Permit CITY TIGARD PLUMBING PERMIT
DEVELOPMENT SERVICES PERMIT #: PLM2005 -00116
. e � ll 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 3/2212005
PARCEL: 2S109DD -00100
SITE ADDRESS: 12635 SW BEEF BEND RD ZONING: R -7
SUBDIVISION: LOT: JURISDICTION: TIG
Project Description: Installation of backflow prevention device for irrigation.
CLASS OF WORK: NEW 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
RIVERSIDE HOMES Description Date Amount
1925 SW AMBERGLEN PKWY STE 250
BEAVERTON, OR 97006 [PLUMB] Permit Fee 3/22/2005 $36.25
[TAX] 8% State Surcharl 3/22/2005 $2.90
Phone : 503 645 - 0988 Total $39.15
Contractor:
ALL METRO LANDSCAPE
PO BOX 1812 REQUIRED ITEMS AND REPORTS
BEAVERTON, OR 97075
Phone : 503- 642 -1350
Reg #: LIC 7908
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 ou to follow rules adopted by the Oregon Utility Notification Center. Those r les are set forth in OAR
952- 01 -0010 th .ugh 952 - 0001 -0100. You may obtain copies of these rules direct questions to OUNC by
ca ing 503 - 246 -6699 •r " -800 -. ' -2344.
111P
Is ed By: , L ,/ ,��.I �1 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.
Plumbing Permit Application , FOR - OFFICE- USE ONLY ' .,,.
City of Tigard Date/By: / i _ permit No.: 1` , `1�
13125 SW Hall Blvd., Tigard, OR 97223
Plan Revie Other Permit No.:
Phone: 503,639.4171 Fax: 503.598.1960 ijtt Date
24- Hour Inspection Line: 503.639.4175 . c!1 I+ Date Ready /By: Ja''. 0 See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method: / ( Supplemental Information
TYPE OF WORK FEE* SCHEDULE
❑ New construction ❑ Demolition For special information use checklist.
Description Qty. 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
❑ 1- 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 i
JOB SITE INFORMATION AND LOCATION Site utilities •
Job site address: ( 7 0035 sj -" Catch basin or area drain 16.60
City/State /ZIP: Drywell, leach line, or trench drain 16.60
?Fz , ,i A I� v t 5c � Footing drain (no linear ft ) Page 2
Suite/bldg./apt. no.: Project name: QJ � -
Manufactured home utilities 110.00
Cross street/directions to job site:
Manholes 16.60
�-e yin j� 20 S.V��-e - *T►'', , Rain drain connector 16.60
�) Sanitary sewer (no. linear ft.: ) Page 2
Storm sewer (no. linear ft.: ) Page 2
•
Subdivision: 1'eg, \ I Lot no.: _Water service (no. linear ft.: ) Page 2
5 ? .� - • c /� Fixture or item
Tax map/parcel no.: f
Absorption valve 16.60
�y DESCRIPTION OF WORK Backflow preventer / Page 2
( f (At� Backwater valve / 16.60
J Clothes washer 16.60
Dishwasher 16.60
1=1 PROPERTY OWNER 1=1 TENANT Drinking fountain 16.60
/� Ejectors /sump 16.60
Name: t` `NU/S (k 1A-Eyy / Expansion tank 16.60
Address: to12s144 VJ /46K 91Cwy S 4'-C 'LSO Fixture /sewer cap 16.60
City/State /ZIP: P.ep,yC-1/ Tl-v‘ t') •-• 9100 6 Floor drain/floor sink/hub 16.60
Phone: ( joa ( Q'Q S' Q/ Fax: ( )
Garbage disposal . 16.60
111 APPLICANT ❑ CONTACT PERSON Hose bib 16.60
Ice maker 16.60 "
Business name: �� -� p I�IV�d �,cr� Interceptor /grease trap 1,6.60
l.{N Contact name: 'vl 1v 1 � �' 1 0 Medical gas (value: $ ) page 2
Address: ? t 0 }, k l kZ Primer 16.60
City/State /ZIP: V - O ✓ 9 7 01 S Roof drain (commercial) 16.60
( O) (,,ti «S I /j) 3i2et (102 Sink /basin/lavatory 16.60
Phone: ''S O Fax: (Sc
Tub /shower /shower pan 16.60
E -mail:
Urinal 16.60
CONTRACTOR Water closet 16.60
Business name: 5kvwz Water heater 16.60
Address:
Other:
Subtotal
City/State /ZIP: t.L-\7 � , j
Minimum permit fee: $72.50 r 5
Phone: ( ) // l( ) Residential backflow minimum permit fee:- $36.25 - CCB Lic.: �b 5 * lumbing Lic. no.: Plan review (25% of permit fee)
State surcharge (8% of permit fee) 9t /
Authorized signature: -
TOTAL PERMIT FEE
Print name: Y,L Vt t!l S s'�(I`5 Date: tit This permit application expires if a permit is not obtained s
ithin
180 days after it has been accepted as complete.
