Permit e .
CITY TIGARD PLUMBING PERMIT
1r1, DEVELOPMENT SERVICES PERMIT #: PLM2006 -00165
�'- 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 4/26/2006
PARCEL: 2S114BB -18900
SITE ADDRESS: 16145 SW 103RD AVE ZONING: R -7
SUBDIVISION: RIVERVIEW ESTATES LOT: 035 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: Q , FEES
MARK & AMY R
16145 SW 103RD AVE 00 Description Date Amount
TIGARD, OR 97224 [PLUMB] Permit Fee 4/26/2006 $36.25
[TAX] 8% State Surcha 4/26/2006 $2.90
Phone : 503- 620 -9674 Total $39.15
Contractor:
DENNIS' 7 DEES LANDSCAPING
7355 SW JOHNSON CREEK BLVD
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PORTLAND, OR 97206 REQUIRED ITEMS AND REPORTS
Contact # : PRI 503- 777 -7777
FAX 503- 777 -2399
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: .(, Permittee Signature: ® 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.
Plumbing Permit Application FOR OFFICE I :SE ONLY
City of Tigard Received � / Permit No l � r x4 !/ 7/ )O6 / ) K5"
13125 SW Hall Blvd., Tigard, OR 97223
Dat 26,-__a:„...:71_ l/
Phone: 503.639.4171 Fax: 503.598.1960 u+ nl D ate /By: • Other Permit No.:
I' .
24- Hour Inspection Line: 503.639.4175' '�) � �� r- ' � Date Ready /By: hns. RI See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method: 11/(r Supplemental information
a r .,. „t ;:. x .: v .>' y ., . . C "�4�...� -. .. 'w• „ - . �>. r: ,.- ..._.. .:�3�. �. . .C £ :, r�.: >k' .aYf::. _'Y::u "..
a
.`�.,� �.� .g:. V ��k F�� K -� ��:. $ � -: >r�' w'v:FEE.:SCHEDLI:E
,'a- ;:..e �.aa- ....,.a �. ._ .,. �..,. �,..c .: a• �;: « „..,.,.; > -,r: Y..�; ^.�..vc. � ..._._ - <, a, ... ._ r, ^__.,a - .rr... ..,. 4 ^.... -.., ,- w..a,-. ... < > _ , - -.
❑ New construction ❑Demolition For special information use check list.
- Description 1 Qty. 1 Ea. 1 Total
❑ Addition/alteration/replacement ® Other: LANDSCAPE New 1 - 2 - family dwellings (includes 100 ft. for each utility connection)
0 -Mal 1i CATEGORY OF CONSI'RU TION a ` zr ; SFR (1) bath 249.20
.s .. -e., m. > .. -.`. r.s. ._. ... :x.. w .. -� �... ..e ..
IV- 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
_ -v �.�.?`�,�.a..,. �,.... 4_ ._. ^ . w,v _.- __,a.r - -.. . >... . x. � �;?= Site utilities
Job site address: / &(y5-- Ste/ 713 ,r9 L. Catch basin or area drain 16.60 .
City /State /ZIP: 7-160-n.,0 .. o� G i `7d9 `f / - Dr leach line, or trench drain . 16.60
Suite/bldg. /apt. no.: Project name: jet/( l, Footing drain (no. linear ft.• ) Page 2
Y I 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.:
Absorption valve 16.60
ESCRIP"I'lU1V,- F .ORK K;;;; ,� » ., Y ,, - ...
. ., ^...^ . >- .. .._ . °�� . _ ^ .. - ,., - -. .... -� _ u - a.:k�; . . _.. _.^ , Backflo p reventer 1 Page 2
INSTALL BACKFLOW DEVICE Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
z ; ; ,,; :r £> ::R.,; ;; ', Dr inking fountain 16.60
_- .❑-PROPERTY •AWNER" ' , x z ❑ TENANT�,
_:...,. ' .3...<. .... ,.. . - / " -` Ejectors /sump . 16.60
Name: � lc- , A-144-4 �l Expansion tank 16.60
Address: JA 4 401/L- Fixture /sewer cap 16.60
City /State /ZIP: Floor drain/floor sink/hub 16.60
Phone: t Fax: Garbage disposal 16.60
(SUS) (0'd51467 ? / ( )
�,' , .: 16.60
,, z ,�'. . -
�APPLICANT` ,',
tN;. ...�. . : ' ` .. ir60NTA('I' PERSON .: : :` Hose bib
, -.
