Permit A, CITY OF TIGARD
PLUMBING PERMIT
DEVELOPMENT SERVICES PERMIT #: PL /11/20 -00534
`' °� 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 10/11/2005
PARCEL: 1 S 134CA -08200
SITE ADDRESS: 11182 SW 117TH TERR ZONING: R -4.5
SUBDIVISION: FEHRENBACHER LOT: 003 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 10/11/200f $36.25
[TAX] 8% State Surchar1 10/11/200: $2.90
Phone : 503 475 - 5041 Total $39.15
Contractor:
REQUIRED ITEMS AND REPORTS
Phone:
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 irect Aeon/ to OUNC by
calling 503 - 246 -669 r 1 -80 32 -2344. j I
Issued By: , Permittee Signature: 1 ,
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
�U P
Plumbing Pe ` ; :"; , `"i olr-Ori IGE ":US,L
City of T i g a r d 1 2005 D at e i B e r 110 i I l I 0 /2 Q Permit No.: 0 � ,o531
13125 SW Hall Blvd., Tigard, r # 4722 Plan Review ' i/ [J
Phone: 503.639.4171 Fax: 5. 8 .1960 Aaxpdu ; � . lir . - I" Dale/By. Other Permit No.:
24- Hour Inspection Line: 516(13S.4�F TIGARD
p ,. III
Date Ready/13y: H ® See Page 2 for
Internet: www.ci.tigard.or I�ING DIVI Notified/Method: Supplemental Information
TYPE OF W OR K FEE* SCHEDULE
❑ New construction ❑ Demolition For special information use checklist.
Description I Qty. I Ea. I Total
❑ Addition /alteration /replacement ❑ Other: New 1 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 El 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
-�- �C qZ 5w i 1-32/1.4 C a t htities •
Job site address: .7 Catch basin or area drain 16.60
City /State /ZIP: \� (� Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: ✓ I Project name: y. f Footing drain (no. linear ft.: ) Page 2
Cross street /directions to job site: . X I�4' (1 k- - Manufactured home utilities 110.00
Iv t "( /`��V��7 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
U C(c o w f 9r s I9C, k K\'e fs Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60 •
❑ PROPERTY OWNER i I ❑ TENANT Drinking fountain 16.60
Ejectors/sump 16.60
Name: 1907 S C� `S ,r✓L 4 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 0 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: ( ) I Fax:: ( )
Sink/basin/lavatory 16.60
Tub /shower /shower pan 16.60
E -mail: Urinal 16.60
CON TRACTOR. Water closet 16.60
Business name: 6 lint" 1"tn(sc. �P Water heater 16.60
Address: [ TqS ‘L'' �'� er^ .c. Other: /State /ZIP: ' 0-U a72�3 Subtotal
q � Minimum permit fee: $72.50
Phone: (c0 ) / - i Sv� Fax: ( ) Residential backflow minimum permit fee: $36.25 •
CCB Lic.: D� ? Plumbing Lic. no.: Plan review (25% of permit fee)
Authorized signature: State surcharge (8% of permit fee)
TOTAL PERMIT FEE
Print name: ; 1 G,w� S
W , C ,e(` 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.
it \Building\ Permits\ PLMF- PennitApp.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:
Site Utilities . Qty.,- Fee (ea) Total _ Square Footage: Permit Fee:
Footing drain - l 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.: Peemit 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
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.
Quantity by (Fixture) Work Performed ❑ Any new commercial building.
Fixture ,Type: Replace ❑ 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 - D 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
CITY OF TIGARD
. BUILDING DIVISION PERMIT #: PLM2005.00534
13125 SW Hall Blvd., Tigard, OR 97223 ATE ISSUED: 10/11/2005
Phone: (503) 639 -4171 % iii "0
Inspection Requests (24 Hrs.): (503) 639 -4175 ,. � fr ' ... .
INSPECTION WORKSHEET FOR DATE: 10/26/2006 TIME: 7:07AM PAGE: 23
SITE ADDRESS: 11182 SW 117TH TERR CLASS OF WORK:
SUBDIVISION: FEHRENBACHER LOT • :. 003 TYPE OF USE:
PROJECT NAME: FEHRENBACI -IER
DESCRIPTION: Backflow preventer for irrigation.
OWNER: PAYS CUSTOM HOMES INC, PHONE #: 503 - 475.6041
CONTRACTOR: PHONE #:
Inspection Request Scheduled For: Date: 10/26/2005 Pour Time: •
Code # Inspection Description Confirm # Contact # Messe
399 '� Q Plumbing final 019403.06 503.475 -5041
orrections /_Comments /Instructions:
sQ .. A 5 ' % 4.v \ .
Wilr .411111110.'-
1 sL Chi c _\, .
•
C
, I ' S
I 0
O _ _ . - - - V
U
►/
L PASS I I PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
<1 ■AIL n CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
i
Inspector: Date: ( 04/ ° ( Phone #: (503) 718