Permit M
CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT PERMIT #: PLM2007 -00162
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 4/25/2007
PARCEL: 2S 109D D - 08900
SITE ADDRESS: 12703 SW DA VINCI LN ZONING: R -
SUBDIVISION: BELLA VISTA LOT: 019 JURISDICTION: TIG
PROJECT: BELLA VISTA
Project Description: Area drain.
CLASS OF WORK: OTR 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: ft
Owner: FEES
RIVERSIDE HOMES, INC.
1925 NW AMBERGLEN PKWY. #200 Description Date Amount
BEAVERTON, OR 97006 [PLUMB] Permit Fee 4/25/2007 $72.50
[TAX] 8% State Surcha 4/25/2007 $5.80
Phone : 503- 645 -0986 Total $78.30
503- 690 -2942
Contractor:
ALL METRO LANDSCAPE
PO BOX 1812
BEAVERTON, OR 97075 REQUIRED ITEMS AND REPORTS
Contact # : PRI 503- 642 -1350
Reg #: LIC 7908
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 0001 -0010 through OAR 952-00011 You may obtain copies of
these rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By: / / , Permittee Signature: (AA,/
Call 503.639.4175 by 7:00 a.m. for an inspection that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of th project.
Approved plans are required on the job site at the time of each inspection. 15
•
Plumbing Permit Application • ' fi l'O R`.0 F FICFQ US O , i '-,'''' ''
4
City of Tigard Li : t traa ;. R � ^ P
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;:4 q 13125 SW Hall Blvd, Tigard, OR 97223 Date/ByL!� � / G � -,
Plan Re w
® .*, Phone: 503.639.4171 Fax: 503.598.1 t� 2UU1
Date/By. ether Permit No.:
Inspection Line: 503.639.4175 ��((
T I G' A K ` D Date Ready/By: ions: ® See Page 2 for
,: a � „ ., Internet: www.tigard - or.gov Notified/Method Supplemental Information
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El New construction B� r F or special information ," 1 ��,�l�tfio^n���TT�'- '1��' on use checklist "
Description ) Qty. I Ea. I Total
❑ Addition /alteration/replacement ❑ Other: New 1 - 2 - family dwellings (includes 100 ft. for each utility connection)
* x . 1 ,t ' � �4'CATEGORY OF CONSTRUCTION , y ,, ` .�" , 4' •:�" ` ``�'$ SFR (1) bath 24920
a ., I :.sue 1 .,,, , Y .+� . -t- ,, . t7, •-.0, ..,:`-.•- .. k' *�,.. S -Nn.. •G N • , 1,4 .W.A. ' > d ,4 'Cala,>,
❑ 1- and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 350.00
❑ Accessory building ❑ Multi - family SFR (3) bath 399.00
❑ Master builder additional bath/kitchen 45.00
❑ Other:
. �... .� . _ . - ��. „ Fire sprinkler ( sq. ft.) Page 2
•; .r JOB SITE IDNFORMATION AND LOCATIONl1''t ' '* '
.. •. -mss �: -W„�c ,_ ^�+- ,.• �' " �.�;,t: Site utilities
Job site address: 12-7 0 3 £9 * ` 1 3) 4 v tb c Lan Catch basin or area drain 16.60
;
City /State/ZIP: 'f ys �,e. 6v Drywell, leach line, or trench drain lJ 16.60
„V ; b 1. Footing drain (no. linear ft.: ) Page 2
Suite/bldg. /apt. no.: I Project name: FJ
Manufactured home utilities 110.00
Cross street/directions to job site: Manholes 16.60
g ..... F AA- iCtine.cot. rite Q Rain drain connector _ 16.60
' Sanitary sewer (no. linear ft.: ) Page 2
Storm sewer (no. linear ft.: ) Page 2
/ Water service linear ce (no. near ft.: )
Subdivision: LG� V �,� I Lot no.: � Wt _ Page 2
Fixture or item
Tax map /parcel no.: -
6 „, , ,,,,•. 5: q :, ,. _ .,.., "•,,
Absorption valve 16.60 a
' ', ¢.€.• C, . r''DF,SCRIPTIONOF'��'VORK { F i
r` t
;gin .t;.:�..,.._, �` ��• t � ..� •,.x �,�x _ . aY��F .t- s,�`=.�� »� . Back flow preventer Paget
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SE Gam.. Backwater valve 16.60
Clothes washer 16.60
•
Dishwasher 16.60
•
U .'> ,�., - fi i v ' 4i a -, i Drinking fountain 16.60
`� ;x .. N. 5 � { M h, a'LE,:a {✓':, "". S - #' �M<F= `g+'t
"? _ ,.'i" �n'P ROBEItTY' • a O .W 1VER '';.' '4 ' '. ', : , = ® ,, ; T , -,- -' . 1 y �' .
^'..`� .'' -.,,. w.w�_..:, «a -, cr: b;, e.,�; ... .m Vii!' °'�`-,. - - .,v- � f ' - .•.
