Permit •
I II CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT PERMIT #: PLM2007 -00007
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 1/10/2007
PARCEL: 25111 AD - 20100
SITE ADDRESS: 14872 SW 89TH CT ZONING: R -4.5
SUBDIVISION: LADY APPLE LOT: 025 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
BEACON HOMES NW, INC.
12703 SW 67TH INC. Description Date Amount
TIGARD, OR 97223 [PLUMB] Permit Fee 1/10/2007 $36.25
[TAX] 8% State Surcha 1/10/2007 $2.90
Phone : 503 -570 -8828 Total $39.15
Contractor:
CONTOUR LANDSCAPING INC
12485 SW TOOZE RD
SHERWOOD, OR 97140 REQUIRED ITEMS AND REPORTS
Contact # : PRI 503- 682 -1302
FAX na
Reg #: LIC 5698
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: / , // Permiftee Signature: V 6
(,)(
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.
. iRECEIVEL.
Plumbing Permit Application 1 2007
JAil City of Tigard p 07 �� Permit N o.: 0/.
� - D OL)o7
• 13125 SW Hall Blvd, Tigard, Ott► 1 2 O F T I G A R D Sao Review
• Phone: 503.639.4171 Fax: BUI DIVISIOR Dm Other Permit No.:
I 1 i ■ 1; 1> Inspection Line: 503.639 Date ReadyBy. Jurim 0 See Page 2 for
Internet: www.tigard- or.gov Notified/Method. Supplemental Information
TYPE OF WORK FEE* SCHEDULE
New construction 0 Demolition For special lnjorneadoe use checklist.
Description I Qty. I Ea. i Total
❑ Addition /alterationheplacement ❑ Other: New 1- 2- family dwellings (includes 100 ft for each utility connection)
CATEGORY OF CONSTRUCTION SFR (1) bath 249.20
I I- and 2- famt7y 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
❑ O ther: Fire sprinkler ( sq. ft.) Page 2
JOB SITE INFORMATION AND,, LOCATION Site utilities
Job site address: 1 N S 7r)- 5(,u O ' e G't a Catch basin or area drain 16.60
City /State/ZIP: 71 6 u), D R Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: 1 Project name: t r y App 1.6 Footing drain (no. linear ft.: ) Page 2
Cross street/directions to job site:
°!�' Manufactured home utilities 110.00
Manholes 16.60
Rain drain connector 16.60
Sanitary sewer (no. linear ft.: ______) Page 2
Storm sewer (no. linear ft.: ) Page 2
Subdivision: 1 Lot no.: 35' Water service (no. linear ft.: ) Page 2
Fixture
Tax
map/parcel no.:
or item
Absorption valve 16.60
DESCRIPTION OF WORK Back flow preventer i Page 2
S Backwater valve 16.60
Se LC Clothes washer 16.60
Dishwasher 16.60
M Drinking fountain 16.60
Name: & J iv w Ex tn 16.60
Expansion tank 16.60
Address: 6 LA) 6 7 2 Fixture/sewer cap 16.60
City/State/ZIP:
1, beczi) ` 0:;) i'j,- Floor drain/floor sink/hub 16.60
Phone: (.; j ) ,_S 0 9 Fax: ( ) Garbage disposal 16.60
D APPLICANT ' . 113 CONTAcr:PERSON
Hose bib 16.60
Ice maker 16.60
Business name:
Interceptor /grease trap 16.60
Contact name: Medical gas (value: S ) Page 2
Address: Primer 16.60
City/State/ZIP: Roof drain (commercial) 16.60
Phone: Sink/basin/lavatory 16.60
( ) Fax::( )
E-mail: Tub/shower/shower pan 16.60
Urinal 16.60
CONTRACTOR Water closet 16.60
Business name: (09u-roc) IL t aS L 4 1 ( ) ,/, ' „Au L Water heater 16.60
Address: !. . k( ) S uJ - rool - 5 Other: I
City/State/ZIP: S iWA-Luvtrt,f, (9 2 11 (ti v Subtotal Minimum permit fee: 572.50 0
Phone: (j:.)S) 6y) - /30 L Fax: (y D3) 6'1 -130 Z Residential backflow minimum permit fee: $36.25
CCB Lic.: 6 R • Plumbing Lic. no.: Plan review (25% of permit fee)
Authorized signature: • / /;_ _ �fJ � State surcharge (8% of permit fee)
' C TOTAL PERMIT FEE
Print name: ' V L #,J,
/ l LO � v +J I Date: ( I I k) / 04 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.
