Permit A .- ' CITY OF TIGARD PLUMBING PERMIT
Ail DEVELOPMENT SERVICES PERMIT #: PLM2005 -00596
'�'' 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 10/24/2005
PARCEL: 2S 111 AA -08900
SITE ADDRESS: 14225 SW 89TH AVE ZONING: R -4.5
SUBDIVISION: GREENSWARD PARK NO. 3 LOT: 073 JURISDICTION: TIG
Project Description: Install residential 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
RON DUFFIELD Description Date Amount
14225 SW 89TH AVE
TIGARD, OR 97224 [PLUMB] Permit Fee 10/24/200E $36.25
[TAX] 8% State Surcharl 10/24/200f. $2.90
Phone : Total $39.15
Contractor:
LANDSCAPE SOLUTIONS LLC
7101 SW STEPHEN LN REQUIRED ITEMS AND REPORTS
PORTLAND, OR 97225
Phone : 503- 224 -6549
Reg #: LIC 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 -000 :: ' ! through OAR 952 - 0001 -0100. You may obtain copies of these rules or direct questions to OUNC by
calling 03 -246 69 0 800 - 332 -2344.
Issue • By: / ( 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.
CITY OF TIGARD
BUILDING DIVISION PERMIT #: PLM200S -00696
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 10/24/2006
Phone: (503) 639-4171
Requests (24 Hrs.): (503) 639 -4175 __..
INSPECTION WORKSHEET FOR DATE: 10/27/2006 TIME: 7:16AM PAGE: 2 i
SITE ADDRESS: 14225 SW 89TH AVE CLASS OF WORK:
SUBDIVISION: GREENSWARD PARK NO. 3 LOT #: 073 TYPE OF USE:
PROJECT NAME: DUFFIELD
DESCRIPTION: Install residential bacldlow preventer for irrigation.
OWNER: DUFFIELD, RON PHONE #:
CONTRACTOR: LANDSCAPE SOLUTIONS LLC PHONE #: 503.224 -6549
Inspection Request Scheduled For: Date: 10/27/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
325 RP /bacl4I prevertter 019532 -01 603970.7877 Y
Corrections/Comments/Instructions:
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ca C. S Xi:c LL
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: 1 \ Date: 1 o)2)l C: Phone #: (503) 718-
Build' xtures
Plum 'ermit Application -, ri o fi � { (i1 i 1S1 , l ,.;qi: ` f- '� 1
Ci}� of Tigard Received 6111( 144# /a905 'e
�,r g I Permit No.
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 J/,�,40 ii:,-, Date/By Other Permit No.:
24- Hour Inspection Line: 503.639.4175 Atli 4..;11.' , ,', Ik?
Internet: www.ci.ti d.or.us ^ T- "f'' k Date Ready/By: ;° la See Page 2 for
Notified/Method: 1 f Supplemental Information
TYPE OF WORK FEE* SCHEDULE .
X New construction ❑ Demolition For special information use checklist
Description 1 Qty. 1 Ea. I Total
❑ Addition /alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (I) bath 249.20
►� 1- and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 350.00
El Accessory building ❑ Multi - family SFR (3) bath 399.00
El 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: l t- '2j SW "A ' AN1 Catch basin or area drain 16.60
City /State /ZIP: i 6 k eJo ®j ci-1 22`{' Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: I Project name: e ', x c ` , 3 � y Footing drain (no. linear ft.: ) Page 2
Manufactured home utilities 110.00
Cross street/directions to job site:
Manholes 16.60
cp ‘k.i t-kC_ \ piti' t‘,-_,-, Rain drain connector 16.60
Sanitary sewer (no. linear ft.: _) Page 2
Storm sewer (no. linear ft: ) Page 2
Subdivision: I 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
.-1-4.1 e ; i" � L'�1=...Ow �
.).�.\ Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
PROPERTY OWNER I 0 TENANT Drinking fountain 16.60
Ejectors/sump 16.60
Name: R p t4 DV c-ri e ,..s.
Expansion tank 16.60
Address: I L( ZiE S1. CI r1 A„! L Fixture /sewer cap 16.60
' . City /State/ZIP: -1-lr C0I,r,c, Ce_ cll Z.`y Floor drain/floor sink/hub 16.60
Phone: ( ) Fax: ( ) Garbage disposal 16.60
Hose bib I 16.60
l APPLICANT ❑ CONTACT PERSON
Ice maker 16.60
Business name: LA' '4 LpcoL So ` v c t ro.J y LAC , Interceptor /grease trap 16.60
Contact name: S C GIN V_ pt fit,' Medical gas (value: $ ) Page 2
Address: ^-1 1 O r w j k -�,. J Primer 16.60
City /State /ZIP: Or- CT, ).-7__%.- Roof drain (commercial) 16.60
� Fax:: Sink/basin/lavatory 16.60
Phone:
(r ` j ) J I ( ) Tub /shower /shower pan 16.60
E -mail: Urinal 16.60
CONTRACTOR Water closet 16.60
Business name: Li 1.3 nc03 .. 1 L.A... c Water heater 16.60
Address: 1 ( o ( s W { � L L Other:
Cit City/State/ZIP: Subtotal
y L �2 ' ° t Z 2'25'
Minimum permit fee: $72.50 /j .02c
Phone: (S°3 ) 2_2\{ . Fax: ( yzg 0-q •,31aL3 LI Residential backflow minimum permit fee: $36.25 a i
CCB Lic.: 7 4 29 5/3i /6 4 Plumbing Lic. no.: t -�, - Plan review (25 %ofpermit fee)
Authorized signatu State surcharge (8% of permit fee) O 0
��� TOTAL PERMIT FEE 3y, _____
Print name: CC3Tf _ e r 1 y /' < Date: l . Jz i.f t 05- 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.
is\ Building \Permits\PLMF- PennitApp.doc 06/05 • 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 n 100' 55.00 0 to 2,000 $115.00
Footing drain - each additional 100' 46.40 2,001 to 3,600 5160.00
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 _ 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 Back flow 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 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 ❑ 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"
-4 „
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- PennitApp.doc 07/06/05