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13535 SW NAHCOTTA DR
CITY OF *TI GA.RD PLUMBING PERMIT
DEVELOPMENT SERVICES PERMIT#: PLM2005-00416
N DATE ISSUED:13125 SW Hall Blvd., Tigard, OR 97223 503-639-4171 PARCEL: 2S 10 251005
0 5DD-03300
SITE ADDRESS: 13535 SW NAHCOTTA DR ZONING: R-7
SUBDIVISION: PACIFIC CREST LOT: 009 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: Sc'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
JOE CANOVA
13535 SW NAHCOTTA DR. Description Date Amount
TIGARD, OR 97223 [PLUMB] Permit Fee 8/29/2005 $36.25
[TAX]8%State Surcharl 8/29/2005 $2.90
Phone: 503-579-1576 Total $39.15
Contractor:
PACIFIC GARDENS& WATERWORKS
PO BOX 2623 REQUIRED ITEMS AND REPORTS
TUALATIN, OR 97062
Phone: 503-682-3370
Reg#: LIC 5807
IL
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This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes
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and all other applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is
W not started within 180 days of issuance,or if work is suspended for more than 180 days. ATTENT:ON: Oregon law
requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules ars set forth in OAR
952-0001-0010 through OAR 952-0001-0100. You may obtain copies of these rules or dirv;ct questions to OUNC by
calling 503-246 9 or 1-800-332-2344.
Issued I _ �. /� Permittee Signature:-221.
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.
001
�. Building Fixtures O
' Plumbing Permit AP lic_ta *
City of Tigard ,�R
��' Recei Date d Lr! U�--- reR„it N� -OCA
13125 SW Hall Blvd„Tigard,01Q ! t 1Q0 PLn R iew -- - -
Phone 503.639.4171 Fax: 503. 98.1960 cL ether Pcrrtul No
t Date/By
24-Hour Inspection Linc: 503.639.4175 Date Ready/By m°r 0 See Pole 2 for
Internet: www.ci.tigard.or.ue t I� Noufied/Method. Supplementallntormatior
ew Construction ❑DElttplldon _,_ For special informadon use cke_ck/Jst
Descri m un I Qty. T Ea. Total
❑Additiordalteralion/replacement ❑Other: New 1-2-family dv,ellings(includes 100 It for each utility connection)
Y" t•:, tl::, t�`.A 1Ci+T ,ORS < i.... SFR(1)bath 249.20
I-and 2-family dwelling ❑Commercial/industrial SFR(2)bath 350_00
❑Accessory building ❑Multi-family SFR(3)bath_—� 399.00
- - Each additional bath/kitchen 45.00
❑Master builder ❑Other: -
Fire sprinkler(_sq.fl.) Page 2
NOW* Site utilities _
Job site address: 3 S-jai CLT UA Catch basin or area drain 16.60
City/State/ZIP: T1 G -�---OR, 722 - Drywell,leach line,or trench drain 16,60
Suite/bldg./apt.no.: Project name: Footing drain(no linear fl.: ) Page 2
Manufactured home utilities 11000
Cross street/directions to job site:
Manhuiw 16.60
Rain drain connector 16.60
Sanitary sewer(no.linear fl.: Page 2
Storm sewer(no.linear fl.: Page 2
Subdivision: Lot no.: Water service(no.linear ft,:_� Page 2
Fixture or Item
Tax ma
p/parcel no
10 � Absorption valve 1660
` y�t Backflow preventer Page 2 a
i1,-e- Backwater valve 16.60
Clothes washer 1660
Dishwasher 16.60
Drinking fountain 16.60
YEiS �r. 'F•"
MMONEjectors/sump 16.60
Name: af424 A Expansion ink 16.60
Address: S MA 141 C a "fA FixtutWsewer cap MAO
City/State/ZIP: "�(� _57,f_20 _ Floor drsin/floor sink/hub 16.60
Phone:(SZ) S �- Fax:( ) Garbage disposal 16.60
kHose bib 16.60
"' O V " Ice maker 16.60
Business name: a Interceptor/grease trap 16.60 ---
Contact name: "p-ic,ie- S6eJ _ Medical gas(value:S ) Page 2
IL Address: �0 � Primer 16.60 _
a Roof drain(commercial) 16.60
N City/State/ZIP: AI.a>�-T�l� OPI
Fax: Sink/basin/lavatory 16.60
Phone: ) --
( t(o Q'2-L(IS 7 (LZ$) ��L-3 37p Tub/shower/shower pan 16.60
J E-mail: ?G L t CUrinal 1660
aY u�r'"`i1v ,r ••"1' •;'tt i ( .' SI.? . Water ClOStt 16.60; 71 � i
J Business name: � FC,�
tIL ^ao-tC S a- Ck�___6lL AQX Water heater 16,60 -
Address: Tb
aux A.(AA3 - Other:
Subtotal
City/StateIZlP: T -tom CY 570fo2," —
� Minimum permit fee: 572.50
Phone:(,qa ) (0 N i 5 -, Fax: Residential backflow minimum pit fee: $36.25 ,Z�
