Permit f1 4,
4 CITY OF TIGARD PLUMBING PERMIT
4 DEVELOPMENT SERVICES PERMIT #: PLM2005-00537
�� 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 10/11/2005 •
PARCEL: 1 S 134CA -08500
SITE ADDRESS: 11118 SW 117TH TERR ZONING: R -4.5
SUBDIVISION: FEHRENBACHER LOT: 006 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 10/11/200: $36.25
[TAX] 8% State Surcharl 10/11/200`. $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 rules are s- fort• in OAR
952 - 0001 -0010 through OAR 952 - 0001 -0100. You may obtain copies of these rules 0 . irec • — .ti'. s to OUNC by
calling 503-246-6699 or 1- 800 - 332 -2344. I
• Issued By: /J & _ 2 e z [ 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
Plumbing Permit Applica • Ew Az . FOR OFFICE USE ONLY
City of Tigard R eceived
`r g Daze By. ( 'n`f ) Permit No / In V05 - 13125 SW Hall Blvd., Tigard, OR 97223 P1 Reew (i �, 1vv ✓/
Phone: 503.639.4171 Fax: 503.598.1960 OCT 1 1 /s�,, ` I \ D aze / B Y Other Permit No.:
24- Hour Inspection Line: 503.639.4175 -aJ.i "•
Internet: www.ci.tigard.or.us Date Ready/By: 11/ ® See Page 2 for
CITY OF TI Notified/Method: y,' Supplemental Information
TYPE OguyJJJ* G DIVISION 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
El 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: I 1 r 5C''' f I ` l ��n Catch basin or area drain 16.60
City /State /ZIP: = 'q(�C Drywell, leach line, or trench drain 16.60
-
Suite/bldg. /apt. no.: J I Project name: Footing drain (no. linear ft.: ) Page 2
) )' fi Manufactured home utilities 110.00
Cross street/directions to job site: )(. J�
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
Drinking fountain 16.60
❑ PROPERTY OWNER 0 TENANT Ejectors sump 16.60
Name: i(n S �(,L J f el, , ( L6 e--S Expansion tank 16.60
Address: (74 Fixture /sewer cap 16.60
City /State /ZIP: Floor drain/floor sink /hub 16.60
Phone: ( ) 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
• CO� Water closet 16.60 -
Business name: ( a2'r C . Water heater 16.60
Address: 1 'Pr S -ern LC Other:
z Subtotal
City /State /ZIP: �; Sr�n or �7� Minimum permit fee: $72.50
Phone: 6) ) _(7 t' - ( Fax: ( ) Residential backflow minimum permit fee: $36.25 _
CCB Lie.: V Z Plumbing Lic. no.: Plan review (25% of permit fee)
Authorized signature: W'//t State surcharge (8% of permit fee)
TOTAL PERMIT FEE
Print name: A) : \; c 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- PetmitApp.doc 06/05 - 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
Footing drain - I" 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
specially requested inspections - per hour 72.50 and including $50,000.00.
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 Com 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 a PERMIT #: PLM2005.00537
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 10/11/2005
Phone: (503) 639- 4171 m r�gjm��i
Inspection Requests (24 Hrs.): (503) 639 -4175 , �! 'I L .
INSPECTION WORKSHEET FOR DATE: 12/5/2005 TIME: 7 :00AM PAGE: 31
SITE ADDRESS: 11118 SW 117TH TERR CLASS OF WORK:
SUBDIVISION: FEHRENBACHER LOT #: 006 TYPE OF USE:
PROJECT NAME: FEHRENBACI - IER
DESCRIPTION: BacIdlowr preventer for irrigation.
OWNER: PAYS CUSTOM HOMES INC, PHONE #: 503 475.5041
CONTRACTOR: BLAZER LANDSCAPE PHONE #: 503 -998 -1507
Inspection Request Scheduled For: Date: 12/5/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
399 Plumbing final 022930-01 503 - 475.5041 Y
Corrections /Comments /Instructions:
t
-PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
I 1 FAIL n CALL FOR INSPECTION I I ADDITIONAL FEES ASSESSED
Inspector: Date: ` Phone #: (503) 718-
/
CITY OF TIGARD
BUILDING DIVISION t ` PERMIT #: PLM2005- 010537
13125 SW Hall Blvd., Tigard, OR 97223 - DATE ISSUED: 10/11/2005
Phone: (503) 639 -4171 titl
Inspection Requests (24 Hrs.): (503) 639 - 4175 . J /,?
