Permit CITY TIGARD PLUMBING PERMIT
l DEVELOPMENT SERVICES PERMIT #: PLM2005 -00367
6.�1I DATE ISSUED: 8/9/2005
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 PARCEL: 2S1 11 DB 15400
SITE ADDRESS: 15095 SW 93RD AVE ZONING: R -4.5
SUBDIVISION: KESSLER ESTATES LOT: 011 JURISDICTION: TIG
Project Description: Installation of backflow device.
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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
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Owner: FEES •
KENNY, TOM & LEAH
15095 SW 93RD AVE Description Date Amount
TIGARD, OR 97224 [PLUMB] Permit Fee 8/9/2005 $36.25
[TAX] 8% State Surcha 8/9/2005 $2.90
Phone : 503- 968 -7618 Total $39.15
Contractor:
DENNIS' 7 DEES LANDSCAPING
7355 SW JOHNSON CREEK BLVD
PORTLAND, OR 97206 REQUIRED ITEMS AND REPORTS
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Phone : 503- 777 -7777
Reg #: LIC 5009
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.
Issued By: - 72 / 7,6 El Permittee Signature: ) -Q e'N
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.
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Plumbing Permit Applic ionCE // a FOR OFFICE USE ONLY
CI of Tigard Rece DateB �- ive
City g 1 Permit No :
13125 SW Hall Blvd., Tigard, OR 97223 46.,, 0 . Yr� �05 1� �Q2��� Q� 3 6
Phone: 503.639.4171 Fax: 503.598.1960 ' � 1r y ! Plan Review
30j ii' Date/By: Other Permit No.:
24- Hour Inspection Line: 503.639.4175 on OF T)r.�� _ _ .. Date Ready /By: luris ® See Page 2 for
Internet: www.ci.tigard.or.us n ,
�I d+Rfi\fiAtn_ I Supplemental
�- .,.. AE - . ^;;,,x +.,,. „Y., .. .,..:,: ".:'; _..,@, r te, ti. : - y_r..
a , Notified/Method: r S entallnformatioo
r��.Y,,�, k � � -TYPE .O WORK••- . ��-� M, � 4 .� .��, s �,�,�FEE SGHEDt10E;�
� .x� .�.... ,.,. -, . °..,. - , ...., ....,,�- �� .... _, w. _ . ... x, Y�.y -.s ..,,.�._ ..,.. ,0 4 ..�,� 3`�.�
❑ New construction ❑ Demolition For special information use check list
Description I Qty. I Ea. I Total
❑ Addition/alteration/replacement IT Other: LANDSCAPE New 1- 2- family dwellings (includes 100 ft. for each utility connection)
,7, � ,%Nt ,v CATEGORY OF CONSTRUCTION SFR (1) bath 249.20
t gi I - and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 350.00
❑ Accessory building ❑ Multi - family SFR (3) bath 399.00
❑ Master builder Each additional bath/kitchen 45.00
❑ Other:
Fire sprinkler ( sq. ft.) Page 2
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- , ' = JOB SITE'lINFORMATIONvAND LOCATION ,
,.. .�., .... -,a �, ....:. n.. �` Site utiliti
Job site address: /5O 5 ,Sw q3' ,'27 Catch basin or area drain 16.60
City /State /ZIP: %-( iZYJ Ole. C 1 ' ?a� y Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: (Project name: i eM/,/ Y 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: Lot no.: Water service (no. linear ft.: _) Page 2
Fixture or item
Tax map /parcel no.:
s o
A orpG n valve
�D��S 1 F = WO K�.
. E CRLPT ON'O w R Backflow preventer 1 Page 2
INSTALL BACKFLOW DEVICE Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
.i
^ , ,, Drinking fountain 16.60
. PROEEBTYr OWNER - - ti , ® TENANT . , , -
„ K.. p _ Ejectors /sump 16.60
Name: Tao/ -,-, 1,4--ii-ii e /' Expansion tank 16.60
Address: :4, ,1'at.' " Fixture /sewer cap 16.60
City /State /ZIP: Floor drain/floor sink/hub 16.60
Phone: (.5-,) g lpf - 2/ , ( ) Garbage disposal 16.60
i= : ^. a , Hose bib 16.60
n` ,. 3 , lQ k4lipir .
. ANT ,a r 4-' ® CONTACT PERSON
_ t : „ . - t
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
r ; , ti .. ._: A t CONTRACTOR . Y -..._. ,. s _ � � � , - ',,, . .< .,,. Water closet 16.60
Business name: DENNIS' SEVEN DEES LANDSCAPING, INC Water heater 16.60
Address: 7355 SE JOHNSON CREEK BOULEVARD Other:
Subtotal
City /State /ZIP: PORTLAND, OR 97206
Minimum permit fee: $72.50 26.. ZS
Phone: ( 503 ) 777 - 7777 Fax: (503 ) 777 - 2399 Residential backflow minimum permit fee: $36.25
CCB Lic.: 5009 ,�j� Plumbing Lic. no.: 05LIBDI Plan review (25% of permit fee)
a
� ` State surcharge (8% of permit fee) . f
Authorized signature: L/� v� TOTAL PERMIT FEE 39. /.-
Print name: DEAN SNODGRASS Date: f' /A5- 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\PLM- PermitAppdoe 12/03 440- 4616T(I0 /02. /COM11/WEB)
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site Utilities Qty Fee (ca) 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 :sfetOit 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
Fe '01) T.Otaft. 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:
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*.
4r,Quantity by (Fiatire)Wairk:Peifoinitd'
Fixture Type . Replace
New Moved Existing 90#0:: Comments regarding fixture work:
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"
Car Wash Drain
Garbage -Domestic
Disposal - Commercial *Note: If the fixture work under this permit results in an
- Industrial
increase of sewer EDUs, a sewer permit will be issued and
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Oil Separator (Gas Station) fees assessed for the sewer increase must be paid before the
Rec. Vehicle Dump Station plumbing permit can be issued. °
Shower -Gang
-Stall
Sink -Bar/Lavatory
Quantity Total
- Bradley
- Commercial Isometric or riser diagram is required if fixture quantity
- Service total is >9.
Swimming Pool Filter
Washer - Clothes
Water Extractor Plan Review
Water.Closet - Toilet Plan review is required if fixture quantity total is >9.
Unbar
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Other Fixtures: •
i \BuddingTermds\PLM-PermitApp doc 3/03
CITY OF TIGARD
BUILDING DIVISION (' PERMIT #: PLM2005 00367
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 6/912006
Phone: (503) 639 -4171 �rA y�u�uy 1111
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 9/15/2005 TIME: 7:03AM PAGE: 94
SITE ADDRESS: 15095 SW 93RD AVE CLASS OF WORK:
SUBDIVISION: KESSLER ESTATES LOT #: Oil TYPE OF USE:
PROJECT NAME: KENNY
DESCRIPTION: Installation of backflow device.
OWNER: KENNY, TOM & LEAH, PHONE #: 503 968 -7618
CONTRACTOR: DENNIS' 7 DEES LANDSCAPING PHONE #: 503 7774777
Inspection Request Scheduled For: Date: W15/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
325 RPlbackflow preventer 015710.01 503-777 -7777 N
Corrections /Comments/ Instructions:
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71AKe(7/&6/ ,
PARTIAL APPROVAL ❑ CANCEL (l NO ACCESS
FAIL CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
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Inspector: / Date: V-V--7 Phone #: (503) 718-