CCB Lie.: 5go7 2 Plumbing Lie.no.: Plan review (25%of permit fee)
State surcharge(8%of permit fee)
Authorized signature: -- TOTAL PERMIT FEE
Print name: �-i L T Date: ��� Thls permit application expires If a permit Is not obtained within
T r��•� n 180 days after It has been accepted as complete
"Fee methodology set by Tri-County Building Industry Service Board
i\Building\Punks\PLMF-PermittAApppdQoc 12/0 0 16T(10/02/COM1wEB)
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Plumbine Permit Application - City of Tigard 0
7,11Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppr-ession Systems:
►,'' '• t,y;,. i< - r ;�Total,a C.r,,.. � �e:�
' .. jsti m i„+.is
Footing drain-1"100' 55.00 :0 to 1,000 $115.00
Allwillou
Footing drain-each additional 100' 46.49 2,001 to 3,600 $160.00 - –---- -
3,601 to 7,200 $220.00
Sewer-1st 100' 5500 7,201 and greater $309_00
Sewer-each additional 100' — N 46.40
Water Service-Ist 100' 55.00 Medical Gas S stems:
Water Service-each additional 100' 46.40 +
Storm dF Ram Drain-I st 100' 55.00 -- '
51.00 to$5,000.00 Minima fee$72.50
Storm&Rain Drain-each additional 100' 46.40 $5,001.00 to$10,000.00 $72 50 or the first$5,000.00 and$1.52 for each
addi'i nal SI OU 00 or fraction thereof,to and
_ incl ir.g$10,000.00.
Commercial Back Flow Prevention Device 4 0 $10,001.00 to S25,000.00 S 18 50 for the first 510,000 00 and$1 54 for
Residential Backflow Prevention Device ch additional$100 00 or fraction thereof,to
minimum permit fee$36.25 27.55 ,�?,s and including$25,000.00.
Rain Drain,single family dwelling 65.25 625,001 00 to$50,000 00 $379.50 for the first$25,000.00 and SI 45 for
Inspection of existing plumbing or each additional$100.00 or fraction thereof,to
s eciall
requested in ections-per hour 72.50 and including$50,000 00.
Subtotal: 1-1
550,001.00 and up 5742 00 for the first$50,000.00 and Sl 20 for
. each additional$100.00 or faction thereof.
Fixture Work:
Are you capping, moving or replacing existing fixtures? If
"yes",please indicate work performed by fixture. Failure to
accurate) report fixtures could result in Increased sewer fees*.
i
w• t.,';' CO tints regarding fixture work:
Ba tis /Font
Bath -Tub/Shower –
-Jacuzzi/Whirlpool _
Car Wash -Each Stall -
-Drive Thru
Cuspidor/Water Aspirator _
Dishwasher -Commercial _
-Domestic
Drinking Fountain
Eye Wash _
Floor Drain/sink -2"
-3"
IL Car Wash Dain
Garbage -Domestic
f j Disposal -Cduor iral *Note- If the ture work under this permit results in an
Ice Mach./Rcfri .Drains _ i increase of sew EDUs,a sewer permit will be issued and
Oil Separator(Om Statin) fees assessed fo the sewer increase must be paid hefore the
Rec.vehicle DurT Station plumbing perml t can be issued.
Shower -Gang
-Stall
W Sink -Bar/1-avatory Quantity Total
-Badley Isometric or risi r diagram is required If fixture quantity-Commercial
-Service total Is>9.
Swigirruing Pool Filter
Washer-Clothes
Water Extractor Plan Review
Water closet-Toilet . V
Urinal t'lan review is required if fixture quantity total is>9.
Other Fixtures:
,\BuildinilTrn it_\PLM-Pe itApp dnc IM3
CITY OF TIGARD
BUILDING DIVISION - ` PERMIT#: Pt-M200F.00416
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 8/2W2005
Phone: (503) 639-4171
Inspection Requests (24 Hrs.): (503) 639-4175
INSPECTION WORKSHEET FOR DATE: 9114/2005 TIME: 7:09AM PAGE: 99
SITE ADD;"=SS: 13535 SW NAI ICOTTA DR CLASS OF WORK:
SUBDIVISION PACIFIC CREt,T LOi#: 009 TYPE OF USE:
PROJECT NAME. (;ANOVA
DESCRIPTION: Har lkflow Ixeventer for irrigation,
OWNER: CP,NOVA, JOE PHONE #: 5035711576
CONTRACTOR: PACIFIC GARDIENS&WATERW()I?KS PHONE M: 503.682-3370
Inspection Request Scheduled For: Date: 9/14/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
325 RP/hauldlow preventer 015567-01 503-515-2011 Y
Corrections/Comments/Instructions:
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'� SS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: —�—_ _ Dab: — Phone #: (503) 718-