Permit r
7 -" ` u CITY TIGARD
PLUMBING PERMIT
° COMMUNITY DEVELOPMENT PERMIT #: PLM2007 -00318
TIGARD. 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 7/18/2007
PARCEL: 25111 DD -02600
SITE ADDRESS: 08870 SW HAMLET ST ZONING: R -4.5
SUBDIVISION: STRATFORD LOT: 032 JURISDICTION: TIG
PROJECT: PEDERSON
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
GRAHAM PEDERSON
8870 SW HAMLET Description Date Amount
TIGARD, OR 97224 [PLUMB] Permit Fee 7/18/2007 $36.25
[TAX] 8% State Surcha 7/18/2007 $2.90
Phone : 503- 746 -7081 Total $39.15
Contractor:
LANDSCAPE SOLUTIONS LLC
14060 SW 89TH AVE
TIGARD, OR 97224 REQUIRED ITEMS AND REPORTS
Contact # : PRI 503- 639 -9500
FAX 503- 624 -4807
Reg #: PLM 7429
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.
i
7
Issued By: CA.. -' Lt.. -t -c , �L.c�. Permittee Signature: .��/ / / 'AO
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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 pro • .
Approved plans are required on the job site at the time of each inspection.
Piumb!ng Permit Apt io r t i . ir n ,
� I is r=f o& •F+s : r �^ i 4 t+. _., ".
Building Fixtures i x 7 " " _t<- ,1 � i iNf FO O FFIC E +U S E , ONLY jT_ : ,, yR w , t p
City of Tigard J L 18 2007 Date/By: i % i • BO Permit No.?J, l 2067 -& 3/ O
v 13125 SW Hall Blvd., Tigard, OR Plan Review
1 Phone: 503.639.4171 Fax: 503.598.1960 Other Permit No.:
Inspection Line: 503.639 . �, � ` z , � n , Da /By:
ar A ►2 Date Ready /B Juris: 0 See Page 2 for
T I G A'R D' Internet: www.ti d - or. o p T F‘ y t ; Notified/Method: Supplemental Information
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( 1 . v - ""'' ? i� ; ` FEE* SCHEDULE
❑ New construction ❑ Demolition For special information use checklist.
Description 1 Qty. 1 Ea. 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
lJ l -and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 350.00
❑ 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: 85 Su,/ 1-4- A- Y' us:r Catch basin or area `drain 16.60
City /State /ZIP: -77 l l l 2.2.,‘ 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
`h -L(r g [✓ 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 1 Page 2
t--,/S) / -t� -1 Jr� c Backwater valve . 16.60
+ n C - 1 � F mot , / 4 ` 1 f 1-yl, Clothes washer 16.60
! J V Dishwasher 16.60
Drinking fountain 16.60
PROPERTY OWNER I ❑;TENANT
/ Ejectors /sump 16.60
Name: /'i t � &7'l. "7N Expansion tank 16.60
Address: 7 0 S W_' I -�y(/l Fixture /sewer cap 16.60
City /State /ZIP: 777 p C `� g 7 2-Z-7" drain /floor sink/hub 16.60
Phone: $Y ) t T7 % , 701V Fax: ( ) Garbage disposal 16.60
Hose bib 16.60
APPLICANT ❑ CONTACT PERSON
// fr Ice maker 16.60
Business name: ��t!_rc j1 ir7 js / - Interceptor /grease trap 16.60
Contact name: sco ff- a Medical gas (value: $ ) Page 2
Address: 14-(` 0 Sc.J gC, r"i-v Primer 16.60
City /State /ZIP G� L • Z/
OA-- , ` ' Roof drain (commercial) 16.60
Sink/basin/lavatory 16.60
Phone: (�('. G5 9 S v Fax:: ( ) Tub /shower /shower pan 16.60
E -mail: Urinal 16.60
' CONTRACTOR Water closet 16.60
Business name: L ! "pSC 4_- /.J77dAis //[ - Water heater 16.60
Address: / `` ¢Q/406W) Sul g 1'-�/F Other:
`
City /State /ZIP: y1,►> d p71? c j 7 (} P ?,'� Subtotal
M permit fee: $72.50
Phone: ( ) g g # (----) .6 - LII �DE( Residential backflow minimum permit fee: $36.25
CCB Lic.: /d0 7! lu g Lic. no.: Plan review (25 % of permit fee)
c State surcharge (8% of permit fee)
Authorized signature: , ,� = TOTAL PERMIT FEE 51 , I C7
t
Print name: p 77- PI �h ' 7, n / Date: d 7 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.
