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Permit
C ITY OF TIGARD PLUMBING PERMIT �W I DEVELOPMENT SERVICES PERMIT #: PLM2006 -00025 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 1/31/2006 � PARCEL: 1S125DC-00200 SITE ADDRESS: 09700 SW 74TH AVE ZONING: R -4.5 SUBDIVISION: BOULEVARD HEIGHTS LOT: 026 JURISDICTION: TIG Project Private storm line for 8 lot subdivision. CLASS OF WORK: NEW GARBAGE DISPOSALS: MOBILE HOME SPACES: TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS: 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: 133 ft Owner: FEES ASH CREEK PROPERTIES LLC Description Date Amount 12655 SW NORTH DAKOTA ST TIGARD, OR 97223 [PLUMB] Permit Fee 1/31/2006 $101.40 [TAX] 8% State Surchan 1/31/2006 $8.11 Phone : 503-780-4375 [PLMPLN] Plan Review 1/31/2006 $15.35 Total $124.86 Contractor: NEW WEST CONSTRUCTORS INC PO BOX 19588 REQUIRED ITEMS AND REPORTS PORTLAND, OR 97280 -2909 Contact # : PRI 503- 977 -2909 FAX 503 -977 -2920 Reg #: LIC 105212 PLM 26 -783PB 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 ire t q . -stions • OUNC by calling 503 - 246 -6699 or 1- 800 - 332 -2344. Issued By: Permittee Signature• jZ CaII 503 - 639 -4175 by 7:00 a.m. for an inspection that business • ay. 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. ite itilities I i � � V J Plumbing Perm p 'cation . " FOR O FFICE USE ONLY y .. ' : , \ 9 p!s City of Tigard 9 206 Date/By. r I 61 4, �� Permit No.:- �� ��, 13125 SW Hall Blvd., Tigard, OR 9 Plan Review Phone: 503.639.4171 Fax: 503 � $ -1, `N T I, B Other Perm No.: D ate /By 24- Hour Inspection Line: 503.63 f 7 G [AVIS _ ."'".11011 .W : �� Date Ready/By: I Ii1 See Page 2 for Internet: www.ci.tigard.or.us BUILIJ Notified/Method: • ! aft Supplemental Information ? TYPE OF WORK FEE* SCHEDULE N ❑ New construction ❑ Demolition • For special information use checklist Description 1 Qty. 1 Ea. 1 Total ❑ Addition /alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection) ' . ;CATEGORY OF CONSTRUCTION , r SFR (1) bath 249.20 ❑ 1- 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: ( bbl, 5q L ° . j 4 T .,_ v■ , Catch basin or area drain 16.60 City /State /ZIP: J r(, , d1 ., ZZ 3 Drywell, leach line, or trench drain 16.60 Suite/bldg. /apt. no.: Project name: y C rt i ,� 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 W Storm sewer (no. linear ft.: /' Page 2 /C . Subdivision: Lot no.: Water service (no. linear 11.: ) Page 2 Fixture or item Tax map /parcel no.: • Absorption valve 16.60 DESCRIPTION OF WORK Backflow preventer Page 2 g 6- A v /s/0 /,-1 Backwater valve 16.60 Clothes washer 16.60 Dishwasher 16.60 Drinking fountain 16.60 . 0. 12 PP OWNER ❑ TENANT . Ejectors /sump 16.60 Name: r�' G,. Ate 0.4145,/,/ a E b /� � Expansion tank 16.60 Address: / 2 tv ,Ct / /!1 ,,,f. K. 5d- -r Fixture /sewer cap 16.60 City/State /ZIP: 'T l `i-w © K t 1-1 Z z3 Floor drain/floor sink /hub 16.60 Phone: ( 5 160 - 4-+' 375 Fax: ( ) Garbage disposal 16.60 Hose bib 16.60 - ❑ APPLICANT ❑ CONTACT PERSON • . Ice maker 16.60 Business name: Interceptor /grease trap 16.60 Contact name: Medical gas (value: $ ) Page 2 Address: Primer 16.60 City /State /ZIP: Roof drain (commercial) 16.60 Sink/basin/lavatory 16.60 Phone: ( ) Fax:: ( ) Tub /shower /shower pan 16.60 E -mail: Urinal 16.60 CONTRACTOR Water closet 16.60 Business name: ,t , f J ,I ) e , t . ft c 1 AC z Water he 16.60 Address: D, ® , BOX 195 Other: ,T City /State /ZIP: �©, �p�t.✓ 1' ?-7 Z O Subtotal ° ! Minimum permit fee: $72.50 Phone: (p3 ) 9 77 Z4 01 Fax: F172 ) 9) ') `Z 21 &V Residential backflow minimum permit fee: $36.25 CCB Lic.: ( ..1 257 ) Plumbing Lic. no.: Plan review (25% of permit fee) r Authorized signature: v y ^ �3�� State surcharge (8% of permit fee) , TOTAL PERMIT FEE '�r Print name: r tm y 5 j Date:) / q / /? This permit application expires if a permit is not obtained within l 180 days after it has been accepted as complete. *Fee methodology set by Tri- County Building Industry Service Board. i:\ Building \Permits\PLMU- PennitApp.doc 06/05 440.4616T(10 /02/COM/WEB). Plumbing Permit Application - City of Tigard _~' = ~, Page 2 - Supplemental Information -' Fee Schedule: . - _ • Residential Fire Suppression Systems: Site Utilities- . Qty. Fee (ea) Total Square - Footage: Permit Fee: , Footing drain - 1' 100' 55.00 0 to 2,000 $115.00 • Footing drain - each additional 100" 46.40 2,001 to 3,600 $160.00 3,601 to 7,200 $220.00 Sewer - 1st 100' i 55.00 SS 7,201 and greater $309.00 Sewer - each additional 100' r 46.40 Water Service - 1st 100' 55.00 Medical Gas Systems: Water Service - each additional 100' 46.40 Valuation: Permit Fee: ' Storm &Rain Drain - 1st 100' 55.00 $1.00 to $5,000.00 Minimum fee $72.50 Storm & Rain Drain - each additional 100' . 