INSPECTION WORKSHEET FOR DATE: 10/12/2005 TIME: 7 :04AM PAGE: 20
SITE ADDRESS: 11118 SW 117TH TERR CLASS OF WORK:
SUBDIVISION: FEHRENBACHER LOT #: 006 TYPE OF USE:
PROJECT NAME: FEHRENBACHER
DESCRIPTION: Backflow preventer for irrigation.
OWNER: PAYS CUSTOM HOMES INC, PHONE #: 503 - 475 -6041
CONTRACTOR: BLAZER LANDSCAPE PHONE #: 503-998.1507
Inspection Request Scheduled For: Date: 10/12/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
399 Plumbing final 018098 -05 603-475-5041 N
Corrections/Comments/Instructions:
•
GP)
- PASS ❑ PARTIAL APPROVAL n CANCEL ❑ NO ACCESS
FAIL n CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED
Inspector: Date: 0/r -2 4 O , Phone #: 503
P ( ) 718 -
Inspections Required for: PLM2005- 00537'
✓ Code Inspection Description PASS Date By ✓ Code Inspection Description PASS Date By
BUP - Building Permit ELC - Electrical Permit
•
405 Excavation 105 Underground /slab cover
410 Fill 110 Temporary electrical service
415 Grading 115 Electrical service
205 Footing 120 Electrical rough -in
805 MFG - Structure grading /footing 125 Wall cover
210 Foundation walls 130 Ceiling cover
215 Footing drain _ 135 Low voltage
220 Slab 140 Sign installation
310 Crawl drain 145 A/C or heating unit circuit
225 Post/beam structural 150 Hot tub /spa/pool
230 Underfloor insulation 195 Misc. inspection:
235 Shear walls /anchors 199 Electrical final
240 Exterior sheathing
245 Firewall
250 Roof nailing ELR - Restricted Energy Permit
255 Wtr proofing basement walls 135 Low voltage
260 Tilt -up panel 195 Misc. inspection:
265 Masonry 199 Electrical final
270 Reinforcing steel (rebar)
275 Framing
810 MFG - Structure set-up MEC - Mechanical Permit
280 Insulation 605 Post/beam mechanical
285 Drywall nailing 610 Gas line
287 Suspended ceiling 615 Mechanical rough -in
295 Misc. inspection: 620 Hydronic piping
899 MFG - Structure final 625 Duct work
498 Grading final 630 Fire damper
299 Final inspection 635 Smoke detector shutdown
640 Exhaust hood •
695 Misc. inspection:
699 Mechanical final
BUP - Fire Protection System Permit
905 Sprinkler underfloor /slab PLM - Plumbing Permit
910 Sprinkler rough -in 305 Plumbing underslab
915 Fire alarm rough -in 310 Crawl drain
920 Suppression trip test 315 Post/beam plumbing
995 Misc. inspection: 320 Plumbing rough -in
998 Alarm final 325 RP/backflow preventer
999 Sprinkler final
330 Water service
335 Rain drain
340 Storm drain
SIT - Site Work Permit 505 Sanitary sewer
405 Excavation 345 Culvert /catch basin
410 Fill 350 Septic tank
415 Grading 395 Misc. inspection:
205 Footing . X 399 Plumbing final
210 Foundation walls
215 Footing drain
420 Sprinkler supply lines SWR - Sewer Permit
495 Misc. inspection: 505 Sanitary sewer
498 Grading final 595 Misc. inspection:
499 Final inspection
•
599 Final inspection
•
L \Building \IVR \InspCard- AOP.doc 06/17/2005
. V ,
C ITY OF T I G ®R® PLUMBING PERMIT
"I DEVELOPMENT SERVICES PERMIT #: PLM2005 -00537
� a' 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 10/11/2005
PARCEL: 1 S 134CA -08500
SITE ADDRESS: 11118 SW 117TH TERR ZONING: R -4.5
SUBDIVISION: FEHRENBACHER LOT: 006 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 10/11/200, $36.25
[TAX] 8% State Surchan 10/11/200 $2.90
Phone : 503 - 475 - 5041 Total $39.15
Contractor:
BLAZER LANDSCAPE
13995 SW FERN ST. REQUIRED ITEMS AND REPORTS 0
TIGARD, OR 97223
Phone : 503- 998 -1507
O
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 rul :s are s- fort in OAR
952 - 0001 -0010 through OAR 952 - 0001 -0100. You may obtain copies of these rules o •ue ti s to OUNC by
calling 503 - 246 -6699 or 1- 800 - 332 -2344. iirec
Issued By: ��_, � �� Permittee Signature: , /L / --
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.