I: \Building\Pumiu\PLM- PmnitApp.doc 0626/06 440- 4616T(10/09KOM/WFB)
Plumbine 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 - l st 100' 55.00
7,201 and greater $309.00
Sewer - each additional 100' 46.40
Water Service - 1st 100' 55.00 Medical Gas Systems:
Water Service - each additional 100' 46.40
Valuation: Permit Fee:
Storrs & Rain Drain - 1st 100' 55.00 $ 1.00 to $5,000.00 Minimum fee $72.50
Storrn & Rain Drain - each additional 100' 46.40 $5,001.00 to S10,000.00 $72.50 for the first $5,000.00 and $ 1.52 for each
Fixture or Item Qty. Fee (ea) Total additional S100.00 or fraction thereof to and
including S10,000.00.
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 Back flow 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
each additional $100.00 or fraction thereof to
Inspection of existing plumbing or and including $50,000.00.
specially requested inspections - per hour 72.50 $50,001.00 and up $742.00 for the first $50,000.00 and $ 1.20 for
Subtotal: each additional $ 100.00 or fraction thereof.
Fixture Work: Plan Review for Plumbing Installations
Are you capping, adding or replacing fixtures? If "yes", Plan review is required for any of the following.
please indicate work performed by fixture. Failure to Please check all that apply.
accurately report fixtures could result in increased sewer fees *. ❑ Any new commercial building with water service 2" and
QuaudtY by (Fixture) Work Performed greater, except systems designed and stamped by licensed
Fixture Type: Replace engineer.
Previous Capped Added Existing ❑ New exterior plumbing site utilities for any complex structure
Baptistry/Font as defined in OAR9I8- 780 -0040.
Bath - Tub/Shower ❑ Medical gas and vacuum systems for health care facilities.
- Jacuzzi/Whirlpool ❑ Any multipurpose fire sprinkler system.
Car Wash - Each Stall ❑ Any complex structure as defined in OAR918- 780 -0040.
-Drive Thru
Cuspidor/Water Aspirator Submit 2 sets of plans with any of the above.
Dishwasher - Commercial
- Domestic
Drinking Fountain Isometric or Riser Diagram
Eye Wash ❑ Isometric or riser diagram is required for new buildings
Floor Drain/sink - 2" that meet the qualifications above.
-3"
4"
Car Wash Drain Comments regarding fixture work:
Garbage - Domestic
Disposal -Commercial
- Industrial
Ice Mach./Refrig. Drains
Oil Separator (Gas Station)
Rec. Vehicle Dump Station
Shower -Gang
- Stall *Note: If the fixture work under this permit results in an
Sink - Bar/Lavatory increase of sewer EDUs, a sewer permit will be issued and
- Bradley fees assessed for the sewer increase must be paid before the
- Commercial
- ice plumbing permit can be issued.
Swimming Pool Filter
Washer - Clothes
Water Extractor
Water Closet - Toilet
Urinal
Other Fixtures:
is \Building\Prnnia\PLM- PamiUpp.doc 09/22/06
CITY OF TIGARD
BUILDING DIVISION .. A
1--- PERMIT #: PLM2007 -00007
13125 SW Hall Blvd., Tigard, OR 97223 E ISSUED: 1/10/2007
Phone: (503) 639- 4171 "�'��1p�� fli� l i 'i
Inspection Requests (24 Hrs.): (503) 639 -4175 �.&�
INSPECTION WORKSHEET FOR DATE: 1/31/2007 TIME: 7:02AM PAGE: 17
/
SITE ADDRESS: 14872 SW 89TH CT CLASS OF WORK:
SUBDIVISION: LADY APPLE LOT #: 025 TYPE OF USE:
PROJECT NAME: LADY APPLE
DESCRIPTION: Backflow preventer for irrigation.
OWNER: BEACON HOMES NW, INC., PHONE #: 503- 570 -8828
CONTRACTOR: CONTOUR LANDSCAPING INC PHONE #: 503 - 682 - 1302
Inspection Request Scheduled For: Date: 1/31/2007 Pour Time:
Code # Inspection Des iptio (, Confirm # Contact # Message
395 Misc. iiispec:tio 042754 -01 503- 320.0183 N
34
Corrections/Com . Lfk.
,..W , 1 4.1V\ '' 1: \ C2 - 2 7
1
z
1.47Ass ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
1 61 ` / 7d z yz 1
Inspector: Date: Phone #: (503) 718 - 1