Permit CITY OF TIGARD
PLUMBING PERMIT
COMMUNITY DEVELOPMENT PERMIT #: PLM2007 - 00059
IGM? 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 2/9/2007
PARCEL: 2S 11X8 - 08600
SITE ADDRESS: 15072 SW KENTON DR ZONING: R -7
SUBDIVISION: ASHFORD OAKS NO. 2 LOT: 100 JURISDICTION: TIG
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
NANCY FRIES
15072 SW KENTON DR Description Date Amount
TIGARD, OR 97224 [PLUMB] Permit Fee 2/9/2007 $36.25
[TAX] 8% State Surcha 2/9/2007 $2.90
Phone : 503 - 639 -8947 Total $39.15
Contractor:
PACIFIC GARDENS & WATERWORKS
PO BOX 2623
TUALATIN, OR 97062 REQUIRED ITEMS AND REPORTS
Contact # : FAX 503- 682 -3370
PRI 503- 682 -4157
Reg #: LIC 10382
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: dit ' / 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.
iiiii it r i. r , 0 t iF t
Plumbing Permit Applic > � _ V . ` .. I' RZ OI:I:IC I l ■ sI.: ONLV
City of Tigard r� '°I( 9/° Permit No kpi 2, ...290
:� to 13125 SW Hall Blvd., Tigard, OR 9722f E3 �.
f3 20Q7
• Phone: 503.639.4171 Fax: 503.598.1960 Plan Renew Other Permit No.:
Inspection Line: 503.639.4175 Date/
T I c.� It D g 3 y Date Ready/By. ® See Page 2 for
Internet: www.tigard- or.gov Vl .Li 1 �� �lvl� g a
et; Supplemental Information
TYPE OF'- f {C III ' I IriTigi 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
15.1 and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 350.00
❑ Accessory building 0 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: 150.72 T 06 Catch basin or area drain 16.60
City / State/ZIP: -n oe. x'722.44 Drywell, (each 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 }- on ftkJ20 t
�t L Manholes 16.60
I-6 al G t.J $ S G ff 0%) Rain drain connector 16.60
F -e-sA4r-01 Sanitary sewer (no. linear ft.: ) Page 2
Storm sewer (no. linear ft.: __J Page 2
Subdivision: 1 Lot no.: Water service (no. linear ft.: ) Page 2
Tax map/parcel no.: Fixture or item
Absorption valve 16.60
DESCRIPTION OF WORK
Back flow preventer Page 2
BAc nice Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
PROPERTY OWNER I ❑ TENANT Drinking fountain 16.60
� A ��..s Expansion tank 16.60
Name: Expansion tank 16.60
Address: 1 st:17a s z y6 bz Fixture /sewer cap 16.60
City/StatelZlP: fl 0Y i1 02- q 22q Floor drain/floor sink/hub 16.60
Phone: (5a) _ Ln Fax: ( ) Garbage disposal 16.60
0 APPLICANT + ❑ CONTACT PERSON Hose bib 16.60
f Ice maker 16.60
Business name: Fie_ GAQA &S Q. t�.. ,rk.$ Interceptor /grease trap 16.60
Contact name: Rt 4 5r, �° Medical gas (value: $ ) Page 2
Address: ' PO ar/J4 a 6 Primer 16.60
City /State/ZIP: "ILA% JA- O 9706 Z Roof drain (commercial) 16.60
Phone: Q ) ( et_ /415-7 Fax: : (&A 6k2.- 3370 Tub/shower/shower Sink/basin/lavatory 16.60
Tub/shower /shower pan 16.60
E-mail: �•:Ww °� co 4 Ce 41 net
Urinal 16.60
/ CONTRACTOR Water closet 16.60
Business name: ick CJIFtL U142tb16+a5 4 (O riseZ tt Water heater 16.60
Address: Other:
City / State/ZIP: S-�C cis. C c,bou
Subtotal
Minimum permit fee: $72.50
Phone: ( ) Fax: ( ) Residential backflow minimum permit fee: $36.25 34.25
CCB Lic.: ICI 382, o 2- a..I/ -0 Se Plumbing Lic. no.: 4e2761q 7 Plan review (25% of permit fee)
Authorized signs State surcharge (8% of permit fee) x 4 10
TOTAL PERMIT FEE 3q, /5". Print name:
"vit h_1 Date: a / 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: \BuildingTermib\PLM- PmmitApp.doc 06/26/06 40- 4616T(1W02/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 Valuation: Permit Fee:
Storm &Rain Drain - 1st 100' 55.00 51.00 to $5,000.00 Minimum fee $72.50
Storm & Rain Drain - each additional 100' 46.40 55,001.00 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 510,000.00.
Commercial Back Flow Prevention Device 46.40 510,001.00 to $25,000.00 $148.50 for the first $10,000.00 and $1.54 for
Residential Back flow Prevention Device "X .ZS each additional $100.00 or fraction thereof to
(minimum permit fee $36.25) 27.55 411 and including $25,000.00.
Rain Drain, single family dwelling 65.25 $25,001.00 to 550,000.00 $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: 3d 25 550,001.00 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
Quaotitz by (Fixture) Work Performed greater, except systems designed and stamped by licensed
Fixture Type: Replace engineer.
Previous Capped Added Exiting ❑ 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.
- lacum/Whirlpool _ ❑ Any multipurpose fire sprinkler system.
Car Wash - Each stall .0 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 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 aid before the
-Commercial
-Service
plumbing permit can be issued. p
Swimming Pool Filter
Washer - Clothes
Water Extractor
Water Closet - Toilet
Urinal
Other Fixtures:
is\ Building \Permitn\PLM- PamitApp.doc 09/27/06
CITY OF TIGARD
BUILDING DIVISION PERMIT #: Pt_M 007- 00059
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 219/2007
Phone: (503) 639 -4171 a ,, ► ° '',;E'I ilk
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 2/12f2007 TIME: 7 :05AM PAGE: 40
SITE ADDRESS: 15072 SW KENTON DR CLASS OF WORK:
SUBDIVISION: ASHFORD OAKS NO. 2 LOT #: 100 TYPE OF USE:
PROJECT NAME: FRIES
DESCRIPTION: Bac:kflo}w prevent :r for irrigation.
OWNER: FRIES, NANCY PHONE #: 503 63943347
CONTRACTOR: PACIFIC GARDENS & WATERWORKS PHONE #: 503-6E32-4157
Inspection Request Scheduled For: Date: 2//2/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
395 Misc. in &-pection 043251 -01 503-615-8667 N
Corrections /Comments /Instructions:
` .Fi r°9 f .1 ,#}flOi llirw .t—L_....41&72. 1 fiM / ' –_,.0r.
1
(d'a.za._, , .
P ASS n PARTIAL APPROVAL CANCEL I I NO ACCESS
FAIL I CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED
Inspector: 1 , " _- Date: —/ 9. 6 - Phone #: (503) 718- y ` �,