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: ( ) I Fax:: ( )
Tub /shower /shower pan 16.60
E -mail:
Urinal 16.60
;.,,. - Vii_,= � -�;` - <`:
°''� . _ .4! `'�` �. Water I 16.60
Business name: DENNIS' SEVEN DEES LANDSCAPING, INC Water heater 16.60
Address: 7355 SE JOHNSON CREEK BOULEVARD Other:
City /State /ZIP: PORTLAND, OR 97206 Subtotal
Minimum permit fee: $72.50 �� ��
Phone: ( 503 ) 777 - 7777 Fax: (503 ) 777 - 2399 Residential backflow minimum permit fee: $36.25
Plan review (25% of permit fee)
CCB Lic.: 5009 Plumbing Lic. no.: 05LIBDI
State surcharge (8% of permit fee) ,;.,7C)
Authorized signature: TOTAL PERMIT FEE 3' (S
Print name: DEAN SNODGRASS Date: t(" (7 ' d This permit application expires if a permit is not obtained within
/j 180 days after it has been accepted as complete.
*Fee methodology set by Tri- County Building Industry Service Board.
i:' Building 'Permits\PLM- PermitAppdot 12/03 440- 4616T(I0 /02. /COM/WEB)
Plumbing Permit, Application - City of Tigard
Page2 S.uppl
Fee Schedule: Residential Fire Suppression Systems:
Qty
Fee..(en) Tota
�., �:. .:... l-
Footing,drain -1 ,i00' , 55.00 0 to 2,000 $115.00
Footing drain - each additional 100' 46.40 2,001 to 3,600 $160.00
Sewer - 1St 100' 55.00 3,601 to 7,200 $220.00
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
fF
Vr. ti xii er ` it >Fee`'
Storm & Rain Drain - 1st 100' 55.00
$ LOO 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
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 $25,000100 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 * .
� � R Quantity by (Fixture) Work Performed
Fixture Type . i 1 * ", Replace
�� N Mo Existing t rapped 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
-4"
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
Ice Mach./Refrig. Drains
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.
Swimming Pool Filter
Washer - Clothes •
Water Extractor Plan Review
Water Closet - Toilet Plan review is required if fixture quantity total is >9.
Urinal
Other Fixtures: •
t. 1BuJding\Permits\PLM- PermitApp doc 3/03
CITY OF TIGARD
BUILDING DIVISION PERMIT #: PLM200&00166
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 4/26/2006
Phone: (503) 639-4171
Inspection Requests (24 Hrs.): (503) 639-4175
INSPECTION WORKSHEET FOR DATE: 6/13/2006 TIME: 7:03AM PAGE: 76
SITE ADDRESS: 16145 SW 103RD AVE CLASS OF WORK:
SUBDIVISION: RIVERVIEW ESTATES LOT #: 035 TYPE OF USE:
PROJECT NAME: KELLY
DESCRIPTION: Backflovv preventer for irrigation.
OWNER: KELLY, MARK & AMY PHONE #: 503-620-9674
CONTRACTOR: DENNIS' 7 DEES LANDSCAPING PHONE #: 503777-77
Inspection Request Scheduled For: Date: 6/8/2006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
395 Misc. inspection 031370-02 503-777-7777
Corrections/Comments/Instructions:
(.)-6
e2Adql fro U ‘r AJJ
lA/Y\ .
a(4'
@(;)
I I PASS fl PARTIAL APPROVAL CANCEL NO ACCESS
V AIL n CALL FOR INSPECTION El ADDITIONAL FEES ASSESSED
Inspector:
(1
Date: t9M
Phone #: (503) 718- 77
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