Permit . .
,
.
. . TGARD PLUMBING PERMIT
',? IA DEVELOPMENT SERVICES PERMIT #: PLM2005 -00504
IIl' DATE ISSUED: 9/29/2005
13 125 SW Hall Blvd., Tigard, OR 97223 503 - 639 4171
PARCEL: 2 S 111 CD -07800
SITE ADDRESS: 15785 SW SERENA CT ZONING: R -4.5
SUBDIVISION: KERWOOD ESTATES LOT: 009 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
GUTE, JOSEPH H AND VIRGINIA E Description Date Amount
15785 SW SERENA CT
TIGARD, OR 97224 [PLUMB] Permit Fee 9/29/2005 $36.25
[TAX] 8% State Surcharl 9/29/2005 $2.90
Phone : 503 - 781 - 1767 Total $39.15
Contractor:
WINTERBLOOM INC.
14780 SW 98TH REQUIRED ITEMS AND REPORTS
TIGARD, OR 97224
Phone : 503 - 598 - 0219
Reg #: PLM 6111
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- 00- 332 -2344.
Issued By: / 6 if , ,a 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.
Building Fixtures C
f : ' GE1 VE T O ' '„ t ,,A,--...1*.,. . v �. .- , Olt or l l�l ku�l c, l�� •
.. ,
Plumbing Permit A _ �_
• City of Tigard Received I
g Date/By low / b b Permit Nc� 1eD 6 50
13125 SW Hall Blvd., Tigard, OR 9722 p 2 9 2005 Plan Revie III v -
Phone: 503.639.4171 Fax: 503.598.1 9 /Lrrr ,y Other Permit No.:
l f''
24 - Hour Inspection Line: 503.63 4 _ I �' Date/By Date Ready/By: uris 611 See Page 2 for
Internet: www.ci.tigard.or.us ' OF T � f 1
P 1t�1 � 7 . �+ f ; /' Notified/Method: �4 Supplemental Information
• . . B $W D CORVISIO1 V �T FEE* SCHEDULE
❑ New construction ❑ Demolition For special information use checklist.
Description 1 Qty. I Ea. 1 Total
M 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
❑ 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: 15 7 4--taa i Sw yetvrn CA Catch basin or area drain 16.60
City /State /ZIP: ((� u,Y1J1 01 ` 91 j L J Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: J I I Project name: Footing drain (no. linear R.: ) Page 2
� /� Manufactured home utilities 110.00
Cross street /directions to job site: Q kev,„ `u SeAre�y�lp. Cl. Manholes 16.60
Rain drain connector 16.60
Sanitary sewer (no. linear ft.: ) Page 2
Storm sewer (no. linear ft: ) Page 2
Subdivision: 1 Lot no.: Water service (no. linear ft.: ) Page 2
Fixture or item
Tax map /parcel no.:
Absorption valve 16.60
• . DESCRIPTION OF WORK Back flow preventer Page 2
Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
El PROPERTY OWNER ❑ TENANT Drinking fountain 16.60
Ejectors/sump 16.60
Name: JUG 6N-ve, Expansion tank 16.60
Address: lc 7 tc SW S✓►-v 6-1 , Fixture /sewer cap 16.60
City /State /ZIP: i i , ( co 7 Z t_ Floor drain/floor sink/hub 16.60
Phone: (l31)3) ? ( 6 1 - 7 b 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
Sink/basin/lavatory 16.60
Phone: ( ) Fes ( ) Tub /shower /shower pan 16.60
E -mail: Urinal 16.60
CONTRACTOR Water closet 16.60
Business name: &Jiyvkr blbopy Trit . Water heater 16.60
Address: 1 H (6,0 s w q 6 +4 -Ave_ Other:
'j l q b2 q Subtotal
City /State /ZIP:
/ ! � Minimum permit fee: $72.50
Phone: (53) fj`I`? 021 1 Fax: ( ) Residential backflow minimum permit fee: $36.25
1CCB Lic.: �/ Jr/ Plumbing Lic. no.:
GI i 0/W o /^ Plan review (25% of permit fee)
State surcharge (8% of permit fee)
Authorized signature: TOTAL PERMIT FEE R. /‘
Print name:) Y O( SC,\r‘kl600. Date: 1 - lei_ be 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:\ Building \Permits\PLMF- PennitApp.doc 06/05 440-4616T(I0 /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'Footagei 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 $10,000.00 $72.50 for the first $5,000.00 and $1.52 for each
Fixture or Item" Q tY• '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: $50,001.00 and up $742.00 for the first $50,000.00 and $1.20 for
each additional $100.00 or fraction thereof.
