PB Plan review (25% of permit fee) State surcharge (8% of permit fee) Authorized signature: / V TOTAL PERMIT FEE 79' t ) Print name: Gary Lippold Date: el /2$ / This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. *Fee methodology set by Tri -County Building Industry Service Board. 1 \Budding\Permits\PLM•PermnApp doc 12/03 440 -4616T(I0 /02/COM/WEB) ' CITY OF TIGARD Pii-Mott 6- ©a 441 BUILDING DI Afe —PERtotFT-4k—Poi9T-289549243— 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 7/18/2005 Phone: (503) 639 -4171 l Inspection Requests (24 Hrs.): (503) 639- 4175ill.. INSPECTION WORKSHEET FOR DATE: 11/2/2006 TIME: 7:04AM PAGE: 24 SITE ADDRESS: 12781 SW WINTERVIEW DR CLASS OF WORK: SUBDIVISION: ARBOR SUMMIT LOT #: 005 TYPE OF USE: PROJECT NAME: ARBOR SUMMIT DESCRIPTION: New SF detached. OWNER: WEST HILLS DEVELOPMENT, PHONE #: 603-647 -7342 CONTRACTOR: WEST HILLS DEVELOPMENT PHONE #: 503 -641 -7342 Inspection Request Scheduled For: Date: 11/2/2006 Pour Time: Code # Inspection Description Confirm # act # Message 326 RP /baclflow preventer 020133 -08 503. 319.6963 N •–•...„ ...,.................:NN\ Corrections /Comments /Instructions: os • c lfij% - r1/■■•1 1 / 4 —Q — ¥ -ems L - a -c " C L. �C ` 9,..,. ‘-,. 1 - . . 6- ` ss \ei G1' D, � \e'( - c.,a_.(.1 k„, e .....(2.12_vv‘ .1 \ ; % 4-c.,A . 00 SA ti 4 K PASS ❑ PARTIAL APPROVAL ❑ CANCEL ACCESS • ►Z AIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED t /2 /a s� Inspector: Date: Phone #: (503) 718-