Permit •
v CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT PERMIT #: PLM2008 -00131
TIGARD DATE ISSUED: 3/27/2008
13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 PARCEL: 1 S134DD -02200
SITE ADDRESS: 11467 SW 107TH PL ZONING: R - 4.5
SUBDIVISION: ALEX ESTATES LOT: 004 JURISDICTION: TIG
PROJECT: ALEXANDER ESTATES
Project Description: Installing (1) backflow preventer.
CLASS OF WORK: ALT 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
FERD & CAT ALEXANDER
TRUSTEES Description Date Amount
21820 SW ELWERT RD [PLUMB] Permit Fee 3/27/2008 $36.25
SHERWOOD, OR 97140 [TAX] 12% State Surch 3/27/2008 $4.35
Phone : Total $40.60
Contractor:
MARK BROWN LANDSCAPING
PO BOX 744
VANCOUVER, WA 98666 -0744 REQUIRED ITEMS AND REPORTS
Contact # : PRI 503- 234 -2667
FAX 360 - 993 -5993
Reg #: LIC 5192
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 ®CG6 G�!G
t•lIMP
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 Pe rmit Application
wilding Fixtures ` FOR OFFICE USE ONLY
P` Received
71 e City of Tigard �� Date/By: - �" / �germit No.i J F._ co , 3 j
® 13 125 SW Hall Blvd., Tigard, OR 97223 Rt ` / l>v '^ r "
'�0 Plan Review
Phone: 503.639.4171 Fax: 503.598.1961 R N� y Other Permit No.�T ) /r,f 7(
TIGARD Inspection Line: 503.639.4175 MP r ' '.0 � ig ethod: Supplemental
yy Juris Page / v W
\
Internet: www.tigard- or.gov i� S ee Pa e 2 for
� pi
j� TYPE OF WORK 01 ® G Q‘ ' FEE *' SCHEDULE.
N ew construction ❑ Demol' 41W. O For special information use checklist
Description I Qty. i Ea. Total
❑ Addition/alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (1) bath 249.20
/
gi =•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: JM6 7 /Q j 7 'A Catch basin or area drain 16.60
City /State /ZIP: 7; Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: I Project name: /'1x d6k irzC a j� S 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.: !S/ 3 g pp -- a Z Z O 0 Absorption valve 16.60
DESCRIPTION OF WORK Backflow preventer / • Page 2
/A o � //✓lC�j 6 t r /U TA) PLVfv ._ True.. e.. Backwater valve 16.60
/471?I ./I //VG fi` .5/4 itlyk! / A s Clothes washer 16.60
J Dishwasher 16.60
❑' PROPERTY OWNER I ❑ TENANT Drinking fountain 16.60
Ejectors /sump 16.60
Name: Expansion tank 16.60
Address: Fixture /sewer cap 16.60
City /State /ZIP: Floor drain /floor sink/hub 16.60
Phone: ( ) Fax: ( ) Garbage disposal 16.60
❑ APPLICANT ❑ CONTACT PERSON' ose bib 16.60
,-7-- Ice maker 16.60
Business name: be, �O S ilt ti c_J /✓ Interceptor /grease trap 16.60
Contact name: �� / Ko k LIZ SSO Medical gas (value: $ ) Page 2
Address: 7 / JhON t L /fib e-: ge/C Primer 16.60
City /State /ZIP: � ! ! lr� e S /a�/f G 9'70
2 '7 Roof drain (commercial) 16.60
( � YM
Phone: ( 3 ) 7 9 py Z I Fax: : ( 3 ) ('5Z) 2y 7 f Sink/basin/lavatory 16.60
Tub /shower /shower pan 16.60
E -mail:
Urinal 16.60
C ONTRACTOR Water closet 16.60
Business name: /7� /'� tit /0-Ad • SGi¢�I/. - /9 7 W heater 16.60
Address: -, � Fe) (/>c 7 Other:
�C /( �� I!! tG( A c/ Subtotal
City/State /ZIP:
t � I \ Minimum permit fee: $72.50 �_
Phone: ( ) Fax: ( ) Residential backflow minimum permit fee: $36.25 3G , �.
