Permit �M r CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT PERMIT #: PLM2008 -00317
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 7/28/2008
PARCEL: 25101 AB -01607
SITE ADDRESS: 07540 SW HERMOSO WAY ZONING: MUE
SUBDIVISION: HERMOSO PARK LOT: 009 JURISDICTION: TIG
PROJECT: LUBY BUILDING
Project Description: Installing (1) commercial backflow preventer.
•
CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS: 1
OCCUPANCY GRP: B 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
STEPHEN RAND
7540 SW HERMOSO WAY Description Date Amount
TIGARD, OR 97223 [PLUMB] Permit Fee 7/28/2008 $72.50
[TAX] 12% State Surch 7/28/2008 $8.70
Phone : Total $81.20
Contractor:
GROW -RITE LANDSCAPE LLC
PO BOX 156
WEST LINN, OR 97068 REQUIRED ITEMS AND REPORTS
Contact # : PRI 503- 969 -9698
Reg #: LIC 7849
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 / — 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
Bt i Fixtures �� *j® FOR OFFICE USE ONLY
Received
City of Tigard Date/By: 7 r Permit No.: , 2� 00 3 t
q 13125 SW Hall Blvd., Tigard, OR tr tea. ci,1 0 � Plan Review ( `%` /
_ :. Phone: 503.639.4171 Fax: 503.5'8. '60 ,v ``\\\ 4 /j v t , ` n ateBy: Other Permit No.:
T I G A R D vv
Inspection Line: 503.639.4175 G` to Ready /By: See Page 2 for
Internet: ww.[igard -oCgov ®y c ` ® Notified /Method Q ®
Supplemental Information
• . • ' - TYPE.O_F WORK- .cA` .w \� - 11 s. - FEE* "SCHEDULE•.
CI New construction ❑ Dei For special information use checklist
Description Qty. I Ea. I Total
El 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
CI Accessory building ❑ Multi- family SFR (3) bath 399.00
Each additional bath/kitchen 45.00
❑ Master builder ❑ Other:
Fire sprinkler ( sq. ft.) Page 2
• : . . `JOB'.SITE INFORMATION `•AND .LOCATION -. - Site utilities
Job site address: '' /
�� -��� ,� �;� X71 / ' /y /Ciy 1. e://C.J� Catch basin or area drain 16.60
City /State /ZIP: -r j G � L z7 7Z 2- l Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: U I Project name : .(,r 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.: r. Absorption valve 16.60
DESCRIPTION OF. WORK Backflow preventer I Page 2 y6, if v
Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
'❑', PROPERTY ,OWNER ' , - Drinking fountain 16.60
.
❑TENANT
Ejectors /sump 16.60
Name: K. Ca ✓I !.7 4 y ix Expansion tank 16.60
Address: 75 ,...4...,/ le r� 4` L ex _-4i Fixture /sewer cap 16.60
City /State /ZIP:' ;‘ t/ G- /Z 97 L z „ 3 Floor drain /floor sink/hub 16.60
Phone: ( ) yr e , _ _- d Fax: ( ) Garbage disposal 16.60
- :. ' ;-.❑ APPLICANT - -- : ' .. Hose bib 16.60
' � �, ❑'CONTACT
6-6.,,.../ ? 1 / _ � � �G Ice maker 16.60
Business name:
' / 1 .7, -
"' 1 .. /�t.si 3Gr C Interceptor /grease trap 16.60
Contact name: `� /� 6-1) 6,----'.2c/ Z Medical gas (value: $ ) Page 2
Address: p 7 430:( ` .O _Primer 16.60
/ t n Roof drain (commercial) 16.60
City /State /ZIP:
�L e y/ I A 0 g 9 7 r!� Sink/basin / lavatory 16.60
Phone: W9) 9 - 16 , k Fax: : ( ) Tub /shower /shower pan 16.60
E -mail:
Urinal 16.60
- , ` CONTRACTOR' • : , _ . • Water closet 16.60
Business name: 6 f J . z / 4 ,... d S z _ z _ Water heater 16.60
Address: j ) i �0,y /_53 Other:
Subtotal
City /State /ZIP: tikj 1 4./#74 e ;., 9 7"6 ?
Minimum permit fee: $72.50
Phone: (5 f k Fax: ( ) Residential backflow minimum permit fee: $36.25
g 7 G j `7 Plan review (25% of permit fee) 1).-5
CCB Lie.: Plumbing Lic. no 6 �/ ` +-
�i�� / 01 State surcharge (12% of permit fee)
Authorized signature: ��-' �C /G�./� -- ���� TOTAL PERMIT FEE / i
Print name: f �-m� Date: 7 - % -• � 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 \Permits\PLMF- PermitApp.doc 12/27/06 440- 4616T(I0/02 /COM/WEB)
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
;Site Ut><Lties; � r rr t '11 Fe
;, Q ty, , . e (ea) Total S uare e,' arc., r� w
.. _. �.� � � �;_ � �' .:,.� -,
Footing drain - li 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 �..
;Valuat on Permit: E0
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
y. '"Total additional $100.00 or fraction thereof to and
E><xtuire.:br`Ifem " a . , Fee,(ea)?
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
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: ,Jj ;it: $50 and up $742.00 for the first $50,000.00 and $1.20 for
- 7�G' each additional $100.00 or fraction thereof.
Commercial Fixture Work: Plan Rev Plural ing Installat ons `'a; : Y,
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
b greater, except systems designed and stamped by licensed
- s Y " fixture Work•PerfoimbdC, "',# ' e ineer.
attire Type ;R ' g
Capped ..Added a °. Ensting ❑ 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 �a ;
fIs t
omeric or'�Riset, .iagram,-rw
Drinking Fountain ''��� µ � - _ ° - - • - -.M.
Eye Wash ❑ Isometric or riser diagram is required for new buildings
Floor Drain/sink - 2" that meet the qualifications above.
-3"
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:
1• \Building\Permits\PLM- PermitApp doc 12/27/06
1 • - ' ,,____ „____
L '
CITY OF TIGARD
BUILDING DIVISION ,
PERMIT #:
PLM2008
13125 SW Hall Blvd., Tigard, OR 97223 .
DATE ISSUED: 7/28/7009
Phone: (503) 639-4171 tilkillitlii?'
Inspection Requests (24 Hrs.): (503) 639-4175
INSPECTION WORKSHEET FOR DATE: 8/1/2008 TIME.
• 7:00AM PAGE: 10
1
SITE ADDRESS: 07540 SW HERMOSO WAY CLASS OF WORK:
SUBDIVISION: HERMOSO PARK LOT It
• 009 TYPE OF USE:
PROJECT NAME: LUBY BUILDING
DESCRIPTION: Installing (1) commercial backflow preventer.
OWNER: RAND, STEPHEN PHONE #:
CONTRACTOR: GROW-RITE LANDSCAPE LLC PHONE #: 503_969_9698
Inspection Request Scheduled For: Date: 8/1/2008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
399 Plumbing final 073606-01 503-969-9698 N
Corrections/Comments/Instructions:
P it ,./% c e_., -- \ r
/ 7,...p.c.„.c . .,....c.LA
X PASS El PARTIAL APPROVAL CANCEL 7 NO ACCESS
El FAIL 7 CALL FOR INSPECTION 7 ADDITIONAL FEES ASSESSED
Inspector: CTOA44.A.--) t :Al --- Date: 71 k i 'CA Phone #: (503) 718-