Permit CITY TIGARD • PLUMBING PERMIT
PERMIT #: PLM2005 -00493
�i�� DEVELOPMENT SERVICES DATE ISSUED: 9/28/2005
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171
PARCEL: 2S 109AD -10400
SITE ADDRESS: 12837 SW WINTERVIEW DR • ZONING: R -7
SUBDIVISION: ARBOR SUMMIT LOT: 002 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: 114a 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.
I
Plumbing Permit Applic GM. i FOR OFFICE USE ONLY •
City of Ti and Received
g CEP 2 8 2 i i Date/By: q 135"' - Permit No lik C'oe J
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone. 503.639.4171 Fax: 503.598.1960 / / '•Iltvel 'i.,' Date/By Other Permit No
24- Hour Inspection Line 503.639.4175 CITY OF TI r.1. 16- u!' i Date Ready /By Iris
Internet www.ci.tigard.or.us BUILDING D ISION Notified/Method — 1" . ' Supplemental ®See Page 2 for Supplemental Information
- TYPE OF WORK .FEE* SCHEDULE
® New construction ❑ Demolition For special information use checklist.
Desertrtion 0t . 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
® 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
0 Fire sprinkler ( sq ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities
Job site address. 0_63 7 SW w I yip to . Catch basin or area drain 16 60
City / State/ZIP: Ti GAR1;, I oc 1712. 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
Water service (no linear ft.. ) Page 2
Subdivision: Arbor Summit I Lot no : 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
Drinking fountain 16 60
' . ® PROPERTY OWNER ❑ TENANT
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 @wcsthillsdevclopment.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 Lie.: 23847 Plumbing Lic. no.: 26 -208PB Plan review (25% of permit fee)
State surcharge (8% of permit fee)
Authorized signature: 6 wio. v-- / , 9 A r�%� TOTAL PERMIT FEE
Print name: Gary Lippold I � J Date: df /4/ 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.
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CITY OF TIGARD
BUILDING DIVISION I PERMIT #: PLM2006-00493
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 9/28/2005
Phone: (503) 639 -4171 /�mwi
Inspection Requests (24 Hrs.): (503) 639 -4175 . 61 I
INSPECTION WORKSHEET FOR DATE: TIME: PAGE: 45
SITE ADDRESS: 12837 SW WINTER VI EW DR CLASS OF WORK:
SUBDIVISION: ARBOR SUMMIT LOT #: 002 TYPE OF USE: 1
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: 10/31/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
325 RP /backflow preventer 019837 -01 503-319-6963 N
Corrections /Comments /Instructions:
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ASS PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: / 0 Date: � I Phone #: (503) 718-