Permit CITY TIGARD PLUMBING PERMIT
;I DEVELOPMENT SERVICES PERMIT #: PLM2006 -00527
� 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 10/31/2006
PARCEL: 2S 110AB -03200
SITE ADDRESS: 14285 SW 114TH AVE ZONING: R -2
SUBDIVISION: COLE'S ACRES LOT: 015 JURISDICTION: TIG
Project Description: Residential 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
VERN & ELL€ MARTIN Description Date Amount
14285 SW 114TH
TIGARD, OR 97224 [PLUMB] Permit Fee 1 0/3 1 1200€ $36.25
[TAX] 8% State Surcharl 10/31/200€ $2.90
Phone : 503 639 - 3912 Total $39.15
Contractor:
OWNER
REQUIRED ITEMS AND REPORTS
Contact # :
Reg #:
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 -246 699 1- 00- 332 -2344.
Issue By: I t(}44 Permittee Signature: K (1 7'G
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.
Plumbin Permit Application
Building Fixtures FOR OFFICE USE ONLY
" City of Tigard RD /6J/ alp / Permit No.: / f / / Ceba
II ii 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
. 111 ,: : Phone: 503.639.4171 Fax: 503.598.1960 Date /By Other Permit No.:
T I GA D Inspection Line: 503.639.4175 Date ReadyBy: ®See Page 2 for
Internet: www.tigard or.gov Notified/Method:�a Supplemental Information
' TYPE OF WORK - . FEE* SCHEDULE
❑ New construction ❑Demolition For special information use checklist.
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 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
❑ Master builder Each additional bath/kitchen 45.00
❑ Other:
Fire sprinkler ( sq. ft.) Page 2
' , ,JOB SITE INFORMATION AND LOCATION ' - - Site utilities •
Job site address: ! il' p S, 1 j ti A4- Catch basin or area drain 16.60
City /State/ZIP: - F-'6_- Z A e"-ta cl.: 47 2 2 L-1 7 7 1 ' Drywell, leach line, or trench drain 16.60
Suite/bldg./apt. no.: `Project name: Footing drain (no. linear ft.: _) Page 2
Cross street /directions to job site: B E 1 4 - x . 5 . 4 %, Ike Manufactured home utilities 110.00
Manholes 16.60
i (,,,L-L- /Mt.& 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
DE SCRIPTION OF WORK " _ , Backflow preventer Page 2
W--04 g..LEAR- 4 .; Ai c rr aki `,/-MYTA'Llierra 1 y Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
,`' PROPERTY OWNER f ' ❑ TENANT' Drinking fountain 16.60
Ejectors/sump 16.60
Name: V .2 e- eazo M A ' M Expansion tank 16.60
Address: j y 2. -' n W. ELrfi ACY.E, Fixture /sewer cap 16.60
City /State /ZIP: T GdE • b 2 '3 7-2 2 '71e) Floor drain/floor sink/hub 16.60
Phone: (31:a) c, ct * j i ( 2 Fax: ( ) Garbage disposal 16.60
' ' ❑ " APPLICANT ❑ .CONTACT PERSON Hose bib 16.60
' 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
CONTRACTOR Water closet 16.60
Business name: NOM, E (17N/L-1 itil E. \j j MAO-VW W Water heater 16.60
Address: 1 C{%, !� , (A, . -; i q ®K, Other:
Subtotal
Cit /State /ZIP: 77 a Av.- 6 , (� � 7 7- 2_ I 7 -I(} Minimum permit fee: $72.50
Phone: („S` _g) 1,-_,2 q - 1 f Z Fax: ( ) Residential backflow minimum permit fee: $36.25
CCB Lie.: Plumbing Lic. no.: Plan review (25% of permit fee)
Authorized signature: rr State surcharge (8% of permit fee)
V Ill
�'� "-, TOT)U. PERMIT FEE r S C I, 1.5
Print name: V P--N F MA f. ` f N Date: jviegt1'OL 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\PLMF PermitApp.doc 04/06/06 4404616T(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 - 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
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
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: $50,001.00 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:
i, U3uilding \PennitsTLM- PetmitApp.doc 09/22/06
' CITY OF TIGARD
BUILDING 1 PERMIT #: PLM2006-00527
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 10/31/2006
Phone: (503) 639 -4171 Alk fn�lp filt
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 11/1/2006 TIME: 7:03A PAGE: 46
SITE ADDRESS: 14205 SW 114TH AVE CLASS OF WORK:
SUBDIVISION: COLE'S ACRES LOT #: 015 TYPE OF USE:
PROJECT NAME: MARTIN
DESCRIPTION: Residential backflow preventer for irrigation.
OWNER: MARTIN, VERN & ELLEN PHONE #: 503 -639 -3912
CONTRACTOR: OWNER PHONE #:
Inspection Request Scheduled For: Date: 11/1/2006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
399 Plumbing final 039121 -01 503 -639 -3912 N
Corrections /Comments / Instructions:
r
I O
1l ,er_
,WV
(2,/ .----- ,
PASS n PARTIAL APPROVAL ❑ CANCEL _ NO ACCESS
FAIL CALL OR INSPECTION I I ADDITIO AL 'EE ASSESSED
0 411 Inspector: i 1 l i I I Date: \ tC Z ` #: (503) 718 -