Permit n CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT PERMIT #: PLM2008 -00353
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 8/27/2008
PARCEL: 1S134DC-10300
SITE ADDRESS: 11496 SW CORNELL PL ZONING: R -4.5
SUBDIVISION: TIGARD PARK LOT: 019 JURISDICTION: TIG
PROJECT: BOWKER
Project Description: Backflow preventer for irrigation.
CLASS OF WORK: ALT 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
LEANNE BOWKER
11496 SW CORNELL PL Description Date Amount
TIGARD, OR 97223 [PLUMB] Permit Fee 8/27/2008 $36.25
[TAX] 12% State Surch 8/27/2008 $4.35
Phone : 503 -293 -0073 Total $40.60
Contractor:
OWNER
REQUIRED ITEMS AND REPORTS
Contact # : PRI
Reg #:
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 0001 -0010 through OAR 952 - 0001 -0100. You may obtain copies of
these rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued B ���- " 11 1111.r. Permittee Signature: 6-k (.. . .
j
Call 503.639.4175 by 7:00 a.m. for an inspection that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Plumbing Permit Application 6 U
Building Fixtures FOR OFFICE USE ONLY
Received ; i City of Tigar Date/B : 111 Permit No.: / n 13125 SW Hall Blv Tigard, OR Plan Review
: Phone: 503.639.4171 Fax: 503.598.1960 ry Date/By: Other Permit No.:
T I GARD Inspection Line: 503.639 AU G 21 Z�" Date Ready /By: J� ®See Page 2 for
Internet: www.tigard- or.gov _ �'$® AR ® Notified/Method: j Supplementallnformation
TYPE, OF WO TY Of I' v FEE* SCHEDULE
❑ N w construction � G D V ISIO' " For special information use checklist
Description Qty. Ea. I Total
°-+A Addition/alteration /replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
CATEGORY.OF CONSTRUCTION . SFR (1) bath 249.20
❑ I- and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 350.00
❑ Accessory building El 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 IIFORMATION,AND, LOCATION Site utilities
.--t Job site address: 11 l f q j . f („3 Co , v.t (I 1:46--e-_,, Catch basin or area drain 16.60
I
' City /State /ZIP: T I (Vet t 6 2 q z -..7 Drywell, leach line, or trench drain 16.60
Suite/bldg./apt. no.: Project name: / Footing drain (no. linear ft.: ) Page 2
t 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.: Absorption valve 16.60
DESCRIPTION OF, WORK Backflow preventer i Page 2 ?..75-5 A - ( -ta II het L ( Backwater valve l 16.60
Clothes washer 16.60
Dishwasher 16.60
--- PROP OWNER ' ' . ❑ TENANT. Drinking fountain 16.60
Ejectors /sump 16.60
--,- Name: L t,,,_, �d A) C Expansion tank 16.60
- Address: I I ¶ L 5 ( v,2 14 7( 4 Fixture /sewer cap 16.60
° `r
- ' City /State /ZIP: ,,___,� 0 ell ZZ 3 Floor drain/floor sink/hub 16.60
I L `
Phone: ( nrs) -1.61/ - o 0 73 Fax: ( s1,3) .2.4 - y if 7 7 Garbage disposal 16.60
El- APPLICANT' - ,
' . ❑ CONTACT PERSON Hose bib 16.60
Ice maker 16.60
----
Business name: f a in G. r a ,I e % pc._
Interceptorlgrease trap 16.60
Contact name: Medical gas (value: $ ) Page 2
Address: Primer 16.60
City /State /Z1P: Roof drain (commercial) 16.60
Sink/basin/lavatory 16.60
Phone: ( ) Fax: : ( )
Tub /shower /shower pan 16.60
E -mail: Urinal 16.60
' CONTRACTOR ' ' _ ' - - - Water closet 16.60
--- Business name: f 0 l.--t__ aJ a o K Water heater 16.60
Address: 01.✓Alc.,,r Other:
City/State /ZIP:
Subtotal
Minimum permit fee: $72.50
Phone: ( ) Fax: ( ) Residential backflow minimum permit fee: $36.25 3�c��
CCB Lic.: Plumbing Lic. no.: Plan review (25% of permit fee)
State surcharge (12% of permit fee) Li, ,J
Authorized signature: ( TOTAL PERMIT FEE LiO / c)
Print name: Let_ �_ � {�2 - Date: L O This permit application expires if a permit is not obtained within
v 180 days after it has been accepted as complete.
