Permit cril 4 4 1 1 1 A
CITY OF TIGARD PLUMBING PERMIT
Z DEVELOPMENT SERVICES PERMIT #: PLM2006 -00164
DATE ISSUED: 4/26/2006
. 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171
PARCEL: 2S 103AC - 09400
SITE ADDRESS: 11460 SW FONNER ST ZONING: R -4.5
SUBDIVISION: GERTZ PARTITION LOT: 003 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
LILY SUN
11460 SW FONNER ST Description Date Amount
TIGARD, OR 97223 [PLUMB] Permit Fee 4/26/2006 $36.25
[TAX] 8% State Surcha 4/26/2006 $2.90
Phone : 503- 431 -2171 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 By: Permittee Signature: 7,,-e,
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 R FOR OFFICE 1 :SF ONLY
AP' ` * Received ,/) CI of Ti and P er m it No 131 SW Hall Blvd , Ti ard, OR, 97223 ��ssy� y Date/B �� (� // ��- �`�� �U �� r
g Gi tl Y i ew Phone: 503.639.4171 Fax: 503.598.1960 w t - p Plan Rev Othe P No
24- Hour Inspection Line: 503.639.4175 ' a ,� RI I � t rs
1 a te Ready /By ® S ee Page 2 for
Internet: www.ci tigard.or.us s Notified/Method f l rr Supplemental Information
r FEE :SCHEDUtiE .•
� ;: � � �: .,. Tl'PE � ;UF; ,.� , -
❑ New construction ❑ Demolition For special information use checklist.
Description I Qty. I Ea J Total
❑ Addition/alteration/replacement ® Other: LANDSCAPE New 1- 2- family dwellings (includes 100 ft for each utility connection)
r ', `' ` s ^' ``t% +=- CATEGORY :OF,' _CONSTRU.CTION t-, • 'ri °. .;.: ` -' SFR (l) bath 249 20
')E2 I- 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:
^M' ;4 e N _ Fire sprinkler ( sq ft) Page 2
y 'JOB' SI TE I V O u
.v.�s•�,r; , •, ,, ___ „. - , _ • _ I, F , RMATI ONw AN D,�LO CAT[ON' =; ;: ',� _„ „ , Site utilities
Job site address: //'6 a ,5z A . S'- Catch basin or area drain 16.60
City /State /ZIP: X67. --- ,, Ox_ 99 PR-2 Drywell, leach line, or trench drain 16 60
Suite/bldg. /apt. no.: Project name: al/11 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: I Lot no.: Water service (no. linear ft . ) Page 2
Fixture or item -
Tax map /parcel no.: Absorption,valve 16 60
x« :r : . rP : -P.. CRIPTON,'OF °,-WORK ; < . ...: , '.;rr` "
. -- ... :�, -. ,�,
,.�, �- ..., .. ... ... . I
. . . . . .'� • >... - � *w�'. b *- ..,,a�_'.- . _ ��iYA';' BackFlow preventer 1 Page 2
INSTALL BACKFLOW DEVICE Backwater valve 1660
Clothes washer 16 60
Dishwasher 16 60
` . Drinking fountain
Ejectors /sump 16 60
16 60
„' =❑: PROPERTY OWNER' ... :,, , r.:.,
`_.:< a•. ,'' ❑,TENA = :_,:;•
•, s- - r . . -- < .��°
Name: Y 'c-(G Y �U� Expansion tank 16 60
Address: S412►e 41 /7� -w Fixture /sewer cap 16 60
City /State /ZIP: �� Floor drain/floor sink/hub 16 60
Phone:
(j J ) 707 - -/77 Fax: ( ) Garbage disposal 16 60
Hose bib 16 60
e 1 ; , ;;,sz ®°aAPPLICANT, «, ''`'•'`,- 0 , ; :! ;i' _" :.
«z- '� =��w ��., ;^�- .,,g,=r • CbNTaCT PERSUI�I
`' 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
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ATO _ . : ., "
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. �� � , �., . fia� � ., �� _ . .... - . _ n . <:: . , _.$ • >_._- ��' << Water closet 16 60
Business name: DENNIS' SEVEN DEES LANDSCAPING, INC Water heater 1660
Address: 7355 SE JOHNSON CREEK BOULEVARD Other
City /State/ZIP: PORTLAND, OR 97206 Subtotal
Minimum permit fee $72 50 •7�
Phone: (503 ) 777 - 7777 Fax: (503 ) 777 - 2399 Residential backtlow minimum permit fee $3625 J
Plan review (25% of permit fee) (----
CCB Lic.: 5009 Plumbing Lie. no.: 05LIBDI
State surcharge (8% of permit fee) ,2 /O
Authorized signature: . /S_ '�� / TOTAL PERMIT FEE 5 (5
Print name: DEAN SNODGRASS I Date: C�`� /a 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 'Budding'Permits\PLM- PermiiAppdoc 17/03 440- 4616T(I0 /02TCONi/WEB)
Plumbing Permit Application - City of Tigard
Page`2 <- Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
( );�''
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:;; a '`Permit-F
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
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
r M; , °z: Quan`dty;by (Fiatu�e)' -Work Performed "
Replge F S4*%
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
Bradley Quantity Total
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 •
\Buidmg \Permlts\PLM- PermiApp doc 3/03
CITY OF TIGARD
BUILDING DIVISION PERMIT #: 26 r 06 i(4
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED:
Phone: (503) 639 -4171 h
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: TIME: PAGE:
SITE ADDRESS: I I 4 (Q 0 j4 CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME:
DESCRIPTION:
OWNER: PHONE #:
CONTRACTOR: PHONE #:
Inspection - Request Scheduled For: Date: Pour Time:
Code # / Inspection Description Confirm # Contact # Message
- Wi a LA44" ( 2 t"^ i CL " G D I,
Corrections /Comments/ Instructions:
. 9 , : VrrAiliy,/
l . .
1
, l PARTIAL APPROVAL ❑ CANCEL n NO ACCESS
I I FAIL n CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED
��. ‘I _
Inspector: L C Date: / 7 Phone #: (503) 718
CITY OF TIGARD
,...-.
BUILDING DIVISION - — -
A PERMIT #: PLM2006-00164 . .
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 4/26/2006
Phone: (503) 639-4171 Amont "Ai ei
Inspection Requests (24 Hrs.): (503) 639-4175
INSPECTION WORKSHEET FOR DATE: 6/8/2006 TIME: 7:03AM PAGE: 75
SITE ADDRESS: 11460 SW FONNER ST CLASS OF WORK:
SUBDIVISION: GERTZ PARTITION LOT #: 003 TYPE OF USE:
PROJECT NAME: SUN
DESCRIPTION: Backflow preventer for irrigation.
OWNER: SUN, LILY PHONE #: 503-431•2171
CONTRACTOR: DENNIS' 7 DEES LANDSCAPING PHONE PHONE #: 503-777-7777
Inspection Request Scheduled For: Date: 6/8/2006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
395 Misc. inspection 031370-03 503-777-7777 N
Corrections/Comments/Instructions:
Ilik —
_
.
,.,
/
•i ,alli ' a ....."___ 7 6 Li g '
1
/
I
7 PASS ,k- PARTIAL APPROVAL 0 CANCEL El NO ACCESS
I I FAIL CALL FOR INSPECTION 0 ADDITIONAL FEES ASSESSED
Inspector: t C\ Date: Li q)/ 0 Phone #: (503) 718- 2 / . 3 (
, .