Permit t <,
'MI n CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT PERMIT #: PLM2007 -00029
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 1/29/2007
PARCEL: 2 S 102 D C -04000
SITE ADDRESS: 13907 SW ANDREW TERR ZONING: R -4.5
SUBDIVISION: MCDONALD WOODS LOT: 013 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
WINDRIDGE HOMES INC.
11401 NW SKYLINE BLVD Description Date Amount
PORTLAND, OR 97231 [PLUMB] Permit Fee 1/29/2007 $36.25
[TAX] 8% State Surcha 1/29/2007 $2.90
Phone : 503- 784 -4328 Total $39.15
Contractor:
REQUIRED ITEMS AND REPORTS
Contact # :
Reg #:
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: 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.
1'' Plumbine Permit Application i .. /' > 012 01 FICI .USI ONI ,
,,L a a r.
City of Tigard
$ ', rv
n I � Received LI
DateBy / 7 ,�f ` { a o z
° ;_z / Pmnn No 1 �'Da 7 .. U d
a 13125 SW Hal Blvd, Tigard, OR 97223 g � 2001 Plan Review
I
Phone: 503.639.4171 Fax: 503.598.1960�N E+ Dan Other Permit No.:
Inspection Line: 503.639.4175 (tia'ARD D ate Read B e 2 for
TI Gi�KI? %T� Ready /By J uris: ® See Page
Internet: www.tigard -or.gov C Li' �ter14,int4 Notified/Method Supplemental Information
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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)
g � ���'v�.2 � Y �,�b1C°i� d . - G SY�..F.. - Ras'_' �i4 W BS
`, ` ' i t �' GATE'CORY,�(OF: 'CONST1:P'44E ON ' � !� sr r,
�; "' :;�:n"`9:� ±: "�.x ,,x �•� ,. . , -... ,.�� ��i���,L °���,��t � SFR (1) bath 249.20
Nil- 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:
_ ` « JOB„,SITE INFORMATION' AND iV 7 ' r° 4 ,
Fire sprinkler ( sq. ft.) Page 2
ae' .. „' . "' , S." ,, h a , +. , °z, , .m.. ,V . x, «. -:.. . ,& I: CATIUN € .. ,. ' rr , , - ^ ,Vi
Si utilities
Job site address: 1390 S AU / I ,0 » Catch basin or area drain 16.60
City /State/ZIP: J ! b (I I'( O Q (3 '7 2 Z3 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
Subdivision: C (� Water service linear ce (no. near R: ) Page 2
M � a u�u� w o ►� r Lot no.: 13 Wt -
Fixture or item
Tax map /parcel no.:
er �w -... ,, ,•s . ,. y Absorption valve 16.60
• f A., , •' ' = -+,DES O RKa 4 ; , x� . a + ` 1
:'.'^z53m. Sz_` ± a", s`M..;x+^r:, ;°sy.*:..;4, - �.. ..,£,.,,,,. nd,',:, »H rvvz:'�,. . .._,°',p ;'urM.,. >:'' * "r.. �d.•.�.NFsX
- . Back flow preventer J Page 2
Backwater valve 16.60
I NsMV( I S / 9 ( 4 c f c t' Ai 0t. v i Clothes washer 16.60
Dishwasher 16.60
b ry t . f „5,. ... ,;. .
,... �,A ?a;,4.a,.,-., k � , zt „t<9 r °. ,- ;�•, Drinking fountain 16.60
. , . .. PRUP OWNE +..Pj . r� i s *TEIV AN T ?.4", r : '.'
