Permit c' �i CITY TY I PLUMBING PERMIT
. , .,-„ COMMUNITY DEVELOPMENT PERMIT #: PLM2007 - 00110
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 3/20/2007
PARCEL: 1 S125DB -02300
SITE ADDRESS: 07210 SW TAYLORS FERRY RD ZONING: R - 4.5
SUBDIVISION: FARCAS LOT: 003 JURISDICTION: TIG
PROJECT: FARCE
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
CORNELL FARCE
7200 SW TAYLORS FERRY RD Description Date Amount
PORTLAND, OR 97223 [PLUMB] Permit Fee 3/20/2007 $36.25
[TAX] 8% State Surcha 3/20/2007 $2.90
Phone : Total $39.15
Contractor:
SAMMY D LANDSCAPE
2010 SW 198TH AVE.
ALOHA, OR 97006 REQUIRED ITEMS AND REPORTS
Contact # : PRI 503 789 - 5472
FAX 503 -848 -0855
Reg #: PLM 7003
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 0001 -0010 through OAR 952 - 0001 -0100. You may obtain copies of
these rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By: Permittee Signature: Lam/ ! -
Call 503.639.4175 by 7:00 a.m. for an inspection that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Plumbing Permit Application _ j �° FO ' o - E��bjSE o ye ;
�' r City of Tigard Received '� t .� .0" k ,- .1v irAkr• Nv$ ? y.11 toss., eat,.-, d , - ' .. ?e :
i° 2 7 Permit No.: H / /
A T-4. 13125 SW Hall Blvd., Tigard, OR 97223 AR 2 ® ZOO! e/B ca
op o , '7 1313
rk. / " o J ! o
.l, 'r t 11 : Phone: 503.639.4171 Fax: 503.598.1760 � Other Permit No.:
T
4..;;10, G' Ft: Inspection Line: 503.639.4175 CITY OF T IGARD Date Ready/By: Page 2 for
aN„ -r at Internet: www.tigard- pr.gov lu Supplemental See p a
&1 111 fllal(a 9�! \fi6vt(1t1� Notified/Methoti Supplemental IntormaHon
e +„ '` JT YPE" . `NOF ,, 3 t) s`» .y,`.- rwT:�' '.a �r; F y{i 3,. . . -d r 'L.e ��� ' %3::i'
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FEE , S C HEDUI:E' . '� 2 " ° , Yly., +�
N ew 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)
, - �; �,„ ,� CAT
,t 3 ,., . + ,„ `EGORY OFICO - N§T CTIt)N !- 4 y ,e.: (1,01' SFR (1) bath 24920
JR- I- -and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 350.00
12 Accessory building El Multi-family SFR (3) bath 399.00
❑ Master builder Each additional bath/kitchen 45.00
❑ Other:
','.4..7-, :.: A: � .. . }x ,. „,, > §t _
, * Fire sprinkler ( sq. ft.) Page 2
t , s,4 49,,B SIT E [IYF9 M# [01V „ � t 7t
- ',,.. �� �+ � +. Site utilities
Job site address: 2 /AC, S v'-- /1- e7 .. Catch basin or area drain 16.60
City /State /ZIP: 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: Lot no.:
Water service (no. linear ft.: ) Page 2
Fixture or item
Tax map /parcel no.:
,,. ;
. Absorption valve 16.60
r: „-` ,t, gip ` ?$ A'. DESCRIPTION Veil tiORKt. b i, � °'(.a ''-"`" : ^ ... ,....'. Pr .'), `
�`�xr:;:" .. ,, 4 4.it, „ .,,�.. ,., ._ ,,,,.,:..;......�,4, -,40. ,.. - vv.,. :: ^_ , AA vi Back flow preventer / Page2
/ (Z.Q_ c'G P-�`hn ,,,,i ' }qC. j/ c„) Backwater valve 16.60
t Clothes washer 16.60
Dishwasher 16.60
,. M = " Drinking fountain . 16.60
16.60
„�'..•..p*,_�"'.� ix.. -.6 ��?r -' " .'"�.+�:�ti�`d :��,Y. ?.`� st, �.:rv� s,�fi; ""..��"r 'fi
it if .. "ra `.,"ik6 RTY OWNER' ' Tk FE®r EINAl ",43? a.y"y ,.t'„,',
/ Ejectors sump
Name: ,C ) e ` < - -,p...-1?..._G ` - 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
`',A +' *t. '' �APPLl 1 _ ;- IV- 2 -r _'" a d• D;ZI: � . . w .. .. i:i.g °. Hose bib 16.60
.qt°:5;; � . r.; j.,�,, „., , A- c�' ' "`. : � t-44: ❑CONTACT PERSON
Ice maker 16.60
Business name: S - e k._p t t,.1 t G,r. - ' Interceptor /grease trap 16.60
Contact name:
- ik- tA. --- 04..1 ra-.Y12_. Medical gas (value: $ ) Page 2
Address: p ( ___.r-,-J I ie j i l 4=1 ... A Primer 16.60
City /State /ZIP: A. ( 1 , 4 ,ci c? 70 0 G Roof drain (commercial) 16.60
Phone: (5 3) 78 5 ?-z. Fax: : ( ) Sink/basin/lavatory 16.60 -
Tub /shower /shower pan 16.60
E -mail:
Urinal 16.60
;;. e ,.r;; .'y.''; : :.. •:.in `:F:CON'ITRACTOI , :;a':' ° '" 'aMr,Ri .. ;A ' '„_ , < , ,, . .
