Permit CITY OF TIGARD
PLUMBING PERMIT
DEVELOPMENT SERVICES PERMIT #: PL /20/2% -00678
' 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 12/20/2005
PARCEL: 2S 111 AD -06300
SITE ADDRESS: 14815 SW HALL BLVD ZONING: R -4.5
SUBDIVISION: LOT: JURISDICTION: TIG
Project Description: Private storm utilities for new subdivision, other fixture is (1) manhole.
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: 1
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES: 1
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: 460 ft
Owner: FEES
BEACON HOMES NW, INC. Description Date Amount
12703 SW 67TH AVE
TIGARD, OR 97223 [PLMPLN] Plan Review 12/20/200E $63.81
[TAX] 8% State Surcharl 12/20/200E $20.42
Phone : 503-570-8828 [PLUMB] Permit Fee 12/20/200E $255.24
Total $339.47
Contractor:
GVS CONTRACTING INC
700 N COLLEGE ST REQUIRED ITEMS AND REPORTS
NEWBERG, OR 97132
Contact # : PRI 503 - 538 - 2998
FAX 503 -538 -9829
Reg #: LIC 54340
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 pla s. This permit will expire if work is
not started within 180 days of issuance, or if work is suspended for more than 180 . - ,s A ENTION: Oregon law
requires you to follow rules adopted by the Oregon Utility Notification Center. Th. - . u e. are set forth in OAR
952 - 0001 -0010 through OAR 952 - 0001 -0100. You may obtain copies of these rul- o i d -ct questions to OUNC by
calling 503 - 246 -6699 or 1- 800 - 332 -2344.
Issued By: �� �- ���r �� 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.
/ (- ITiCSL' f1 13 vA •
_
Site IJtiiities • �..� � � r~ • 0 � 00,5 -�0000
• , Piui'nbing PermityAp.p c on F OR o FFlc.r ' USE ONLY
City of Tigard ,� 2005 Received � � O S 9 P No.: ` l5 = � $
13125 SW Hall Blvd., Tigard, OR 972P�fC Date/By.
Plan Review
Phone: 503.639.4171 Fax: 503.598.11 r , ; , / /,,ty j,q � ,• Date/By. j 2I 9 1 0•S' St--1 Other Permit No.:
24- Hour Inspection Line: 503.639.4175“ Oc 1 1 G P _ •� I. , Date Ready/By: �'"� ® See Page 2 for
Internet: www.ci.tigard.or.us CI i j � iXT1 t , J1'' Notified/Method: ik Su pplemental Information
I' .70N `WORK F EE* SCHEDULE . '
1 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)
. • CATEGORY OF CONSTRUCTION.' - SFR (I) bath 249.20
E 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: / s v.) 14 ALL- e/ Catch basin or area drain 1 16.60 1
. City /State /ZIP: ! /G Aak to ( D Z 'MO Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: I Project name: D ,4 ?/�jL s K$ Footing drain (no. linear ft.: ) Page 2
1 Y Manufactured home utilities 110.00
Cross street /directions to job site: -
Manholes ( 16.60 0.0. top
52 t Se•..1,4 ci Rpa,f.•. • $W /1,44Rfri) Rain drain connector 16.60
Sanitary sewer (no. linear ft.: ) Page 2
A Storm sewer (no. linear ft.: ODD I Page 2 2 0. z ... 0,
z4b 7 4PP1 ._ I Lot no.: S./y Water service (no. linear ft.: ) Page 2
' • ' Fixture or item
Tax map /parcel no.: / < . I W n A6 GS 0 - Absorption valve 16.60
. DESCRIPTION OF WORK Back flow preventer Page 2
SItral%44_ ?a i s/p?,e seraj¢.- L, _ Backwater valve 16.60
ST t GTsfreA r • 4 .474401 --j • . J Clothes washer 16.60
• Dishwasher 16.60
Drinking fountain 16.60
(OPERTY OWN_ R . ❑ TENANT
Ejectors/sump 16.60
6
Name: 4C"1 0 /VA) -/_, _ , Expansion tank 0 16.60
Address: 12..?03 SW 67M ke Fixture /sewer cap 16.60
City /State /ZIP: 1 /6Ab OZ_ g7 23 Floor drain/floor sink /hub 16.60 -
