Permit MI CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT PERMIT #: PLM2007 -00346
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 8/6/2007
PARCEL: 1S134DB-07900
SITE ADDRESS: 11184 SW FOREST LN ZONING: R -4.5
SUBDIVISION: STONECHASE LOT: 003 JURISDICTION: TIG
PROJECT: STONECHASE
Project Description: Install residential backflow device.
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
FOUR D CONSTRUCTION CO
PO BOX 1577 Description Date Amount
BEAVERTON, OR 97075 [PLUMB] Permit Fee 8/6/2007 $36.25
[TAX] 8% State Surcha 8/6/2007 $2.90
Phone : 503 -590 -0805 Total $39.15
Contractor:
CROWN LANDSCAPE INC
STEPHEN HARMS
22821 BOONES FERRY RD REQUIRED ITEMS AND REPORTS
AURORA, OR 97002
•
Contact # : PRI 503- 678 -7900
Reg #: LTC 6181
PLM 14939
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 9 - 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: <
, J
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.
'numbing Permit Application
FOR OFFICE USE ONLY
1111 City of Tigard Received
Date/By: �/ I � / S Pe rmit No.: :LA / 2 g A 344
- a 13125SW•HallBlvd., Tigard, OR 97223 Plan D ` r r "� `w "
Plan Review r !s ! �
Phone: 503.639.4171 Fax: 503.598.1960 Other Permit No.:
Da . Inspection Line: 503.639.4175 Date Read /B P1 See Page 2 for
3 TTGAKD Internet: www.ti ard -or. ov Ready /By: g
g g l S upp l emental Information
TYPE OF WORK . . FEE *' SCHEDULE .
❑ New construction ❑ Demolition For special information use checklist
Description Qty. Ea. I Total
❑ Addition/alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
. _ CATEGORY OF CONSTRUCTION - SFR (1) bath 249.20
❑ 1- and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 350.00
El Accessory building El Multi-family SFR (3) bath 399.00
Each additional bath/kitchen 45.00
❑ Master builder El Other:
Fire sprinkler ( sq. ft.) Page 2
" ' ' _ 'JOB SITE INFORMATION AND LOCATION Site utilities
Job site address: /// k4f Si-) f p" LA./ Catch basin or area drain 16.60
City /State /ZIP: ."7-74 , G2 Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: 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: Lot no.: Water service (no. linear ft.: ) Page 2
Fixture or item
Tax map /parcel no.: •
Absorption valve 16.60
DESCRIPTION OF WORK Backflow preventer / Page 2 56. 2 r
NJ,/ a 1 y � /,gi • 5 • Backwater valve 16.60-
/ / Clothes washer 16.60
Dishwasher 16.60
■ Drinking fountain 16.60
' [PROPERTY OWNER ❑` TENANT _ ' -
Ejectors /sump 16.60
Name: G Z C esi 5 T Expansion tank 16.60 .
Address: .0„/7 Rqx / 5-7 7 Fixture /sewer cap 16.60'
City /State /ZIP: 5.VA) , 0/4 517o7S' Floor drain/floor sink/hub 16.60
Phone: (5'03) 7 - 00 17_
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
Phone: ( ) Fax:: ( ) Sink/basin/lavatory 16.60
Tub /shower /shower pan 16.60
E -mail: Urinal 16.60
CONTRACT,OR ' ,' • Water closet 16.60
' Business name: /I t aS Water heater 16.60
Address: c 2 28 / AO PAAS FOX/142 Other:
Subtotal
City /State /ZIP: ,hv 402.4 ` Dg, 5' 7 o O Z_ Minimum permit fee: $72.50
Phone: ( ) 6-7r - •p Fax: ( ) _ Residential backflow minimum permit fee: $36.25
CCB Lt.: 6 / / Plumbing Lic. no.: Plan review (25% of permit fee)
State surcharge (8% of permit fee) 2,9 0
Authorized s • = re: , /5
TOTAL PERMIT FEE
Print name: _ _ Date: e �i 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.
C \Building \Permits\PLM - PermitApp doe 12/27/06 440- 46t6T(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 - 1S 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
Valuation: 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 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 fist $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:
Are you capping, adding or replacing fixtures? If "yes ", Plan Review for Plumbing Installations.
• plea indicate work performed by fixture. Failure to Plan review is required for any, of the following. •
accurately report fixtures could result in increased sewer fees Please check all that apply. ' '
Quantity by (Fixture) Work Performed ❑ Any new commercial building with water service 2" and
Fixtu_ re :Type: Replace greater, except systems designed and stamped by licensed
Previous Capped • _ Added Existing. engineer.
Baptistry/Font
Bath - Tub /Shower CI New exterior plumbing site utilities for any complex structure
as defined in OAR918- 780 -0040.
- Jacuzzi /Whirlpool
Car Wash Each Stall CI Medical gas and vacuum systems for health care facilities.
Drive Stall CI Any multipurpose fire sprinkler system: -
Cuspidor /Water Aspirator ❑ Any complex structure as defined in OAR918- 780 -0040.