CCB Lic.: C 7 I 41 ' lumbing.Lic. no.: WI � I Plan review (25% of permit fee)
Authorized signature: ,� A Ai ',, State surcharge (12% of permit fee) t(, 35
i TOT AL PERMIT FEE `(() GO
Print name: D f�415 4 b eJZ l SC n) Date: 3 27 Q$ 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.
1:\ Buitdin g\Permits\PLMF- PermitApp.doc 12/27/06 440- 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 - 1s' 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: 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 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
Inspection of existing plumbing or each additional $100.00 or fraction thereof, to
and including $50,000.00.
specially requested inspections - per hour 72.50
Subtotal: $50 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 *. El Any new commercial building with water service 2" and
Quantity by (Fixture) Work Performed greater, except systems designed and stamped by licensed
Fixture Replace engineer.
Previous Capped Added Existing ❑ New exterior plumbing site utilities for any complex structure
Baptistry/Font as defined in OAR918- 780 -0040.
Bath - Tub /Shower ❑ Medical gas and vacuum systems for health care facilities.
- Jacuzzi /Whirlpool ❑ Any multipurpose fire sprinkler system.
Car Wash -Each Stall ❑ Any complex structure as defined in OAR918- 780 -0040.
-Drive Thru
Cuspidor/Water Aspirator Submit 2 sets of plans with any of the above.
Dishwasher - Commercial
- Domestic •
Drinking Fountain _ or Riser.Diagram
Eye Wash ❑ Isometric or riser diagram is required for new buildings
Floor Drain /sink - 2" that meet the qualifications above.
-4"
Car Wash Drain
Garbage - Domestic Comments regarding fixture work:
' Disposal - Commercial
- Industrial
Ice Mach. /Refrig. Drains
Oil Separator (Gas Station)
Rec. Vehicle Dump Station
Shower -Gang
-Stall
Sink -Bar /Lavatory
• - Bradley *Note: If the fixture work under this permit results in an
- Commercial increase of sewer EDUs, a sewer permit will be issued and
- Service fees assessed for the sewer increase must be paid before the
Swimming Pool.Filter plumbing permit can be issued.
' Washer - Clothes
Water Extractor.
Water Closet - Toilet
Urinal
Other Fixtures:
i:\ Building \Permits\PLM- PermitApp.doc 12/27/06
CITY • F 11G pLM 200q -00131
, JHLI ING DDVIISDO6�1 PERMIT #: 4 4 °'1 Ica
i�
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 4t� /i^1i` LUG
Phone: (503) 639 -4171 �/�m�eglim k l" f
Inspection Requests (24 Hrs.): (503) 639 -4175 A� ''r�
INSPECTION WORKSHEET FOR DATE: ,/77i IAa. TIME: :03AM PAGE: 2
SITE ADDRESS: `I1467 : 107TH P1, CLASS OF WORK:
SUBDIVISION: ALEX E`:a'IA1'E'^ LOT #: 004 TYPE OF USE:
PROJECT NAME: ALIXAIIDE:f= ES A :,
DESCRIPTION: N<'w t F
OWNER: AI..P°XAND€ R, F + CAP-ERNE IA, PHONE #:
CONTRACTOR: DER COMM RUGTION II,C. PHONE #: ;t' 2:2-
Inspection Request Scheduled For: Date: a127120(1 Pour Time:
Code # Inspection Description Confirm # Contact # Message
: s s
Plumbing f'in 0%74r4 01 603. - M9 , 9042
Corrections /Comments /Instructions: 71
P , g14i1, _s Y "L `L ` _ . �1CL vI CO �r
¢.- a povl'2..O0, tom- ®0 1 '(o c,.>
u R r Lei
PASS I PARTIAL APPROVAL CANCEL n NO ACCESS
FAIL I I CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED
Inspector: CroANI.k,- AAA). Date: c3 1t2) Phone #: (503) 718-