Permit CITYOF TIGARD PLUMBING PERMIT
'` ° COMMUNITY DEVELOPMENT PERMIT #: PLM2007 -00407
,TIGARD DATE ISSUED: 9/5/2007
._ _ 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 PARCEL: 2S111AD -18500
SITE ADDRESS: 14936 SW JONAGOLD TERR ZONING: R -4.5
SUBDIVISION: LADY APPLE LOT: 009 JURISDICTION: TIG
PROJECT: LADY APPLE
Project Description: Install backflow device for sprinkler system.
CLASS OF WORK: OW 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 AVE. Description Date Amount
TIGARD, OR 97223 [PLUMB] Permit Fee 9/5/2007 $36.25
[TAX] 8% State Surcha 9/5/2007 $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 Same as above
Reg #: LIC 5698
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. s'.ecialty Codes and all other
applicable laws. All work will be done in accordance with approved plans. This permit will expire if /Ark is no tatted within 180 days of
issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law requires you,. follow les dopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 0001 -0010 through OAR 952 -'00) -0100. ou m y obtain copies of
these rules or direct questions to OUN by calling 503.246.6699 or 1.800.332.2344. 1
// Issued = , : /L ii II' Permittee Signature
/F
Call 503.639.4175 by 7:00 a.m. for an inspection that b iness 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.
Plumbing Permit Application -
FOR OFFICE USE ONLY
• City of Tigard Received : Permit No.: P LM iio
a 13125 SW Hall Blvd., Tigard, OR 972
0 5 2007 Plan Review
e, S/01, s J pe rm ��''�
p 2007 Plan Review
1- : Phone: 503 - 639.4171' Fax: 503.598 Date/By: Other Permit No.: MCT b ^ a y ■
Inspection Line: 503.639.4175 VI See Page 2 for
TIGARD CITYOF Y 1 Y ' Date Ready/By: Y /B Y 'q
Internet: www,tigard -or. � t � g Notified/Method: // Supplemental Information
` TYPE .OF WORK _ ' - . , .FEE * = .SCHEDULE' '
New construction ❑, Demolition For special information use checklis
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 (1) bath 249.20
'Z1 -1- and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 350.00
El Accessory building ❑ Multi- family SFR (3) bath 399.00
Each additional bath/kitchen 45.00
❑ Master builder ❑ Other:
Fire sprinkler ( sq. ft.) Page 2
JOB SITE INFORMATION AND LOCATION. Site utilities
Job site address: r �l P J a /l 44 8a �� Catch basin or area drain 16.60
City /State /ZIP: 1-', (�
` J i -a 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: c � ;P j � Manholes 16.60
5 fr 1 G` C� ./,- / ,C� " t Rain drain connector 16.60
Sanitary sewer (no. linear ft.: ) Page 2
Storm sewer (no. linear ft.: ) Page 2
Subdivision: 9: , __,_____:1-- Lot no.: / Water service (no. linear ft.: ) i I Page 2 .
Fixture or item
Tax map /parcel no.:
Absorption valve 16.60
, � - ASCR Backflow preventer I Page 2 3e.1
/ S
" /�/�(Ai �i• 7 " • S �// Backwater valve 16.60
�/ G Clothes washer 16.60
Dishwasher 16.60
- - PROPERTY OWNER TENANT . Drinking fountain 16.60
C� / ece,cayl 1 v � A) Ejectors/sump 16.60
Name: J • �' ;
Expansion tank 16.60
Address: l 3. 3-0 3 5!N Gil - � - ..Q Fixture /sewer cap 16:60
City /State /ZIP: `..I ! C �-- qj�a ,� ' p Floor drain /floor sink/hub 16.60
Phone: ( ) j �(,l tQ 5 Fax: ( ) J Garbage disposal 16.60
• ❑ .APPLICANT 0 CONTACT PERSON : Hose bib 16.60
• " 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 /showerpan 16.60
E -mail: Urinal 16.60 -
;' CONTRACTOR.' ' Water closet 16.60
Business name: . A..1'U1/t/�• -- j S Water heater 16.60
Address: ) - C/. S 5 7O 2,....Q._ /L-- Other:
)i e ,v-- � -„- � q 7--14-/e) 7--14-/e) 7--14-/e) Subtota
City /State /ZIP: 5 �i -jpZ /3 Fax: Minimum permit fee: $36.20 •
( ) Residential backflow minimum permit fee: $36.25 ��• 2S
Phone: ( ` )
��j, q ; 1 r
CCB Lic.: ✓(f l 71 Bing Lic. no.: Plan review (25% of permit fee)
State surcharge (8% of permit fee) 2.
Authorized signature: /� 1 TOTAL PERMIT FEE :))9 • tS
Print name: / / �j�� Date: e / A� This permit application expires if a permit is not obtained within•.
11 180 days after it has been accepted as complete.
*Fee methodology set by Tri- County Building Industry Service Board.
I: \ Building \Permits\PLM- PermitApp.doc 12/27/06 440- 4616T(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) . zonal •
S qua r e:Footage: - Perinit " ..
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 - 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
Storm & Rain Drain - 1st 100' 55.00 Valuation: Permit <Fee:
$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 (ea) 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 first $25,000.00 and $1.45 for
Inspection of existing plumbing or each additional $100.00 or fraction thereof, to
and including $50,000.00.
specially requested inspections - per hour 72.50
Subtotal: $50 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
please 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
Fixture 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 ❑ Medical gas and vacuum systems for health care facilities.
Drive Stall ❑ Any multipurpose fire sprinkler system.
CI 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
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 will 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
CITY OF TIGARD
'BUILDING DIVISION PERMIT #: PLM2007 -00 407
j 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 812007
Phone: (503) 639 -4171
Inspection Requests (24 Hrs.): (503) 639 -4175
• INSPECTION WORKSHEET FOR DATE: 902007 TIME: 7: 00AIVM PAGE: 34
SITE ADDRESS: 14936 SW JONAGOLD TERR CLASS OF WORK:
• SUBDIVISION: LADY APPLE LOT #: 009 TYPE OF USE:
PROJECT NAME: LADY APPLE
DESCRIPTION: Install backflow device for sprinkler system.
OWNER: BEACON HOMES NW, INC., PHONE #: 503 57U
CONTRACTOR: CONTOUR LANDSCAPING INC PHONE #: 503 - 682-1302
Inspection Request Scheduled For: Date: 9.16/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
399 Plumbing final 065249-01 503 -724 -0305 N
Corrections /Comments /Instructions:
Cart -
PASS I I PARTIAL APPROVAL 71 CANCEL NO ACCESS
❑ FAIL I I CALL FOR INSPECTION ADDITIONAL FEES ASSESSED
Inspector: I, J \ 14-4— Date: 91 I b 7 Phone #: (503) 718-