Permit t ri?t
CITY OF T I ® D PLUMBING PERMIT
°n? = % - COMMUNITY DEVELOPMENT PERMIT #: PLM2008 -00127
� .
TI GARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
DATE ISSUED: 3/25/2008
PARCEL: 2S 104AC -14000
SITE ADDRESS: 12902 SW HILLSIDE TERR ZONING: R -4.5
SUBDIVISION: HILLSIDE ESTATES LOT: 005 JURISDICTION: TIG
PROJECT: MARTINEZ
Project Description: Installing backflow preventer.
CLASS OF WORK: ALT 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
Description Date Amount
[PLUMB] Permit Fee 3/25/2008 $36.25
[TAX] 12% State Surch 3/25/2008 $4.35
Phone : Total $40.60
Contractor:
TERRA -SOL LANDSCAPING
21685 SW HEDGES DR
TUALATIN, OR 97062 REQUIRED ITEMS AND REPORTS
Contact # : PRI 503 -691 -6105
Reg #: LIC 5019
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 - - if wor not started within 180 days of
issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law r q you folio rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 0001 -0010 through AR 952 - 0001 -I 01. You may obtain copies of
these rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344
I
Issued By - — Permittee Signat re: _Att A 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 com •letio of the project.
Approved plans are required on the job site at the time of each inspec ion.
Plumbing Permit Application
EPA
co ( a < �, ro FOR O FI E I II ON LY I M..
° Received /�
i City of Tigard 2d Date/By:
/327' Permit No.: {h �.._co 1
AR plan Review v ✓v
� q 13125 SW'Hall Blvd., Tigard, OR 97223 M
;: C • Phone: 503.639.4171 Fax: 503.598.1960 Other Permit No.:
n IiateB
Inspection Line: 503.639.4175 1 ®� TIGr . ti
} ;R eady /By: etho )uric: El See Page 2 for
TIC' R u Internet: www.tigard - or.gov Ci G cV,V IS f�
1 j ofied/Md: Supplemental Information
TYPE OF WORK BUIt °'.- • .
FEE* SCHEDULE
,New construction ❑ Demolition For special information use checklist
Description 1 Qty. 1 Ea. 1 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 ❑ 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 � N i ' LOCATION Site utilities
f Z 5j 1
Job site address: 29 041 1 �1. ice Catch basin or area drain 16.60
City /State /ZIP: 1 Try t ( (/JC_ Drywell, leach line, or trench drain 16.60
Footing drain (no. linear ft.: _) Page 2
Suite/bldg. /apt. no.: I Project name: . �C�C Z
`/ / 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: I Lot no.: Water service (no. linear ft.: ) Page 2
Fixture or item
Tax map /parcel no.:
bk on val te�
,((
DESCRIPTION OF WORK Backflow preventer / Page age 2 2 ... 2 S
t V `t'ti.. L4.) `k i ^ B ackwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
Drinking fountain 16.60
• - ❑ PROPERTY OWNER { I I ❑ - TENANT Ejectors /sump 16.60
Name: 4.,Vc p \ 1 t 'Qt1 - L''-(f h\-1�'� Expansion tank 16.60
Address: Fixture /sewer cap 16.60
City /State /ZIP: Floor drain/floor sink/hub 16.60
Phone ) 7 .-..77 (0 Z Fax: ( ) Garbage disposal 16.60
'0 -APPLICANT ❑ 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
Sink/basin/lavatory 16.60
Phone: ( ) I Fax: : ( ) -
Tub /shower /shower pan 16.60
E -mail: Urinal 16.60 • CONTRACTOR Water closet 16.60
Business name ,n �„ _ 6,� ( + W (� Water heater 16.60
Address: t Lp�? � j' - ` [1` S ,/�_ 1 tc � Other:
•
City /State /ZIP: .� _ : .„- 't 9 - 7 0 62
1 - Subtotal
Minimum permit fee: $72.50
non- :1 ) 671 Co 10 Fax: ( ) • Residential backllow minimum permit fee: $36.25 J b , mss
CCB Lic.: I �O� 9 Plumbing Lic. no.: Plan review (25 %ofpermit fee)
State surcharge (12% of permit fee) G' . vs
Authorize signature: �d . TOTAL PERMIT FEE '.4d 6 U
Print nam h I , Date:S '� 0 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\PLM- PermitApp.doc 1212 E. 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) Total Square Footage: Permit Fee:
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
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:
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 ❑ New exterior plumbing site utilities for any complex structure
-Tub/Shower • as defined in OAR918- 780 -0040.
Car Wash Each Stall ❑ Medical gas and vacuum systems for health care facilities.
Drive tall ❑ 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 er p
- 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''ermits\PLM- PermitApp.doc 12/27/06
CITY OF TIGARD
P ERMIT #: P M2.0(i3 00127
l BUILDING DIVISION _I
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 3/25/ 2t
Phone: (503) 639 -4171 ° ����ea:
Inspection Requests (24 Hrs.): (503) 639 -4175 s' c'IIL `
INSPECTION WORKSHEET FOR DATE: 4/1512008 TIME: ?:O2AMV1 PAGE: 18
j,_1111.41/(11 t. C +3w /;sz
SITE ADDRESS: 12902 SW HILLSIDE TEPIR CLASS OF WORK:
SUBDIVISION: F llt.LSIDCE ESTATES LOT #: 006 TYPE OF USE:
PROJECT NAME: MARTINEZ
DESCRIPTION: Installing backflow preventer.
OWNER: PHONE #:
CONTRACTOR: TERRA -SOL LANDSCAPING PHONE #: 03. 69'1 -6105
Inspection Request Scheduled For: Date: 4/15f200+3 Pour Time:
Code # Inspection Description Confirm # Contact # Messa. -
359 Ph mbing final 068397 - 01 503 - 6105 40.
Corrections /Comments /Instructions:
• -_SS 11 PARTIAL APPROVAL ❑ CANCEL n NO ACCESS
l% n CALL FOR INSPECTION ❑ ADDITIO AL FEES ASSESSED
/, I / / C �L/
Inspector: _ Date: `� Phone #: (503) 718 - L_c