46.40 $5,001.00 to $10,000.00 $72.50 for the first $5,000.00 and $1.52 for each Fixture or Item_ Qty. Fee (ea) Total additional $100.00 or fraction thereof, to and including $10,000.00. ' Commercial Back Flow Prevention Device 46.40 $10,001.00 to $25,000.00 $148.50 for the first $10,000.00 and $1.54 for Residential Backflow Prevention Device each additional $100.00 or fraction thereof, to (minimum permit fee $36.25) 27.55 and including $25,000.00. Rain Drain, single family dwelling 65.25 $25,001.00 to $50,000.00 $379.50 for the first $25,000.00 and $1.45 for Inspection of existing plumbing or each additional $100.00 or fraction thereof, to specially requested inspections - per hour 72.50 and including $50,000.00. Subtotal: $50,001.00 and up • - $742.00 for the first $50,000.00 and $1.20 for each additional $100.00 or fraction thereof. • Fixture Work: • Plan Review for Complex Structure Are you capping, adding or replacing fixtures? If "yes ", A "complex structure" is defined as an installation of a plumbing please indicate work performed by fixture. Failure to system that meets any of the following criteria. accurately report fixtures could result in increased sewer fees *. Please check all that apply. Quantity_by (Fixture) Work Performed CI Any new commercial building. Fixture Type: . " . Replace ❑ Any new exterior plumbing site utilities. Previous Capped Added Existing ❑ A commercial building with installation, alteration or addition Baptistry /Font of nine (9) or more new or relocated plumbing fixtures. Bath - Tub /Shower ❑ Medical gas and vacuum systems for health care facilities - Jacuzzi/Whirlpool providing services to human beings. Car Wash -Each Stall . . ..❑ • Plumbing installatiops, alterations or additions to food service -Drive Thru facilities where new plumbing fixtures, including interceptors, Cuspidor /Water Aspirator are being installed for the food service area. Dishwasher - Commercial ❑ Any new residential building containing three (3) or more -Domestic dwelling units. Drinking Fountain ❑ Any NFPA 13 -D multipurpose fire sprinkler system. Eye Wash Floor Drain /sink 2" Submit 2 sets of plans with any of the above. -3" -4" Car Wash Drain Isometric or Riser Diagram , Garbage - Domestic ❑ Isometric or riser diagram is required for new buildings Disposal - Commercial three (3) or more stories in height. - Industrial Ice Mach. /Refrig. Drains Oil Separator (Gas Station) Comments regarding fixture work: • Rec. Vehicle Dump Station . Shower -Gang -Stall Sink - Bar /Lavatory - Bradley - Commercial • - Service Swimming Pool Filter Washer - Clothes *Note: If the fixture work under this permit results in an Water Extractor P Water Closet - Toilet increase of sewer EDUs, a sewer permit will be issued and Urinal fees assessed for the sewer increase must be paid before the Other Fixtures: plumbing permit can be issued. i:\ Building\Permits\PLM- PermitApp.doc 07/06/05 „ •. CITY OF TIGARD BUILDING DIVISION A 1, / PERMIT #: -11,000,6-00026 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 1 6 i Phone: (503) 639-4171 Inspection Requests (24 Hrs.): (503) 639-4175 A1 IL INSPECTION WORKSHEET FOR DATE: 2/16/2006 TIME: 7 Am PAGE: 61 SITE ADDRESS: 09700 SW 74TH AVE CLASS OF WORK: SUBDIVISION: BOULEVARD HEIGHTS LOT #: an TYPE OF USE: PROJECT NAME: ASH CREEK GATES SUBDIVISION DESCRIPTION: Private storm line for 8 lot subdivision: • OWNER: ASH CREEK PROPERTIES LLC, PHONE #: 60 CONTRACTOR: NEW WEST CONSTRUCTORS INC PHONE #: 503„977.2909 Inspection Request Scheduled For: Date: 2116/2006 Pour Time: Code # Inspection Description Confirm # Contact # Message 340 Storm drain 026994-01 603-969-5711 N Corrections/Comments/In tructions: . t 1 7, 7 ,.” . . ..„ffie ! r 7 .., .fr = . ' 7 • # PASS . 0 PARTIAL APPROVAL 0 CANCEL • 1 1 NO ACCESS FAIL 1 CALL FOR INSPECTION 0 ADDITIONAL FEES ASSESSED Inspector: VA L ---- Date: &jib / ° k --- Phone #: (503) 718-