E r ..�r w_ _ss,a ....I..' co -:�' n rv�: � . #�sr =AC a,` -� �� e���ra�sa - - * _ ��s, 5;.� _ =�� Ejectors/sump 16.60
Name: L4J ES7y/ e W Go NSlit DN Expansion tank 16.60
Address: Fixture /sewer cap 16.60
City /State /ZIP: Floor drain/floor sink/hub 16.60
•
Phone: ( ) Fax: ( ) Garbage disposal 16.60
r. .. . ,.::.,� Hose bib 16.60
S ; APt12j(: A �. =tf-C-. +"'-c s; {. _ ii CUIVTAG #4:0 i= i
f= su... ^.�5 ,. a' ..- :`5:;. 7.... .az�' T'e^,k..,n „� . .,cx o.2.as _ s.. ..a...:+v.�H%£:. Ice maker 16.60
Business name: 'TPA S ( 41 Pest L(, c Interceptor /grease trap 16.60
Contact name: 7 tg, y f N I U I✓ Medical gas (value: $ ) Page 2
Address: 2I b 0 t l 6/■ / f M gEpwapp The. . Primer 16.60
City/ State/ZIP: pit L(, A g b p op. 9 �) 24 Roof drain (commercial) 16.60
Phone: (',,)? ) I b Y - 2,04( Fax:: ( 11) ) S J ? ) 1 all, Sink/basin/lavatory 16.60
t Tub /shower /shower pan 16.60
E -mail:
`.,_ . , t',s: ° . _ .. �, �.., Sr . e . K ..., u., Urinal 16.60
..a `" -, 2: "..f 3 +F'�:'' s�";x'"+�" ail, CONTBAGTOR_ , L:`° 'b4.r`.'',-,?;k°i,!:'? •,.• .,P! `:;F,k',
_.. sa^i.r.� .�# ��! �F
. v.,,,iai• - �. - :r� . „` '�, ", • ;;, , ,: :, ,r _ l ' Wate closet
- -'� tyx �x..- 6.60
Business name: 71,1.4s P -J, M L.0 Water heater 16.60
Address: 2 lib O () /(4/V 41' y j ()OP D g. Other:
City /State/ZIP: I! I Gag D t t) i 6g 1 7 12 y Subtotal
53/- Minimum permit fee: $72.50
Phone: (b' ) R �9 - ?AG) y Fax: ( 5 3) 9 2,/-1, Residential backflow minimum permit fee: $36.25
CCB Lic.: L"U #- "f b Z. Plumbing Lic. no.: Plan review (25% of permit fee)
State surcharge (8% of permit fee)
Authorized signature: Thu,
TOTAL PERMIT FEE
Print name: ! (E N I L(. Date: 1 - 2, / b 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.
I:\ Buildineetmits \PLM- PermitApp.doc 06/26/06 440.4616T(IO/02/COM/WEB)
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
;Site Utiht es �. ry '.
II . • :3111QIM t(id, 12,111 S yuare Footage P P i) . .
Footing drain - l 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' 55.00 7,201 and greater $309.00
Sewer - each additional 100' 46.40
Water service - 1st loo' 55.00 Medical Gas Systems:
Water Service - each additional 100' 46.40
. Yaluafi 6 7 6 1t.NT 4] �eFern>!tFFee,��:���,� AT
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
aFee, e a � t additional 100.00 or fraction thereof to and
Toial�� a
c Fiztii-e orItem "z. a�a� das•,a�� Aa'': +' 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
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: '.:.., ...: , uh. to l .i.- i s1� .
Plan:;° Rev ><ew` s�
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
greater, except systems designed and stamped by licensed
"� ��„ ,,, ..,. Quantity ;bp (Fiafure)Wor'it;P.erCdrmed " %.c
} 'P re oust Capped AdA d ' E • ❑ New exterior plumbing site utilities for any complex structure
Baptistry/Font as defined in OAR918- 780 -0040.
Bath - Tub /Shower ❑ Medical gas and vacuum systems for health care facilities.
- Jacurzi/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 Mss ®YnCtriCOr,I
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 lumbin permit can be issued.
- Service P g P
Swimming Pool Filter
Washer - Clothes
Water Extractor
Water Closet - Toilet
Urinal
Other Fixtures:
•
i:\ Building \Pennits\PLM- PennitApp.doc 09/22/06
CITY OF TIGARD
BUILDING DIVISION PERMIT #: PLM2007-00029
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 1/2912007
Phone: (503) 639-4171 Atk
t
Inspection Requests (24 Hrs.): (503) 639-4175 JAJ. t h l
INSPECTION WORKSHEET FOR DATE: 3/13/200 TIME: 7:02AM PAGE: 51
SITE ADDRESS: 13907 SW ANDREW TERR CLASS OF WORK:
SUBDIVISION: MCDONALD WOODS LOT #: 013 TYPE OF USE:
PROJECT NAME: MCDONALD WOODS
DESCRIPTION: Backflovvpreventer for irrigation.
•
OWNER: VVINDRIDGE HOMES INC., PHONE #: 503-784-4328
CONTRACTOR: t PHONE #:
Inspection Request Scheduled For: Date: 3/1312(107 Pour Time:
Code # Inspection Description Confirm # 1 Contact # Message
395 Misc. inspection 044712-01 ' 503-969-2144
Corrections/Comments/Instructions:
PASS • "A? APPROVAL fl CANCEL El NO ACCESS
I FAIL FA CALL FOR INSPECTION ADDITIO FE . ASSESSED
,
Inspector AIL Phone #: (503) 718-- tift
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