Fixture Work: PlanReview for Complex Structures'..
Are you capping, adding or replacing fixtures? If "yes", A "complex structure" is defined as an installation of a plumbing
please indicate work performed by fixture. Failure to system that meets any of the following criteria.
accurately report fixtures could result in increased sewer fees *. Please check all that apply.
Quantity by (Fixture) Work Performed ❑ Any new commercial building.
= Fixture Type: Replace ' El Any new exterior plumbing site utilities.
Previous Capped Added Existing ❑ A commercial building with installation, alteration or addition
Baptistry/Font of nine (9) or more new or relocated plumbing fixtures.
Bath - Tub /Shower ❑ Medical gas and vacuum systems for health care facilities
- Jacuzzi/Whirlpool providing services to human beings.
Car Wash - Each Stall ❑ Plumbing installations, alterations or additions to food service
- Drive Thru facilities where new plumbing fixtures, including interceptors,
Cuspidor/Water Aspirator are being installed for the food service area.
Dishwasher - Commercial ❑ Any new residential building containing three (3) or more
- Domestic dwelling units.
•
Drinking Fountain ❑ Any NFPA 13 - D multipurpose fire sprinkler system.
Eye Wash
Floor Drain /sink 2" Submit 2 sets of plans with any of the above.
-3"
Car Wash Drain Isometric or Riser Diagram
Garbage - Domestic ❑ Isometric or riser diagram is required for new buildings
Disposal - Commercial three (3) or more stories in height.
- Industrial
Ice Mach. /Refrig. Drains
Oil Separator (Gas Station) Comments regarding fixture work:
Rec. Vehicle Dump Station
Shower -Gang
-Stall
Sink - Bar/Lavatory
- Bradley
- Commercial
- Service
Swimming Pool Filter •
Washer - Clothes *Note: If the fixture work under this permit results in an
Water Extractor P
Water Closet - Toilet increase of sewer EDUs, a sewer permit will be issued and
Urinal fees assessed for the sewer increase must be paid before the
Other Fixtures: plumbing permit can be issued.
i:\ Building \Pennits\PLM- PetmitApp.doc 07/06/05
CITY OF TIGARD
BUILDING DIVISION PERMIT #: PLM200& -0004
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 9/29/2005
Phone: (503) 639-4171
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 10/13/2005 TIME: 7:04AM PAGE: 103
SITE ADDRESS: 15785 SW SERENA CT CLASS OF WORK:
SUBDIVISION: KERWOOD ESTATES LOT #: 009 TYPE OF USE:
PROJECT NAME: GUTE
DESCRIPTION: Bsackflow preventer for irrigation.
OWNER: GUTE, JOSEPH H AND VIRGINIA E, PHONE #: 503 -781 -1767
CONTRACTOR: WINTERBLOOM INC. PHONE #: 503-598-0219
Inspection Request Scheduled For: Date: 10/13/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
325 RP /bacldlow preventer 018210 -01 503997- 8757 N
Corrections /Comments /Instructions:
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
n FAIL lik)4 ❑ CALL FOR INSPECTION (1 ADDITIONAL FEES ASSESSED
Inspector: Date: U Phone #: (503) 718 -