Permit CITY TIGARD PLUMBING PERMIT
' DEVELOPMENT SERVICES PERMIT #: PLM2003 -00558
x 411 > DATE ISSUED: 10/27/03
°"' ° --'" 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
PARCEL: 2S 104CC -04600
SITE ADDRESS: 13729 SW ESSEX DR
SUBDIVISION: HILLSHIRE ESTATES NO. 2 ZONING: R -7
BLOCK: LOT: 154 JURISDICTION: TIG
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
Remarks: Installation of residential backflow prevention device for irrigation.
FEES
Owner:
Description Date Amount
DELOSO, MICHAEL R + LINDA ALLEN [PLUMB] Permit Fee 10/27/03 $36.25
TIGARD, OR 97224 4
13729 SW ESSEX [TAX] 8% State Surchari 10/27/03 $2.90
Total $39.15
Phone :
Contractor:
DOWN TO EARTH IRRIGATION
13075 SW PACIFIC HWY
TIGARD, OR 97223 REQUIRED INSPECTIONS
Phone : 684 3500 RP /Backflow Preventer
Final Inspection
Reg #: LIC 5281
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
Issued By: i` - I Permittee Signature:
f�•
CaII (50 639 -4175 by 7:00 P.M. for an inspection needed the next business day
Building Fixtures
Plumbing Permit Application FOR OFFICE USE ONLY
Received Plumbing t, �
Date/By: /0 %-7 e 3 Permit No.: � £J7 5 - X)5S�j
City of Tigard Planning Approval Sewer
`J DateBy: Permit No.:
13125 SW Hall Blvd. Plan Review Other
Tigard, Oregon 97223 DateBy: Permit No.:
Phone: 503-639-4171 Fax: 503-598-1960 Post - Review Land Use
Date /By: Case No.:
Internet: www.ci.tigard.or.us .' I Contact r 1u • ® See Page 2 for
24 -hour Inspection Request: 503- 639 -4175 Name/Method: / ra Supplemental Information.
TYPE OF WORK FEE* SCHEDULE (for special information use checklist)
❑ New construction ❑ Demolition Description I Qty. I Fee(ea.) I Total
Addition/alteration/replacement ❑ Other: New 1 - & 2 - family dwellings
CATEGORY OF CONSTRUCTION (includes 100 ft. for each utility connection)
& 2- Family dwelling ❑ Commercial /Industrial SFR (t) bath 249.20
El SFR (2) bath 350.00
['Accessory Building ❑ Multi- Family SFR (3) bath 399.00
❑ Master Builder ❑ Other: Each additional bath/kitchen 45.00
JOB SITE INFORMATION and LOCATION Fire sprinkler - sq. ft.: Page 2 _
Job site address: 1 3 7 zl' .S t. / L S Se-. x b �_ Site Utilities
Suite #: Bldg. /Apt. #: Catch basin/area drain 16.60
Project Name: �� Drywell/leach line /trench dram 16.60
0� Footing drain (no. linear ft.) Page 2
Cross street/Directions to job site: Manufactured home utilities 110.00
Manholes 16.60
Rain drain connector 16.60
Sanitary sewer (no. linear ft.) Page 2
Subdivision: Lot #: Storm sewer (no. linear ft.) Page 2
Tax map /parcel #: Water service (no. linear ft.) Page 2
DESCRIPTION OF WORK Fixture or Item
Absorption valve 16.60
- k. -.. /.1•c._�P -C.o c,> Backflow preventer Page 2
Backwater valve 1 16.60
Clothes washer 16.60
Dishwasher 16.60
Drinking fountain 16.60
❑ PROPERTY OWNER 1 ❑ TENANT Ejectors/sump 16.60
Name: Dcfl._eso Expansion tank 16.60
Address: 1 h 'Z 2 - 7 5 a SgcS y -- p Fixture /sewer cap 16.60
Floor drain/floor sink/hub 16.60
City /State /Zip: -- 11i , „, J e 1722_5 Garbage disposal 1 6.60
Phone: Fax: Hose bib 16.60
❑ APPLICANT 0 CONTACT PERSON Ice maker 16.60
Name: Interceptor /grease trap 16.60
