Permit `q CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT
. PERMIT #: PLM2008 -00215
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 5/15/2008
PARCEL: 25111 AC -00500
SITE ADDRESS: 14570 SW 91ST AVE ZONING: R-4.5
SUBDIVISION: PINEBROOK TERRACE LOT: 046 JURISDICTION: TIG
PROJECT: KLEIN
Project Description: Installation of irrigation backflow.
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
FRANK KLEIN
14570 SW 91ST AVE Description Date Amount
TIGARD, OR 97223 [PLUMB] Permit Fee 5/15/2008 $36.25
[TAX] 12% State Surch 5/15/2008 $4.35
Phone : 503- 746 -5446 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, Stat- • OR. S•ecialty Codes and all other
applicable laws. All work will be done in accordance with approved plans. This permit wi : •• e if wor is not started within 180 days of
issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon la , e• Tres yo to •flow rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 0001 -0010 throu• OAR 9 - 0001 -1 00. You may obtain copies of
these rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.23 , 4.
_1:ZW I....... _ i
Issued By: P ermittee Signature: " . IL.,
Call 503.639.4175 by 7:00 a.m. for an inspection that busine s day.
This permit card shall be kept in a conspicuous place on the job site until co • • ••n of the project.
Approved plans are required on the job site at the time of each inspection.
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MAY 1 5 2008 � ,2 , -,t,, .e. ti- .. 1 .1'.x, :1 ... :<. 1
,l Received / � r i� /
r. r Cit o Ti gard 11. 4� U r Permit No.'
�i,� �r Date/By: � / �- + /�Q��'�Op� /..5" 13125 SW Hall Blvd., Tigard, OR 9 N-
Z I�lf� u r I IGA Plan Revie
I- Phone: 503.639.4171 Fax: 503.5 6 Other Permit No.:
Date/By:
*+ r. i k Inspection Line: 503.639.4175 BUILDING DIVISION
T I A R D' Date Ready/By: Juris ® See Page 2 for
e ,,,,.t;! Internet: www.tigard or.gov Notified/Method: Supplemental Information
TYPE OF WORK FEE* SCHEDULE
❑ New construction ❑ Demolition For special information use checklist
Description Qty. I Ea. Total
Ad dition/alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (1) bath 249.20
igk1- 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
r q `-1 Site utilities
Job site address: I Li 5 7 '-'0 I ` 6 i Catch basin or area drain 16.60
City /State /ZIP: Y Drywell, leach line, or trench drain 16.60
Footing drain (no. linear Page 2
Suite/bldg. /apt. no.: Project name:
ft.: ) Pa g
Manufactured home utilities 110.00
Cross street/directions to job site:
Manholes 16.60
Rain dram 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
Tax map /parcel no.: Fixture or item
e on valve 16.60
PTI
DESCRION OF WORK Backflow preventer Page 2
b o, `(, -- - /�� a w ter valve 16.60
Clothes washer 16.60
Dishwasher 16.60
❑ PROPERTY OWNER ❑ TENANT Drinking fountain 16.60
Ejectors /sump 16.60
Name: �z- ,`,.__ l._''a 1 RAI Expansion tank 16.60
Address: Fixture /sewer cap 16.60
City /State /ZIP: Floor drain/floor sink/hub 16.60
Phone: 3) `) ( ( <-(..i Fax: ( ) Garbage disposal 16.60
❑ 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
Phone: ( ) Fax::( )
Sink/basin /lavatory 16.60
Tub /shower /shower pan 16.60
E -mail: Urinal 16.60
C ONTRACTOR Water closet 16.60
Business name ( � �t . ,' /w . t Water heater 16.60
Address: 9, G. l \--Y) L S n Other:
City /State /ZIP. -V 1, I q -70 2
Subtotal
M inimum permit fee: $72.50
Phone ■ _c_6°/. ( I .0 Fax: ( ) Residential backflow minimum permit fee: $36.25 j X5"
CCB Lic.: Plumbing Lic. no.: 50 1 1 Plan review (25% of permit fee)
State surcharge (12% of permit fee) / 3, j
Auth. ' L • natur••
411111111■\ a A i l TOTAL PERMIT FEE ye , 6 Q
Print nam gP: I M Date:5 /NM This permit application expires if a permit is not obtained within
MIFF 180 days after it has been accepted as complete.
* Fee methodology set by Tri -County Building Industry Service Board.
t. \ Building \Permits\PLMF- 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) 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 $1.00 to $5,000.00 Minimum fee $72.50
Storm & Rain Drain - each additional 100' 46.40 $5,001.00 to $10 $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
each additional $100.00 or fraction thereof, to
Inspection of existing plumbing or and including $50,000.00.
specially requested inspections - per hour 72.50 $50,001.00 and up $742.00 for the first $50,000.00 and $1.20 for
Subtotal: 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 *. 12 An 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
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Other Fixtures:
\Building\Permits\PLM- PermitApp.doc 12/27/06
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CITY OF TIGARD
BUILDING DIVISION PERMIT #: PLM2008- 00215
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: //512008
Phone: (503) 639 -4171 I � L
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 5/21/20013 TIME: 7:00AM PAGE: 10
SITE ADDRESS: 1457(1 SW 91ST AVE. *CLASS OF WORK:
SUBDIVISION: PINEf3ROOK TERRACE LOT #: 046 TYPE OF USE:
PROJECT NAME: KLEIN
DESCRIPTION: Installation of irrigation backtiovv.
OWNER: KLEIN, FRANK •PHONE #: 503 - 74(7.5416
CONTRACTOR: TERRA -SOL LANDSCAPING ` PHONE #: 603691 -6105
Inspection Request Scheduled For: Date: 5/21/2008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
399 Plumbing final 070221 -01 503-691 -6105 Y
Corrections /Comments /Instructions:
Care
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PASS n PARTIAL APPROVAL ❑ CANCEL n NO ACCESS
U FAIL ❑ CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED
Inspector: V Ui Date: 2i� 1 tic' Phone #: (503) 718-