*Fee methodology set by Tri- County Building Industry Service Board.
P\Building\Permits\PLMF- PermitApp.doc 12/27/06 440- 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). T °tai" . Square .Footage *
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 - 1st 100' 55.00 Medical Gas Systems:
Water Service - each additional 100' 46.40
Valuation:' • ..Pern><it 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
additional $100.00 or fraction thereof, to and
>F1Xtldl'e,Or.Itell)t .Qty ' , F ee;(ea) TotaC =. 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
Subtotal: $50 and up $742.00 for the first $50,000.00 and $1.20 for
each additional $100.00 or fraction thereof
Commercial Fixture Work: . Plan Review- for Plumbing Installations-
Are you capping, adding or replacing fixtures? If "yes ", Plan review is required for any of the following.
please indicate work performed by fixture. Failure to Please check all that apply.
accurately report fixtures could result in increased sewer fees ❑ Any new commercial building with water service 2" and
Qdantity by (Fixture) "Work Performed ,. greater, except systems designed and stamped by licensed
engineer.
Fixture Type:. Replace
.. ."`..Previous : .Capped_ Added Eristin>;: - ❑ New exterior plumbing site utilities for any complex structure
Baptistry/Font as defined in OAR918- 780 -0040.
Bath - Tub /Shower ❑ Medical gas and vacuum systems for health care facilities.
- Jacuzzi/Whirlpool ❑ Any multipurpose fire sprinkler system.
Car Wash -Each Stall ❑ Any complex structure as defined in OAR918- 780 -0040.
-Drive Thru
Cuspidor/Water Aspirator Submit 2 sets of plans with any of the above.
Dishwasher - Commercial
- Domestic
Diagra
Drinking Fountain
Isometric or Riser m;.
Eye Wash ❑ Isometric or riser diagram is required for new buildings
Floor Drain/sink - 2" that meet the qualifications above.
-3"
4 "
Car Wash Drain
Garbage - Domestic Comments regarding fixture work:
Disposal - Commercial
- Industrial
Ice Mach. /Refrig. Drains
Oil Separator (Gas Station)
Rec. Vehicle Dump Station
Shower -Gang
-Stall
Sink - Bar /Lavatory
- Bradley *Note: If the fixture work under this permit results in an
- Commercial increase of sewer EDUs, a sewer permit will be issued and
- Service fees assessed for the sewer increase must be paid before the
Swimming Pool Filter plumbing permit can be issued.
Washer - Clothes
Water Extractor
Water Closet - Toilet
Urinal
Other Fixtures:
i.\ Building \Permits\PLM - PermitApp.doc 12/27/06
CITY ������U��������
��m m m ��m� � n�m�mnm��
BUILDING DIVISION '� -' '~ • PERMIT #: PLK4200E-00353
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 8/2712008
Phone: (503) 639-4171
Inspection Requests (24 Hrs.): (503) 639-4175
INSPECTION WORKSHEET FOR DATE: 9/4/2008 TIME: 7:02AhA ' PAGE: 4
SITE ADDRESS: 11496 SW CORNELL PL CLASS OF WORK:
SUBDIVISION: TIGARD PARK LOT #: 019 TYPE OF USE:
PROJECT NAME: B0WKER
DESCRIPTION: E1acWOomprwmwntmrfor irrigation.
OWNER: BOWKER, LEANNE PHONE #: 503'293-0073
CONTRACTOR: OWNER PHONE #:
Inspection Request Scheduled For: Date: EV4/2008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
399 Plumbing final 075086-01 • 503-824'0939 N
Corrections/Comments/Instructions:
5kPASS El PARTIAL APPROVAL n CANCEL I I NO ACCESS
|| FAIL || CALL FOR INSPECTION ri ADDITIONAL FEES ASSESSED
Inspector: ~-fi Date: «i /(C / 0?) Phone #: (503) 718-