Address: Medical gas - value: $ Page 2
City /State /Zip: Primer 16.60
Roof drain (commercial) 16.60
Phone: Fax: Sink/basin/lavatory 16.60
E -mail: Tub /shower /shower pan 16.60
CONTRACTOR Urinal 16.60
Business Name: `7e e.,� To c �� z Water closet 16.60
`�� t , Water heater 16.60
Address: t S - -- . q„„. .£.. u -- Other:
City /State /Zip: t C a - o 97 2 z3 Other:
s oc Permit Fees* Fax: Plumbing Per
Phone: -5'a 3 - �,g �--3 Subtotal $
CCB Lic. #: Plumb. Lic. #: Minimum Permit Fee $72.50 $ 54 , a �
Authorized e 4 • Residential Backflow Minimum Fee $36.25
Sig t • e: 4I v Date: Z- / Plan Review (25% of Permit Fee) $
, AU. State Surcharge (8% of Permit Fee) $ Acto
(P ease pri t ' e) TOTAL PERMIT FEE $ 3/ , s5
Notice: This permit application expires if a permit is not obtained within All new commercial buildings require 2 sets of plans with isometric or
180 days after it has been accepted as complete. riser diagram for plan review.
*Fee methodology set by Tri- County Building Industry Service Board.
is \Dsts \Permit Forms \PlmPermitApp.doc 01/03
•
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 - 100' 55.00 0 to 2,000 $115.00
Footing drain - each additional 100' 46.40 2,001 to 3,600 $160.00
Sewer 3,601 to 7,200 $220.00
ewer - 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 $10,000.00 $72.50 for the first 55,000.00 and $1.52 for each
additional $100.00 or fraction thereof, to and
Fixture or Item Qty. Fee (ea) Total including $10,000.00.
Commercial Back Flow Prevention Device 46.40 $10,001.00 to S25,000.00 $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 536.25) 27.55 and including $25,000.00.
Rain Drain, single family dwelling 65.25 525,001.00 to $50,000.00 $379.50 for the first $25,000.00 and $1.45 for
Inspection of existing plumbing or each additional 5100.00 or fraction thereof, to
and including $50,000.00.
specially requested inspections - per hour 72.50 550,001.00 and up $742.00 for the first 550,000.00 and $ 1.20 for
Subtotal: each additional $100.00 or fraction thereof.
Fixture Work:
Are you capping, moving or replacing existing fixtures? If
"yes ", please indicate work performed by fixture. Failure to
accurately report fixtures could result in increased sewer fees *.
Quantity by (Fixture) Work Performed Comments regarding fixture work:
Fixture Type: Replace
New Moved Extsung Capped
Baptistry/Font
Bath - Tub /Shower
- Jacuzzi/Whirlpool
Car Wash -Each Stall
-Drive Thru
Cuspidor /Water Aspirator
Dishwasher - Commercial
- Domestic
Drinking Fountain
Eye Wash
Floor Drain/sink - 2"
—3
-4"
Car Wash Drain *Note: If the fixture work under this permit results in an
Garbage - Domestic un P
Disposal - Commercial increase of sewer EDUs, a sewer permit will be issued and
- Industrial fees assessed for the sewer increase must be paid before the
Ice Mach. /Refrig. Drains plumbing permit can be issued.
Oil Separator (Gas Station)
Rec. Vehicle Dump Station
Shower -Gang
-Stall
Sink - Bar /Lavatory
- Bradley
- Commercial
- Service
Swimming Pool Filter
Washer - Clothes
Water Extractor
Water Closet - Toilet
Urinal
Other Fixtures:
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