`�'� "" `� rr Ejectors/sump 16.60
Name: f4„..4.,"... Ask_ 1.4,,, % 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
,`< � ...-..- - '
`.. ,$'1 ® .,... 1 .. ., . _. ,, r.,-,`{,... 1 :fin {.� •,y�rr�w ", .T ; 5 ... y. _t'V.'i!t ,, -- Hose bib 16.60
is : ;•APPLICANT. , T 'ii ❑ 'CONTACT PER k
w : ,� M;m f„ a a Ice maker 16.60
Business name: Ai( NA Interceptor /grease trap 16.60
Contact name: Medical gas (value: $ ) Page 2
Address: 'P D hole ( q. t t Primer 16.60
City /State /ZIP: Umpf.N6f. "14‘17-0 -s' Roof drain (commercial) 16.60
Sink/basin/lavatory 16.60
Phone: ( 01?) t.. '(L r f a Fax:: ( ) 1.77-4f 6 'L
Tub /shower /shower pan 16.60
E -mail:
Urinal 16.60
s~, ' x! > 'may,.:,, ,. •: , is `' Water closet 16.60
,, a `,. , '� � . " ja , ' CONTRACTOR ;� t ,•4 , g'` '� ;: ,� � ( ;w.� ^
Business name: A^ VL- 11/.4 , Water heater 16.60
Address: P it, P›vik I t . L Other:
City /State/ZIP: y o - 1 '7o 7
Subtotal
' Mi nimum permit fee: $72.50
Phone: ( S 03 4 yZ .st, Fax: ( (V3 3-7 Z c C 2 Residential backflow minimum permit fee: $36.25 _
CCB Lic.: • Plumbing Lic. no.: t-0.31910$ Plan review (25% of permit fee)
State surcharge (8% of permit fee)
Authorized signature: �..... '6/ TOTAL PERMIT FEE 3p
Print name: •A - ri Dvyr-, Date: K/z 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.
L\ Building \Permits\PLM -Perm itApp.doc 06/26/06 40- 1616T(I0/02JCOM/WEB)
jr
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
a : Fce(e8) % x, s:s P a tea: i�t,a', y z
` T,Y AYSt a ' Squareyl�OOtage , .11; t� iii_Hi o ee_ , 4700
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 100' 55.00 Medical Gas Systems:
Water Service - each additional 100' 46.40 _• r K. �:.
TValuatioii.A; 51Permitr, .. ` .,d -
Storm & Rain Drain - 1st 100' 55.00..• y
$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
additional $100.00 or fraction thereof to and
FiXtt "re orItei>re z ;;« ; p'Qty:; .Fee (ea) Total,`
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: n °N.'Plan Review ;forPluiibng:'Iiistallatons
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
Y , - greater, except systems designed and stamped by licensed
Fixt
Quantifz.IW(Fixture) Work °Performed
°T yure Typer ;� � :. .,.,,..� "` �� .•P fi engineer.
s y3 r' 3, i >. s, M'.. "PRe twee'
� a� 1 Capped :.:Added., ��i ist;o��' « ❑ 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.
- 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 �x.•,,`
Drinking Fountain
.: L_X ,tal'„Asori etric;orR ser,„D agram7=Z: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
Service plumbing permit can be issued.
Swimming Pool Filter
Washer - Clothes
Water Extractor
Water Closet - Toilet
Urinal
Other Fixtures:
i:U 3uilding \Pennits\PLM- PennuApp.doc 0922/06
• CITY OF TIGARD
BUILDING DIVISION PERMIT #: PLM2007-00162
4 41 1 ,,, ...
13125 SW Hall Blvd., Tigard, OR 97223 - DATE ISSUED: 4/2512007
Phone: (503) 639-4171 . „....i ttplt
Inspection Requests (24 Hrs.): (503) 639-4175
INSPECTION WORKSHEET FOR DATE: 5122/2007 TIME: 7:01AM PAGE: c
0
SITE ADDRESS: 12703 SW DA VINCI LN CLASS OF WORK:
SUBDIVISION: BELLA VISTA LOT #: 019 TYPE OF USE:
PROJECT NAME: BELLA VISTA
1 DESCRIPTION: Area drain.
OWNER: RIVERSIDE HOMES, INC., PHONE #: 503-645-0986
CONTRACTOR: MOS= ItiMISCM , PHONE #: 603-6RIZU
1 Inspection Request Scheduled For: Date: 5122/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
399 Plumbing final 048831-01 503-642-1350 N
Corrections/Comments/Instructions:
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PASS r ---- 1 PARTIAL APPROVAL III CANCEL F NO ACCESS
I I FAIL fl CALL FOR INSPECTION E] ADDITIONAL FEES ASSESSED
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Inspector: M I ).._ f / Date: Phone #: (503) 718-
— ' - • - ' '