Permit CITY OF TIGARD
PLUMBING PERMIT
DEVELOPMENT SERVICES PERMIT #: PLM2005 -00536
x 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 10/11/2005
PARCEL: 1S134CA-08400
SITE ADDRESS: 11142 SW 117TH TERR ZONING: R -4.5
SUBDIVISION: FEHRENBACHER LOT: 005 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
PAYS CUSTOM HOMES INC Description Date Amount
17481 SW HOODOO CT
BEAVERTON, OR 97007 [PLUMB] Permit Fee 10/11/200E $36.25
[TAX] 8% State Surcharl 10/11/200E. $2.90
Phone : 503 475 - 5041 Total $39.15
Contractor:
BLAZER LANDSCAPE
13995 SW FERN ST. REQUIRED ITEMS AND REPORTS
TIGARD, OR 97223
Phone : 503- 998 -1507
Reg #: PLM 6872
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 r . les are set forth in OAR
952 - 0001 -0010 through OAR 952 - 0001 -0100. You may obtain copies of the r rul:, s •, dir estions to OUNC by
calling 503 - 246 -669 or 1-800-332-2344. 1
i R
Issued By: �' `∎"`.���1/c) Permittee Signature:
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.
Building Fixtures
Plum Permit etiotE® FOR OFFICE USE ONLY
City of Tigard BC. Received / Ni gyoi
13125 SW Hall Blvd., Tigard, OR 97223
Date/BY �� l �� �'j �'� -005 -1:;f0
Plan Review
Phone: 503.639.4171 Fax: 503.59 1 1 20 1 /cirl
r, i l ,\ p��g Other Permit No.:
24- Hour Inspection Line: 503.639.405/i D . i
_
Internet: www.ci:tigard.or.us TIG R DateReadyBy: 1 o 'El SeePage2for
UN Of S IO Pt Notified/Method: �y Supplemental Information
glltQ trk 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 (I) 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
Ili f (� Site utilities
Job site address: ( r I I / 5 (I 7 4 1 7f'//1 Catch basin or area drain 16.60
City /State/ZIP: \ - r ` t l Drywell, leach line, or trench drain 16.60
fa ���ttt Ci
Suite/bldg. /apt. no.: I Project name: r g Footing drain (no. linear ft.: ) Page 2
><, y I _ r _ � ejr Manufactured home utilities 110.00
Cross street /directions to job site: /� 1'� 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
DESCRIPTION OF WORK Back flow preventer Page 2
Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
❑ 'PROPERTY OWNER i I ❑ TENANT Drinking fountain 16.60
S Plgi Ejectors/sump 16.60
Name: Cu,S ti� - 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
Hose bib 16.60
• ❑ APPLICANT ❑ CONTACT PERSON
• 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: ( ) I Fax: : ( ) Sink/basin/lavatory 16.60
Tub /shower /shower pan 16.60
E - mail: Urinal 16.60
CONTRACTOR i Water closet 16.60
Business name: r) f R Zer n t c * Water heater 16.60
Address: / 3 �-? $ "' ,e/`fl S 1-' Other:
City /State /ZIP: f T-.5q'd b q722 Subtotal
Minimum permit fee: $72.50
Phone: q:5 4) 9/'� / S'D7 Fax: ( ) Residential backflow minimum permit fee: $36.25
CCB Lic.: ( ��Z 1 bing Lic. no.: Plan review (25 %ofpermit fee)
Authorized signatur
tA) � State surcharge (8% of permit fee)
TOTAL PERMIT FEE
Print name: WA. i ` 1` C r Date: 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 06/05 440-4616T(10/02/COM/WEB)
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
r Site-Utilities ... • 'a Qty. Fee (ea) • Total " S quare.: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 - 1 st 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 Back flow 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
specially requested inspections - per hour 72.50 and including $50,000.00.
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 Complex Structures
Are you capping, adding or replacing fixtures? If "yes ", A "complex structure" is defined as an installation of a plumbing
please indicate work performed by fixture. Failure to system that meets any of the following criteria.
accurately report fixtures could result in increased sewer fees *. Please check all that apply.
Quantify by (Fixture) Work,Performed ❑ Any new commercial building.
Fixture Type: ' Replace El Any new exterior plumbing site utilities.
Previous Capped Added Existing ❑ A commercial building with installation, alteration or addition
Baptistry/Font of nine (9) or more new or relocated plumbing fixtures.
Bath - Tub /Shower ❑ Medical gas and vacuum systems for health care facilities
- Jacuzzi/Whirlpool providing services to human beings.
•
Car Wash -Each Stall ❑ Plumbing installations, alterations or additions to food service
-Drive Thru facilities where new plumbing fixtures, including interceptors,
Cuspidor /Water Aspirator are being installed for the food service area
Dishwasher - Commercial ❑ Any new residential building containing three (3) or more
- Domestic dwelling units.
Drinking Fountain ❑ Any NFPA 13 - multipurpose fire sprinkler system.
Eye Wash
Floor Drain /sink - 2" Submit 2 sets of plans with any of the above.
-3"
-4 ,,
Car Wash Drain Isometric or Riser Diagram
Garbage - Domestic ❑ Isometric or riser diagram is required for new buildings
Disposal - Commercial three (3) or more stories in height.
- Industrial
Ice Mach. /Refrig. Drains
Oil Separator (Gas Station) Comments regarding fixture work:
Rec. Vehicle Dump Station
Shower -Gang
-Stall
Sink - Bar/Lavatory .
- Bradley
- Commercial
•
- Service
Swimming Pool Filter
Washer - Clothes *Note: If the fixture work under this permit results in an
Water Extractor
Water Closet - Toilet increase of sewer EDUs, a sewer permit will be issued and
Urinal fees assessed for the sewer increase must be paid before the
Other Fixtures: plumbing permit can be issued.
i:\ Building\Permits\PLM- PermitApp.doc 07/06/05
w \`
CITY OF TIGARD
BUILDING DIVISION PERMIT #: PLM2005 -00636
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 10/11/2005
Phone: (503) 639 -4171 �i20y u1��; °� I�
Inspection Requests (24 Hrs.): (503) 639-4175 W
INSPECTION WORKSHEET FOR DATE: 10/14/20055 TIME: 7:02AM PAGE: 123
SITE ADDRESS: 11142 SW 117TH TERR CLASS OF WORK:
SUBDIVISION: FEHRENBACHER LOT #: 005 TYPE OF USE:
PROJECT NAME: FEHRENBACHER
DESCRIPTION: Backflow preventer for irrigation.
OWNER: PAYS CUSTOM HOMES INC, PHONE #: 503-476-6041
CONTRACTOR: BLAZER LANDSCAPE PHONE #: 503-998.1507
Inspection Request Scheduled For: Date: 10/14/2006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
3 Plumbing final 018265 -02 503 - 475-5041 Y
•
Corrections /Comments/ Instructions:
,PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL n CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Date: Phone #: (503) 718-