Permit CITY TIGARD PLUMBING PERMIT
: I i DEVELOPMENT SERVICES PERMIT #: PLM2005 -00440
----- � cI � 13125 SW Hall Blvd., Tigard, OR 97223 503- 639 -4171 DATE ISSUED: 9/6/2005
PARCEL: 2S 103C D -00900
SITE ADDRESS: 11595 SW FAIRVIEW LN ZONING: R -4.5
SUBDIVISION: HOLLYTREE LOT: 004 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
RICK, RUTH, ROBINSON Description Date Amount
11595 SW FAIRVIEW
TIGARD, OR 97223 [PLUMB] Permit Fee 9/6/2005 $36.25
[TAX] 8% State Surcharl 9/6/2005 $2.90
Phone : 503 380 - 9102 Total $39.15
Contractor:
OWNER
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 direct questions to OUNC by
calling 503-246-.. "• o - 800 - 332 -2344.
Issued By: / 4.67/1/
Permittee Signature Ajtkitk-Vv.) (
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.
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Building Fixtures RECEIVED
Plumbing Permit Application FOR OFFICE USE ONLY '
City of Tigard SLY 0 6 2005 Received // .60 g Date/B 9. t/ Q5 Permit No. i� / /
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13125 SW Hall Blvd., Tigard, OR 97223 Plan Revi •
Phone: 503.639.4171 Fax: 503. 598.1960 CITY OF TIGAfif .. 1'r� ' ( Date/By Other Permit No.:
24- Hour Inspection Line: 503.639.4175 BUILDING DI1/Ic 4 �I „ Date Ready/By: to s: See Page 2 for
Internet: www.ci.tigard.or.us . Nodfied/Method: Supplemental Information
TYPE OF WORK FEE* SCHEDULE
❑ New construction ❑ Demolition For special information use checklist
Description 1 Qty. I Ea. I Total
4Addition/alteration/replacement ❑ Other: New I- 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
❑ 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: VI `I( \ ) \ l) ( Catch basin or area drain 16.60
City /State /ZIP: It �j 1, I/ a .7.'71, Drywell, leach line, or trench drain 16.60'
Suite/bldg./apt. no.: v y Project name: Footing drain (no. linear ft.: ) Page 2
Manufactured home utilities 110.00
Cross street /directions to job site: .
\ ` p� Manholes 16.60
1 1S erj / t l ∎M\ 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
06 .w J\ltilh I/ S� Jn( \ , Backwater valve / 16.60
l Clothes washer 16.60
Dishwasher 16.60
PROPERTY OWNER .. ❑ TENANT Drinking fountain 16.60
Ejectors /sump 16.60
Name: ''`( V S l &kflk N °i�'' Expansion tank 16.60
Address: I /C S S w / ✓1 �e (.L) Lh Fixture /sewer cap 16.60
City /State /ZIP: �, 1 S 7 Z z
Phone: Floor ge disposal sink/hub
Garbage 16.60
S _ J Fax: ge disposal 16.60
() " rh / d 7r ( ) Hose bib 16.60
❑ APPLICANT . ❑ CONTACT PERSON
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
• • CONTRACTOR . Water closet 16.60
• Business name: ( • I ;, . . Qy lt n l /n Water heater 16.60
Address: \SA 52_ Sw t' VV ` Other:
• City /State /ZIP: 1[,6)(16 ( 11Z,2�1 Subtotal
M inimum permit fee: $72.50
Phone: ( �) � 2Gj -- n'l 2) Fax: ( ) Residential backflow minimum permit fee: $36.25 r 14pp
CCB Lic.: / Plumbing Lic. no.: Plan review (25% of permit fee)
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State surcharge (8% of permit fee) . /19
uthorized signature:
.1 3 ./ 6
/ ti l\- 8 ( P f- TO TAL PERMIT FEE "`
Print name: II IP P r /a_ • \O l S Date: This permit application expires if a permit is not obtained within
/ 7 180 days after it has been accepted as complete.
*Fee methodology set by Tri -County Building Industry Service Board.
i.\ Building \ Permits \PLMF- PermitApp.doc 06/05 440-461 6T( 10/02/COM/WEB)
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site "U
Qty. , Fee '
(ea) Total S_quare•-Footage:. Permit Fee: a . .
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• 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 Back flow 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 Complex Struct
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,
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accurately report fixtures could result in increased sewer fees. Please check all that apply.
,Quantity, by (Fixture) Work Performed El 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.
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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 ermit results in an
Water Extractor p
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.
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i:\ Building \Permits \PLM- PennitApp.doc 07/06/05
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CITY OF TIGARD
BUILDING DIVISION PERMIT #: P M2005.00440
13125 SW Hall Blvd., Tigard, OR 97223 • - DATE ISSUED: 9/6/2005
Phone: (503) 639 -4171 Ag >mpn�
Inspection Requests (24 Hrs.): (503) 639 -4175 ...,11'
. .' W %_..
INSPECTION WORKSHEET FOR DATE: 9/19/2005 TIME: 7 :06AM PAGE: 4
SITE ADDRESS: 11595 SW FAIRVIEW LN CLASS OF WORK:
SUBDIVISION: HOLLYTREE LOT #: 004 TYPE OF USE:
PROJECT NAME: ROBINSON
DESCRIPTION: I'3ackflow preventer for irrigation.
OWNER: ROBINSON, RICK, RUTH, RYAN PHONE #: 503 -380 -9102
CONTRACTOR: OJER PHONE #:
Inspection Request Scheduled For: Date: 9/19/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
325 RP /backflow preventer 016048 -01 503-550-1324 N
Corrections/Comments/Instructions:
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A 0.•_,. _ / ./ /' _
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l • S El PARTIAL APPROVAL ❑ CANCEL _ NO ACCESS
V FAIL H CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED
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Inspector 1 Date: / � Phone #: (503) 718-