Dishwasher - Commercial •
Domestic Submit 2 sets of plans with any of-the above. -
Drinking Fountain
Eye Wash Isometric or Riser.Diagram
Floor Drain/sink - 2" ❑ Isometric or riser diagram is required for new buildings
3„ that meet the qualifications above.
- 4"
Car Wash Drain
Garbage - Domestic Comments regarding fixture work:
Disposal - Commercial
- Industrial
Ice Mach./Refrig. Drains
Oil Separator (Gas Station)
Rec. Vehicle Dump Station
Shower -Gang
-Stall
Sink Bar /Lavatory *Note: If The fixture work under this permit results in an
- Bradley
- Commercial increase of sewer EDUs, a sewer' permit be issued and
- Service fees assessed for the sewer increase must be,paid before the
Swimming Pool Filter plumbing permit can be issued.
Washer - Clothes •
Water Extractor .
• Water Closet - Toilet •
Urinal • ,
Other Fixtures:
•
i \Building\Permits\PLM- PermitApp.doc 12/27/06
08/06/2007 14:02 FAX 5036787901 Z002/004
Pu. It F2
CITY OF TIGARD
C; 0 IA U NIP( DEVELOPMENT
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1 2 5 SW H 511 r31O. Tpr0 Q14 0722'3
a Form
IMPORTANT PERMPI NOTICE
CROWN LANDSCAPE MC
STEPHEN HARMS
22821 BOON ES PERRY RD
AURORA,. OR 97502
PLM2007-00345
Cate Issued
Faroei. 1S134;DEt
Site ACidEGSS. 11184 SW FOREST LN
5:3ubdivisiori: STONE:CHASE
003
Jurisdiction. R-4,5
710
Polec: POJ SIONECIHASE
peso' vc.-sit..lenti b2Acidky pro
Your cc puny boon indica:red as the piLynbing permit ieferended edDove. In order for the
PliJmnlng perlmt :c bc val;cl, .n ease Im Dr a;:rprr=r";:rr-: r-s;rr your company sign r..,elov;" and return this
PrumbiN SignaiLre Porn p; ;or Ic the r, or cr. 'orm to: City of TiclarrlIi, BL;idIng
1175 SW Had 5'c. Ticiard OR, 97;4:23 yC !Tin; , : 53.524 3681
If you have any c.; please ccI 5D3,71
No pltimbina InspectIons will be authorized :inn thk. form in received
CON cl r‘,/EN CONTRACTOR:
FOUR 0 CONSTRUCTION CO CROWN LANDSCAPE INC
PO BOX 1577 STEPHEN HARMS
BEAVERTON OR 137075 ?2u21 BOONES FERRY RD
.. OR 97002
P110Ht-, 503-590 .-;1 . mr - le#: 503-678-7900
(3! S )
P I .4 93 9
AN INK SIGNATURE ;;S REtIti:LIRED ON THIS FORM
-
SignatUre of Authorl4ed Pi:_mber
CITY OF TIGARD
BUILDING DIVISION PERMIT #: PLM2007- 00346
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 8/6/2007
Phone: (503) 639-4171
Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 818/2007 • TIME: 7:00AM PAGE: 39
SITE ADDRESS: 11184 SW FOREST LN CLASS OF WORK:
SUBDIVISION: STONECHASE LOT #: 003 TYPE OF USE:
PROJECT NAME: STONECHASE
DESCRIPTION: Install residential backrlow device.
OWNER: FOUR D CONSTRUCTION CO, PHONE #: 503 - 590 -0805
CONTRACTOR: CROWN LANDSCAPE INC PHONE #: 503- 678 -7900
Inspection Request Scheduled For: Date: 8/8/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
399 Plumbing final 053589-02 503- 720 -0012 N
Corrections /Comments/ Instructions:
4;::72A e, t ( .4 9,1„..)
tXt PASS n PARTIAL APPROVAL n CANCEL ❑ NO ACCESS
n FAIL I CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED
,Inspectors t —J Date: I W Phone #: (503) 718-
CITY OF TIGARD L,
BUILDING DIVISION PERMIT #: PL.M2007 -00346
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 8/6/2007
Phone: (503) 639-4171
Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 8/8/2007 TIME: 7:00AM PAGE: 40
SITE ADDRESS: 11184 SW FOREST LN CLASS OF WORK:
SUBDIVISION: SI'ONECHASE LOT #: 003 TYPE OF USE:
PROJECT NAME: STONECHASE
DESCRIPTION: Install residential backflow device.
OWNER: FOUR D CONSTRUCTION CO, PHONE #: 603 -530 -0806
CONTRACTOR: CROWN LANDSCAPE INC PHONE #: 503-678-7900
Inspection Request Scheduled For: Date: 8/8 /2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
320 Plumbing rough -in 053589-01 503-720-0012 Y
Corrections /Comments /Instructions:
1K PASS ( PARTIAL APPROVAL n CANCEL n NO ACCESS
FAIL CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED
Inspector: 6 Date: QJ 4 l 0 Phone #: (503) 718-