Permit CITY TIGARD PLUMBING PERMIT
I DEVELOPMENT SERVICES PERMIT #: PLM2005 -00388
'- - 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 8/15/2005 •
PARCEL: 25111 DB -16900
SITE ADDRESS: 15155 SW 94TH AVE ZONING: R -4.5
SUBDIVISION: KESSLER ESTATES NO. 2 LOT: 026 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
RENNARD, CAROLINE
15155 SW 94TH AVE Description Date Amount
TIGARD, OR 97224 [PLUMB] Permit Fee 8/15/2005 . $36.25
[TAX] 8% State Surcha 8/15/2005 $2.90
Phone : 503- 684 -3980 Total $39.15
Contractor:
DENNIS' 7 DEES LANDSCAPING
7355 SW JOHNSON CREEK BLVD
PORTLAND, OR 97206 REQUIRED ITEMS AND REPORTS
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: _2„ .i z. Permittee Signature: ,
jz_,� ' 'p o
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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.
57Yc(Y
aimbing Permit Appl.icatiofVED FOR OFFICE USE .ONEI'
�� L. U R eceive
City of Tigard Permit No.:
13125 SW Hall Blvd., Tigard, OR 97223 Ail'' 1 1 5 2005 Date/By 1 � 1M�o0S va �B
Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 !M \
Other Permit No.:
24 Hour Inspection Line: 503.639.4175 a 1 `�ij Date/By. r urir
- �+i Date Ready /By: ® Se P
See 2 for
Internet: www.ci.tigard.or.us `' TIGARD
,.... Fes, , .,,F .- :.,�.:.,, .,, OF ,,-._, .� tai f
�CITY �s Notified/Method: Supplemental Information
i'^ a .:. 0 7 ,19.,.- '.�.4 Nit;' "i`.. #" "•:^fie; � , -,
. .gy ,�;, . . f" . ' ..3. :�w .�
=�;,f Tl`.I�E�.OF��WORI�- ..�4;` �.. �, r,.FEE..;?SCIiEDiJLE °;:
❑ New construction ❑ Demolition For special information use checklist.
Description I Qty. I Ea. I Total
❑ Addition/alteration/replacement ® Other: LANDSCAPE New 1 - 2 - family dwellings (includes 100 ft. for each utility connection)
- '�•� .:;.CATEGORY- OF „CONSTRLCI70N SFR (1) bath 249.20
p I- and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 350.00
El Accessory building ❑ Multi- family SFR (3) bath 399.00
❑ Master builder ❑ Other: Each additional bath/kitchen 45.00
Fire sprinkler )
F ( sq. Page 2
- JOB SITE INFORMATION AND- LOCATION " ° ,: ,2‘ Site utilities
Job site address: / /SS )'J 9f/'`k.yZ e/Z Catch basin or area drain 16.60
City /State /ZIP: //6 , 0 ` /7e2-�y Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: I Project name: /2/1///.4
� 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
Rl If N : U . K ,
ESC PTO ,OF R
- ..r..•, ;. >_. � .. ,4 � - _� ..... _� _..� . ,.. _.._ a Backflow preventer 1 Page 2
INSTALL BACKFLOW DEVICE Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
:, . - ,. i •. -_$" ., in fountain 16.60
t.. ❑ , *,40,010 - y , -, -
ROPERTY OWNER .... _ ? s ,.. 0 TENA Lt .;a Dr
Ejectors /sump 16.60
Name: 6ifileM L{ - /emu./ /1, ,ti Expansion tank 16.60
Address: ,Mir/L Fixture /sewer cap 16.60
City /State /ZIP: Floor drain/floor sink/hub 16.60
Phone: ( SO3)&P' -77,0 Fax: ( ) Garbage disposal 16.60
s ;• _ ; : Hose bib 16.60
, ,;.. . -. A.PLICAIYT . . CONVICT Pi.RSO?Y `."
Ice maker 1 ak 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
:, ..
s CON `_ ' :°
°'e 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
Phone: ( 503 ) 777 - 7777 Fax: (503 ) 777 - 2399 Residential backflow minimum permit fee: $36.25 �
CCB Lic.: 5009 Plumbing Lic. no.: 05LIBDI Plan review (25% of permit fee)
��� // � State surcharge (8% of permit fee) �(
Authorized signature: � TOTAL PERMIT FEE 3`l. . •
/S
Print name: DEAN SNODGRAS S C Date: ff/ /O.3 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. lBuildinglPermits\PLM- PermitApp doe 12/03 440- 4616T(10 /02'COM/WEB)
Plumbin2 Permit Application - City of Tigard -
Page 2 - Supplemental Information r.
Fee Schedule: Residential Fire Suppression Systems:
Site ,z9tYr Fee.1”): ,
„ „ .„ 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
Valuation:. PermitFee:,
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
Qty fee 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
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
Qua ntity
Ftxture Type Replace
N Moved xIstIng Capped = 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"
- 4"
Car Wash Drain
Garbage -Domestic
Disposal - Commercial *Note: If the fixture work under this permit results in an
- Industrial
i
Ice Mach./Refrig. Drains ncrease of sewer EDUs, a sewer permit will be issued and
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
Isometric or riser diagram is required if fixture quantity
- Commercial
. - Service total is >9.
Swimthing Pool Filter
Washer - Clothes
Water. Extractor Plan Review
Water Closet - Toilet Plan review is required if fixture quantity total is >9.
Urinal
Other Fixtures: a
liuildingWermits\PLM-PermitApp.doc 3/03
CITY OF TIGARD
BUILDING DIVISION - PERMIT #: PLh►f2005 -003 E
i 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 8/15/2005
Phone: (503) 639 -4171 e'tEjt i�l�'
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 8/26/2005 TIME: 7 :06AM PAGE: 95
SITE ADDRESS: 15155 SW 94TH AVE CLASS OF WORK:
SUBDIVISION: KESSLER ESTATES NO. 2 LOT #: 026 TYPE OF USE:
PROJECT NAME: RENNARD
DESCRIPTION: Backflow preventer for irrigation.
OWNER: RENNARD, CAROLINE, PHONE #: 603- 684 -3980
CONTRACTOR: DENNIS' 7 DEES LANDSCAPING PHONE #: 503-777-7777
Inspection Request Scheduled For: Date: 8/26/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
325 RP /back low preventer 014312 -01 603-777-7777 N
Corrections /Comments /Instructions:
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PASS n PARTIAL APPROVAL ❑ CANCEL n NO ACCESS
n FAIL n CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: c it A Date: X 71 .24 PIT Phone #: (503) 718-