_ ,� 4. °t' -, . , , ,,-,, °'� Water closet 16.60
Business name: Water heater 16.60
Address: Other:
City /State /ZIP:
7 Subtotal
Minimum permit fee: $72.50
Phone: ( ) -- Fax: ( ) Residential backflow minimum permit fee: $36.25
CCB Lie.: �Gzs 7, , 03 Plumbing Lic. t'.: Plan review (25% of permit fee)
I I 7". � 0 State surcharge (8% of permit fee)
Authorized signature: - � . r .. TOTAL PERMIT FEE r.9. I S-
Print name: 4 .--- -�ic : T Date: ?mot tot h 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.
1:\ Building \ Permits \PLrM- PermitApp.doc 06/26/06 440- 4616T(10/02/COM/WEB)
Plumbing Permit Application - City of Tigard •
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
' ny�;wre` ('q., -y;. „.,;,x1 ;✓�;:p "6.` : "i <<.x :Y` Win: °'rsas,^ ,s- rrp .,, „ X., �.-.;` .,, ., .,, y ,�a,^ i °mil. >..
S ite °Utili'ties � ' „i vQty pFee`(ea)," Totalar r.
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 .; ' r ; . `j `� . r. , q . �..sNVef
v1 1UatHOH1 ,,- �CH'ffiH 5
.`� � � r :� � t ,
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
additional $100.00 or fraction thereof to and
F12I1tU15 ;ItHi1 m ;' Q _)
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 and up $742.00 for the first $50,000.00 and $1.20 for
each additional $100.00 or fraction thereof
Fixture Work: ' Plan Wylie* for Plumtii>ag Installahoi s a: _ ;
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
Qu:intitYliy (FaztUkef , Work =Performed:
greater, except systems designed and stamped by licensed
v,1tejilace,, engineer.
- xt , - � ='�a'revi a "s t Capped .vAdded , >�iistina. ❑ 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
Drinking Fountain
sonri;o= Ri Diagi�a
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.\ Building \Pmnits\PLM- PermitApp.doc 0922/06
CITY OF TIGARD
BUILDING DIVISION A • PERMIT #: PLM2007-00110
13125 SW Hall Blvd., Tige-rd, OF 97223 DATE ISSUED: 3/20/2007
Phone: (503) 639-4171 isidtIll1411t
Inspection Requests (24 Hrs.): (503) 639-4175 ,,.,- .-4 t...
INSPECTION WORKSHEET FOR DATE: 3/23/2007 , . TIME: 7:03AM PAGE: 6
SITE ADDRESS: 07210 SW TAYLORS FERRY RD ,,
CLASS OF WORK:
SUBDIVISION: FARCAS LOT#: 003 TYPE OF USE:
c .
PROJECT NAME: FARCE
DESCRIPTION: Bac:know preventer for irrigation.
•:
' OWNER: FARCE, CORNELL ,' PHONE #:
CONTRACTOR: SAMMY D LANDSCAPE PHONE #: 503-789-5472
k
Inspection Request Scheduled For: Date: 3/23/2007 Pour Time:
Code # Inspection Description " Confirm # Contact # Messase
396 Misc. inspection 046327-01 603-789-5472 40
Corrections/Comments/Instructions:
•
•,
. .
.. .
. .
' .
(01111
. _ _. • .
' -
' / ■ '
10
p PASS VI PARTIAL APPROVAL CANCEL n NO ACCESS
_
FAIL ra CALL FOR INSPECTION I I ADDITIO , , L FEES 'SSESSED
Inspector: Alinia■
1... Date: Z.-- / d' Phone #: (503) 718- .7_715/ ... .1„, t .
CITY OF TIGARD
`re ,.'•
BUILDING DIVISION PERMIT #: PLIv12007-00110
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 3/2012007
Phone: (503) 639-4171 '4o ( 41,
Inspection Requests (24 Hrs.): (503) 639-4175
INSPECTION WORKSHEET FOR DATE: 312212007 TIME: 7:00AM PAGE: 75
SITE ADDRESS: 07210 SW TAYLORS FERRY RD CLASS OF WORK:
SUBDIVISION: FARCAS LOT #: 003 TYPE OF USE:
PROJECT NAME: FARCE
DESCRIPTION: Backflow preventer for irrigation.
OWNER: FARCE, CORNELL PHONE #:
CONTRACTOR: SAMMY D LANDSCAPE PHONE #: 503
Inspection Request Scheduled For: Date: 3122/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
395 WM. inspection 045197-01 503-789-5872
Corrections/Comments/Instructions:
Z -73
_
wilv - _ -
j„PASS PARTIAL APPROVAL L1 CANCEL fl NO ACCESS
FAIL n CALL FOR INSPECTION ADDITIONAL FEES ASSESSED
Inspector: ) I.', Date: ■3)2 Phone #: (503) 718-