Permit C ITY OF TIGARD PLUMBING PERMIT
DEVELOPMENT SERVICES PERMIT #: PLM2006 -00416
A DATE ISSUED: 9/11/2006
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171
PARCEL: 1 S 134AD -04800
SITE ADDRESS: 10765 SW BLACK DIAMOND WAY ZONING: R -4.5
SUBDIVISION: BLACK BULL PARK LOT: 031 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
DREW SNODGRASS
10765 SW BLACK DIAMOND WAY Description Date Amount
TIGARD, OR 97223 [PLUMB] Permit Fee 9/11/2006 $36.25
[TAX] 8% State Surcha 9/11/2006 $2.90
Phone : 503- 969 -3033 Total $39.15
Contractor:
DENNIS' 7 DEES LANDSCAPING
7355 SW JOHNSON CREEK BLVD
PORTLAND, OR 97206 REQUIRED ITEMS AND REPORTS
Contact # : PRI 503- 777 -7777
FAX 503- 777 -2399
Reg #: LIC 5009
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 503 - 246 -6699 or 1- 800 - 332 -2344.
Issued B y : �l4)) ' /�; Permittee Signature: Sp
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.
rl 7
Plumbing Permit AprilEC I V D F. OFFICE VSE ONLY
City Of Tigard (`1 Date/By: 1' le`, Permit Nom\ / I 1 !O y
13125 SW Hall Blvd., Tigard, OR 97223 J �00� Plan Review
(J
Phone: 503.639.4171 Fair: 503.598.19 Other Permit No.:
C • 24- Hour Inspection Line:' .503:639A175 OF TI GAR lij Date/By
75 � //M , Date Ready/By: lu " See 2 for
Internet: w w.ci.tigard.ot us BUILDING [)IVI� s. Notified/Method: s Supplemental Page Information
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❑ New construction ❑ Demolition For special information use check list.
Description I Qty. I Ea. I Total
❑ Addition/alteration/replacement ® Other: LANDSCAPE New 1- 2- family dwellings (includes 100 ft. for each utility connection)
/ 01 "CATEGORYOFCOIVSTItI)�� p ON� .9.,�,. <_�= ,�` „ r�''`.:as �r : SFR 1 bath 249.20
p a- 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
"JOBS= SITE ='IN TI ``
N "' �ND:� LOCATION. <'.':'::.:17 s;a�c�r::;
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Job site address: 7(s7 5 56d / K , /� Z ( r j /1 Air Catch basin or area drain 16.60
City/State/ZIP: G6,tt�G` U, 9 70-01 Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: I Project name: 146/V / °S Footing drain (no. linear ft.: ) Page 2
Manufactured home utilities 110.00
Cross street/directions to job site: Manholes 16.60
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.:
;,,_. s o ve .
A orpti n val
� DFSeCR[! ' 1ION 0 WORK ..- ._ .z _ _6 ,,. . Backflow preventer 1 Page 2
' INSTALL BACKFLOW DEVICE Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
;; ; _, ;, ,;; -, ,- Drinking fountain 16.60
`PRUPERTI'tzOWNER�= = =`. v ❑$ >TEIVAP[T. �.� ,
_, - �� ` "'� Ejectors/sump 16.60
Name: 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
f; ,, ` .. „„, �,,:,,_ : k . ; x or. 1i.'. Hose bib 16.60
,..,, 4" �. APPI ICANT :::, >,. - , `> '�.. - TA . PERSON �.
/" Ice maker 16.60
Business name:
Interceptor /grease trap 16.60
Contact name: t9 L s,v lootzkg S Medical gas (value: $ ) Page 2
Address: Primer 16.60
City/State/ZIP: Roof drain (commercial) 16.60
Phone: (563 ) 1Kvq�3073 I Fax: : ( ) Sink /basin/lavatory 16.60
Tub /shower /shower pan 16.60
E -mail:
Urinal 16.60
,..�. , _.. _ .. ,.... .. -„ ... Water closet 16.60
Business name: DENNIS' SEVEN DEES LANDSCAPING, INC Water heater 16.60
Address: 7355 SE JOHNSON CREEK BOULEVARD Other:
City /State/ZIP: PORTLAND, OR 97206 Subtotal
Minimum permit fee: $72.50 3 f ��
Phone: ( 503 ) 777 - 7777 Fax: (503 ) 777 - 2399 Residential backflow minimum permit fee: $36.25 t 0
Plan review (25% of permit fee) `---
CCB Lic.: 5009 Plumbing Lic. no.: 05LIBDI
State surcharge (8% of permit fee) 4 7 2 -(.)
Authorized signature: al ' - /P / TOTAL PERMIT FEE 3 (s
Print name: DEAN SNODGRAS S ` I Date: 940k k 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\Permits1PLM- PermitApp doc 12/07 410- 4616T( l0 /02JCOM /WEB)
Plumbing Permit Application - City of Tigard
Page'2.- :Supplemental Information •
Fee Schedule: Residential Fire Suppression Systems:
Qty Fee (ea) Total i
Si te�UtiUt es, : Sgiiaite Peirm><t. 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
Sewer - 1st 100' 55.00 • 3,601 to 7,200 $220.00
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
Vatuation: :� :�P.ermt = =Fee:h: .
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 9r. Item,c
"Qt,' 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
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 * .
•
,'' " ; Quan'lily:b?(Fixture)'wo k.Perfo'rmed;.,:
Fixture• f ` .,r<. M s w goiko' 4; :�
�F N o E tsng� , Atcfik#,:t 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"
-4"
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
Commercial Isometric or riser diagram is required if fixture quantity
Service total is >9.
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:
r\ Building \Permits\PLM- Perm0App.doc 3/03
CITY OF TIGARD
BUILDING DIVISION PERMIT #: PLM200G- 00116
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 9/11/2006
Phone: (503) 639 -4171 /404110 �
Inspection Requests (24 Hrs.): (503) 639 -4175 =�!i • // tA
INSPECTION WORKSHEET FOR DATE: 10/3/2006 TIME: 7 : 06AM PAGE: 52
SITE ADDRESS: 10766 SW BLACK DIAMOND WAY CLASS OF WORK:
SUBDIVISION: BLACK BULL PARK LOT #: 031 TYPE OF USE:
PROJECT NAME: SNODGRASS
DESCRIPTION: Bacidlow preventer for irrigation.
OWNER: SNODGRASS, DREW PHONE #: 503 -9(9 -3033
CONTRACTOR: DENNIS° 7 DEES LANDSCAPING - PHONE #: 503 - 777 -7777
Inspection Request Scheduled For: Date: 10/3/2006 - Pour Time:
Code. # Inspection Description Confirm # Contact # Message
395 Miss, inspection 037627 -02 503 - 777 -T177 N
Qorrections /Comments/ Instructions:
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PA'S I I PARTIAL APPROVAL ❑ CANCEL I I NO ACCESS
X FAIL n CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: I4 c Date: E NV V t, Phone #: (503) 718- 7'17i'7