Permit CITY TIGARD PLUMBING PERMIT
IN ° ` COMMUNITY DEVELOPMENT PERMIT
#: PLM2006 -00567
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 11/22/2006
PARCEL: 1 S126DC -09000
SITE ADDRESS: 09889 SW 92ND AVE ZONING: R -12
SUBDIVISION: PERRY PARTITION /MLP2003 -00008 LOT: 003 JURISDICTION: TIG
Project Description: Backflow preventer for irrigaition.
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
NORTH CREEK HOMES INC
PO BOX 231148 Description Date Amount
TIGARD, OR 97281 [PLUMB] Permit Fee 11/22/200E $36.25
[TAX] 8% State Surcha 11/22/200E $2.90
Phone : 503 -579 -1698 Total $39.15
Contractor:
SHOWSCAPES LANDSCAPING, INC.
PO BOX 950
WILSONVILLE, OR 97070 REQUIRED ITEMS AND REPORTS
Contact # : PRI 503- 638 -0114
Reg #: PLM 7018
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.
i i �r 4
Issued By: , .- _ - / s ,� /
Permittee Signature: , i ,,# `yam /
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.
' Plumbing Permit Application
• Building Fixtures �p FOR OFFICE use - ' •
City of Tigard 't` EC EN D ateive
By Permit No 1 Z // ) y/1 . 7
6w
n 13125 SW Hall Blvd., Tigard, OR ' 2' Plan Review
0 , Phone: 503.639.4171 Fax: 503.598.1960 Other Permit No.:
tt �] O D
Inspection Line: 503.639.4175 140\1 �e `O D ate Ready/By: luris H See Pa e 2 for
TIGAkO y y B
Internet: www.tigard or.gov V � 1,G�Q Notified/Method: Supplemental Information
TYPE OF' WORM 1 I �A /MK:. E
4 special information I FEE* SCHEDULE -
�qq3 ((��e For s ormation use checklist
❑ New construction Ll�e
_ Description I Qty. I Ea. I Total
❑ Addition /alteration/replacement ❑ Other: New 1 - 2 - family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION ' ' e 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: ( )keg 5,1 9 p Catch basin or area drain 16.60
City /State /ZIP: - . t d e 9.-2-.2-31\ Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: Project name: f2Q y I 2 77 Footing drain (no. linear ft.: ) Page 2
Manufactured home utilities 110.00
Cross street /directions to job site: Manholes 16.60
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 ' ' Backflow preventer / Page 2 t g 6 , A .
A - `•E - 3 W Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
Drinking fountain 16.60
❑�PROPERTY.OWNER ❑ TENANT
Ejectors/sump 16.60
Name: 61 2 •Z La o i Expansion tank 16.60
Address: i 3 q."c1 Svj ttsrArmAinf,I N g-- - 5 Fixture /sewer cap 16.60
City /State /ZIP: TA, kpU-rt -0 CIt 77 7.**2..'3 Floor drain/floor sink/hub 16.60
•
• Phone: (;o ) Garbage disposal 16.60
3 5' - t(01 Fax: (So3 )S71- -IR( 8 -
'❑ APPLICANT Hose bib 16.60
❑ CONTACT PERSON
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
CONTRACTIR Water closet 16.60
. Business name: S ‘,A_LAA) 5L Iwo fA I ^'• S c t (,.to lvs C z Water heater 16.60 _
Address: '/ Other:
. City /State /ZIP: Subtotal
Minimum permit fee: $72.50 J ,vs."
Phone: ( ) Fax: ( ) Residential backflow minimum permit fee: $36.25 6% •
CCB Lic.: PlumbingLic, no.: Plan review (25 %ofpermit fee)
• State surcharge (8% of permit fee) A .96
Authorized signature: A 24 ---
• TOTAL PERMIT FEE 1 '' /
/ S
Print name: `t ` tok v 1,-e, 0 ���///������///lll Date:// / l0 This permit application expires if a permit is not obtained within
r 180 days after it has been accepted as complete.
*Fee methodology set by Tri -County Building Industry Service Board.
1:\ Building \Permits\PLMF - PermitApp.doc 04 /06/06 4404616T(l0/02/COM/WEB)
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
-Site. Utilities: Qtr. :Fee: (ea) Total Square Footage: " Permit
Footing drain - I" 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
Storm & Rain Drain - 1st 100' 55.00 Valuation: Permit Fee:
$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
Fixtu `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
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: 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
Quantity by (Fixture) Work Performed greater, except systems designed and stamped by licensed
Fixture Type: Replace engineer.
Previous Capped Added Existing ❑ Any new exterior plumbing site utilities.
Baptistry/Font ❑ Medical gas and vacuum systems for health care facilities.
Bath - Tub /Shower ❑ Any multipurpose fire sprinkler system.
- Jacuzzi /Whirlpool ❑ Any complex structure as defined in OAR918- 780 -0040.
Car Wash - Each Stall
- Drive Thru Submit 2 sets of plans with any of the above.
Cuspidor/Water Aspirator
Dishwasher - Commercial
Domestic • Isometric or Riser Diagram
. Drinking Fountain ❑ Isometric or riser diagram is required for new buildings
Eye Wash that meet the qualifications above.
Floor Drain /sink - 2"
-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
•
Sink - Bar/Lavatory *Note: If the fixture work under this permit results in an
•
- Bradley increase of sewer EDUs, a sewer permit will be issued and
- Commercial fees assessed for the sewer increase must be paid before the
- Service plumbing permit can be issued.
Swimming Pool Filter
Washer - Clothes
Water Extractor
• Water Closet - Toilet
Urinal
Other Fixtures:
is \Building\ Permits \PLM- PertnitApp.doc 09/22/06