p
Phone: ( ) sf'e Fax: ($53 ) a
ryL MO Garbage disposal 16.60
Hose bib 16.60
APPLICANT ❑ CONTACT PERSON - • -
Ice maker 16.60
Business name: S .a_ Ageo-e- Interceptor /grease trap 16.60
Contact name: ' 5 I } T 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
CONTRACTOR , 0 Water closet 16.60
Business name: I /5 Water heater 16.60
Address: '}oo N. voOw, Sr • Other:
City /State /ZIP: Adt ■)
Minimum'permit fee
S : '1 13Z Subtotal : $72.50 29s.2ht
C� "
Phone: (P5 )53,5_ Fax: ) ,c , ?W1 Residential backflow minimum permit fee: $36.25
// / Plan review (25% of permit fee) ( , t #`
CCB Lie.: S'l/3L�D Plumbing Lic. no.: �/
/t , s - � � State surcharge (8% of permit fee) 2 . WI-
Authorized signature: , � TOTAL PERMIT FEE 22f\ ti '
• Print na n =� _ i �irj/ � Date /1�6 :67S 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 \Pemiits\PLMU- PennitApp.doe 06/05 440-4616T(10 /02/COM/WEB)
Plumbing Permit Application - City of Tigard •- -
• Page 2 - Supplemental Information v --'
• P Schedule:' '' Residential Fire Suppression Systems:
Site ' tilities. _ Qty .%Fee (ea). ' Total • SquarefFootage:, ' 'Permit Fee,:
Footing .I :in - 1 '' 100' 55.00 0 to 2,000 $115.00
Footing drai - each additional 100' ' 46.40 2,001 to 3,600 $160.00
3,601 to 7,200 $220.00 y
Sewer - 1st 101 55.00 7,201 and greater $309.00 , ,
Sewer - each addi •onal 100' 46.40 *
Water Service - 1st 10' 55.00 Medical Gas Systems: 1
• Water Service - each ..s ditional 100' 46.40
Valuation 't• Permit •ee: - ' .
Storm & Rain Drain - 1 t 100' . I 55.00 $1.00 to $5,000.00 Minimum f. $72.50
Storm & Rain Drain - - ch additional 100' 3. cQ 46.40 /47,011 $5,001.00 to $10,000.00 $72.50 fort - first $5,000.00 and $1.52 for each
Fixture Or Ite Qty.. Fee (ea)' Total additional $ 00.00 or fraction thereof, to and
Commercial Back Flo Prevention Device 46.40
including
14 8 . 50 g the first $
$10,001.00 to $25,000.00 $148.50 fr the first $10,000.00 and $1.54 for
Residential Back flow Prevention Device each add' ional $100.00 or fraction thereof, to
(minimum permit fee $3 ,.25) 27.55 ., . , +:- , and inc : ding_$25,00 Q t
Rain Drain, single family ' welling 65.25 $25,001.00`.t&$'. 00.10 `$379. I 'foIstfi&. first $ 5 and $1.45 for
1 2
Ins ection of luml or ti ro•,x. eact( dditional $100;1 t Q(fraetion thereof, to
p g p g '* ,,,�, and nc i 1 ifab'y
s.ecially re:nested ins.ection 'Cr hour • 72.50 •�
'ant t': $50 plio: ig apau . • $7.2.00 for the first $50,000.00 and $1.20 for
ubtotal: Z,p1 ' "' r ch y additional $100.00 or fraction thereof.
r' # C . , ..d tes,ar ` t°3 24 "••- ct -:
i
• .
Fixture Work: `s�, "':� Plan Review for Co ">tYis d St tures
Are you capping, addin r replacing fixtures? If "yes ", A struct a isdefined as•an instal] t'on of a plumbing
please indicate work rformed by fixture. Failure to , system t ha t meets a ny' t"the following criteria.
accurate)
* Please check all that apply.
re ort fi �fu could result _. <
accurately p res co res t m increased sewer fees -- -.,
Quantity by (Fixture) Work Performed ❑ An}c tle,,w.,comm. � tiding. , A„ t rxC, .. '.1.04- a�t4- „
' 'Fixtu"re.T.ypet - - Replace ' ❑ Any new exterior site•utilities.� ,
Previous .Capped Added Existing ❑ AcommertiiarbitiadiNetA' di installation): lt>'taion'bl 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/Whirlp of providing services to human beings.