(:\Building \Permits \PLMF- PermitApp.doc 12/27/06 4404616T(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 - I' 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 ValuatlOn• • Permit" 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 (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 tt 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: $50,001.00 and up $742.00 for the first $50,000 "00 and $1.20 for
each additional $100.00 or fraction thereof.
•
Fixture Work: Plan Review for Plumbing Installations
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
Quantity by (Fixture) Work Performed greater, except systems designed and stamped by licensed
Fixture Type: Replace engineer.
Previous Capped Added Existing ❑ 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 Isometric. Or Riser _Diagram
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
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 •
- Bradley *Note: If the fixture work under this permit results in an
- 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:
is\ Building \Permits\PLM- PermitApp.doc 12/27/06
CITY OF TIGARD
BUILDING DIVISION PERMIT #: PLM2007 -00318
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 7/18.!2007
Phone: (503) 639 -4171 `A ° " �f� � 0 ._______ , ,
Inspection Requests (24 Hrs.): (503) 639 -4175 '. '1 I ,.
INSPECTION WORKSHEET FOR DATE: 7/24/2007 TIME: 7:00AM PAGE: 1t3
SITE ADDRESS: 08a70 SW HAMLET ST CLASS OF WORK:
SUBDIVISION: STRATFORD LOT #: 032 TYPE OF USE:
PROJECT NAME: PEDERSON
DESCRIPTION: Bacldlow preventer for irrigation.
OWNER: PEDERSON, GRAHAM PHONE #: 503 -716- 7081
CONTRACTOR: LANDSCAPE SOLUTIONS LLC PHONE #: 503 - 639.3500
Inspection Request Scheduled For: Date: 7/24/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
395 Misc. inspertion 052607 -01 503 -970 -7877 N
Corrections/Comments/ Instructions e,t b/'
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PASS I 1 PARTIAL APPROVAL I I CANCEL n NO ACCESS
n FAIL n CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: " Phone #: (503) 718" f
CITY OF TIGARD
BUILDING DIVISION ' w - ^ PERMIT #: PLM2007- 00311)
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 7/18/2007
Phone: (503) 639 -4171 i° n � � Inspection Requests (24 Hrs.): (503) 639 -4175 I "'..
INSPECTION WORKSHEET FOR DATE: 7/20/2007 TIME: 7 :03AM PAGE: 42
SITE ADDRESS: 08870 SW HAMLET ST CLASS OF WORK:
SUBDIVISION: STRATFORD LOT #: 032 TYPE OF USE:
PROJECT NAME: PEDERSON
DESCRIPTION: Back flow preventer for irrigation.
OWNER: PEDERSON, GRAHAM PHONE #: 503 - 7467081
CONTRACTOR: LANDSCAPE SOLUTIONS LLC PHONE #: 503.638.850()
Inspection Request Scheduled For: Date:. 7/2012007 Pour Time:
Code # Inspection Description Confirm # Contact # Mess- - -
385 Misr.. inspection 052442 -01 503-639-9500
Corrections /Comments / Instructions:
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i PASS PA P' RTIAL APPROVAL El CANCEL ❑ NO ACCESS
1 I FAIL 4. • LL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: —�- �� Date: 7/Z Phone #: (503) 718- Z� G
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