*Fee methodology set by Tri -County Building Industry Service Board. -
i:\ Building \Permits\PLM- PermitApp.doc 12/03 440- 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) I 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
each additional $100.00 or fraction thereof, to
'Inspection of existing plumbing or and including $50,000.00.
specially requested inspections - per hour 72.50 $50,001.00 and up $742.00 for the first $50,000.00 and $1.20 for
Subtotal: each additional $100.00 or fraction thereof.
Fixture Work:
Are you capping, moving or replacing existing fixtures? If
"yes ", please indicate work performed by fixture. Failure to
• accurately report fixtures could result in increased sewer fees * .
Quantity by (Fixture) Work Performed
Fixture Type: Replace
New Moved Existing Capped Comments regarding fixture work:
Baptistry/Font
Bath - Tub /Shower
- Jacuzzi /Whirlpool
Car Wash -Each Stall
-Drive Thru
Cuspidor/Water Aspirator
Dishwasher - Commercial
- Domestic
Drinking Fountain
Eye Wash
Floor Drain/sink - 2"
- 3"
Car Wash Drain
Garbage - Domestic
Disposal - Commercial *Note: If the fixture work under this permit results in an
-Industrial increase of sewer EDUs, a sewer permit will be issued and
Ice Mach./Refrig. Drains
Oil Separator (Gas Station) fees assessed for the sewer increase must be paid before the
Rec. Vehicle Dump Station plumbing permit can be issued.
Shower -Gang
-Stall
Sink - Bar/Lavatory Quantity Total
-Bradley • Isometric or riser diagram is required if fixture quantity
- Commercial total is >9.
- Service -
Swimming Pool Filter
Washer - Clothes
Water Extractor Plan Review
•
Water Closet - Toilet Plan review is required if fixture quantity total is >9.
Urinal
Other Fixtures:
isBuiidin gTermrts\PLM- PermitApp.doc 3/03
:#0111,voilift
CITY OF TIGARD
January 30, 2006
OREGON
Re: Expired Plumbing Permits
All Metro Landscape
PO Box 1812
Beaverton OR 97075
Dear Contractor:
Our records indicate that you have been issued plumbing permits for a backflow
preventer and these permits have no final inspection or approval.
Failure to call for inspection within 24 hours of completion of the work is a violation of
OAR 918- 785 -0210 and failure to call for a re- inspection within 30 days is a violation of
OAR 918 - 785 -0230.
These permits have been expired by limitation and a new permit must be obtained, or
these permits may be reinstated for final inspection. The fee in either case is the same.
Reinstated permits are only valid for thirty days, by which time the work must be
inspected and final approval given. The permits in question are:
PLM2005- 00067, 00116, 00117
If these permits are not replaced with new permits or re- instated for final inspection by
the close of business February 17, 2006, this report will be forwarded to our Codes
Enforcement Officer for further action.
If you have questions, call Jeanne Temple at 503- 718 -2433
Sincerely,
Darrel "Hap' Watkins
Inspection Supervisor
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 TDD (503) 684 -2772
CITY OF TIGARD pC. �'►
BUILDING DIVISION PERMIT #:aQ 5 — oc // 4,
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED:
Phone: (503) 639 -4171 ii� i(l 1n
Inspection Requests (24 Hrs.): (503) 639 -4175 iii ':_..
INSPECTION WORKSHEET FOR DATE: TIME: PAGE:
SITE ADDRESS: / 2_(..S , U /: CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME:
DESCRIPTION:
OWNER: PHONE #:
CONTRACTOR: PHONE #:
Inspection Request Scheduled For: Date: 3- g- d p Pour Time:
Code # Inspection Description Confirm # Contact # Message
37 751- < y 751- sea
Corrections /Comments /Instructions:
✓i' eAc vee ,.: fc. 44'4 �G,,, �r�ie•i✓ �3 a1L / �� - - P/ ol�
•
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL n CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Date: 3 h 0 C Phone #: (503) 718 -