Car Wash -Each Sta ❑ Plum h inst4Iltitipns, altgaq u ,or addiii,m.W14•j service
-Drive T facilities'tyhere n plumblii&fixtitft s, includitlgiht0eptors,
Cuspidor /Water Aspirator are beiij i stalle o? t1e food tl vice area ..' ~" k.
Dishwasher - Commercial ❑ Any new s§ttl1 i .l buildN containiti (ee (3) or more
- Domestic
{lw,pll in its. ` ; ., . � . ■•
Drinking Fountain 1.`.i, ..-11"1:' •' ' l ''� �
Eye Wash � A1iy.NFP 1 3 D multipurpo e� prinkltr. • �`.
Floor Drain /sink _ 2„ Submit 2 sets of plays rlany the gbove.
-.
Car Wash Drain, ISOmC�j1E -tn ep t l � i� i .
Garbage - Domestic J ❑ Isometr c, or riser diagram is required fo 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' •
��tall
-- -Sink - Bar/Lavatory .,,,-,7
- Bradley t r+
- Commercial . . /T -,�'%� 3 : ° ' , L'I O ki j
P'`,. n t ,. .� � I • r • v
-Service :! ? •4 . 4 �i': '
Swimming Pool Filter ! %s=� r - � 1 „�`` -..��; r'
Washer - Clothes •vs y ;',..ii ,k. �? \ -
per
Water Extractor : « -�ti* * L 1,. J � If the fixture work under this tn , t re�ul ,
s in an
Water Closet - Toilet -' tfSrease of sewer EDUs, a sewer permit will and
Urinal .:,,(4' ' fees assessed for the sewer increase must be paid before the
Other Fixtures: ---, '
- -' plumbing permit :can be issued.
� 4,.•,w -- - A ",V ,; < 'n t` � . *;: ._, 'a ,:
• ½ " t
i:\ Building \Permits\PLM- PermitApp.doc 07/06/05
AN. - .ti'2Draiti..L ;
SEPTIC SE VICE
".' {. P.O.BOX 1130
, WILSONVILLE, OR 97070
=may (503) G82.1929 FAX ( 503) 570477
•
:' - CUSTOMERS ORDER. NO. PHONE
.� D TE
• "3 /J /7 -0-
NAME P j
._ ADDRESS - q
s ' e- 2 9 04 9 -
SOLD BY CASH C.O.D. CHARGE ON ACCT. MDSE. RET'D. PAID OUT
/4414 A'
,
QTY.. DESCRIPTION PRICE. AMOUNT ,
/ �� i� ���i � .
1 3aPR a r>✓ - ("A A A..< e
� /1 /0 - °`3.---- S 3
16
3654
. J
• M
ii-//6--- /
"
f li/' ' ..
. TAX
- RECEIVED BY
. TOTAL `?49
All claims and returned goods MUST be accompanied by this bill.
/AGIN21 To Rem ' THANK YOU - t
- MO-225483R0 OT neb9,CCm
,. j
CITY OF TIGARD
BUILDING DIVISION r. PERMIT #: PLM2005.0 )676 j
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 12/20.
Phone: (503) 639 -4171 "109itlll ill's
Inspection Requests (24 Hrs.): (503) 639 -4175 .. ' `_ ..
INSPECTION WORKSHEET FOR DATE: 1/4/2008 TIME: 8 :59AM PAGE: 35
SITE ADDRESS: 148'15 SW HALL BLVD CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: LADY APPLE
DESCRIPTION: Private storm utilities for new subdivision, other fixture is (1) manhole.
OWNER: BEACON HOMES NW, INC., PHONE #: 503
CONTRACTOR: CVS CONTRACTING INC PHONE #: 503-538-2990
Inspection Request Scheduled For: Date: 1/4/2006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
340 Storm drain 024347-01 503-209-8172 V
Corrections /Comments /Instructions:
0
N /z.,...____
i
V \ t
•
) '
` 4 1 PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
FAIL ❑ CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED
Inspector: /2
Date: /
.r Phone #: ( 503 ) 718-