Permit •
c ii CITY OF TIGARD
PLUMBING PERMIT
COMMUNITY DEVELOPMENT
PE
COMMUNITY PLM2008 - 00137
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 4/2/2008
PARCEL: 2S 110DD -09200
SITE ADDRESS: 15860 SW HIGHLAND CT ZONING: R -7
SUBDIVISION: SUMMERFIELD NO.6 LOT: 308 JURISDICTION: TIG
PROJECT: GIBSON
Project Description: Installing backflow preventer.
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
GLORIA GIBSON
LEONARD LEE Description Date Amount
15860 SW HIGHLAND CT [PLUMB] Permit Fee 4/2/2008 $36.25
TIGARD, OR 97223 [TAX] 12% State Surch 4/2/2008 $4.35
Phone : Total $40.60
Contractor:
JOHN SLAUGHTER LANDSCAPING
15055 SW 100TH AVE
TIGARD, OR 97224 REQUIRED ITEMS AND REPORTS
Contact # : PRI 503- 639 -1336
FAX 503- 639 -2127
Reg #: LIC BACKFLOW &
PLM 12288
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of 0 -Spec -t A 6 r -s and all her
applicable laws. All work will be done in accordance with approved plans. This permit will -... _ -if is not arte• ithin 1 8'0 days of
issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law equi -' follow r es adop` -d b :e Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 0001 -0010 through 0A' "I - /001 -0 '0. ou - • • ain copies o
these rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.234.
O 11111 11116/ -
Issued = : / ,• Permittee Signat • 1 i
/r
Call 503.639.4175 by 7:00 a.m. for an inspection that busine s •
This permit card shall be kept in a conspicuous place on the job site until completion of the pro
Approved plans are required on the job site at the time of each inspection.
Plumbing Permit Application �' , �. ';
a i'
FOR OFFICE USE ONLY
spr...:.t
IN City of Tigard °)
a 1312 SW Hal Blvd., Tigard, OR 97223 i?ale 1 Received�
Perm N o G
�` a ry - v VPI tt vie
II _ : Phone: 503.639.4171 Fax: 503.598.1960 \ t � � yal Other Permit No.:
TIC; A R D Inspection Line: 503.639.4175 t t ( (.��. Date Ready/By: Juris: RI See Page 2 for
Internet: www.tigard- or.gov SOL Notified/Method: Supplemental Information
TYPE OF WORK FEE* SCHEDULE
❑ / Npw construction ❑Demolition For special information use checklist.
Description I Qty. I Ea. Total
O Addition/alteration /replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (1) bath 249.20
Ell 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
JOB SITE INFORMATION AND LOCATION Site utilities
Job site address: j cir 60 <t.. l-1 LsL.l,.a-rv, z- Catch basin or area drain 16.60
City/State /ZIP.. i tt <0 3.., r , -i- t CYL. I '7 7-7.-14 Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: I Project name: 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
v ‘„co �� / Storm sewer (no. linear ft.: ) Page 2
`v� hopr- ter ✓r t k)Vl C
Subdivision: Lot no.: Water service (no. linear ft.: _) Page 2
Fixture or item
Tax map /parcel no.:
Absorption valve 16.60
DESCRIPTION O1; WORK 2
Backflow preventer i Page 2 (�
i 4-c-ie..--Ro ,, r•-- _Try- t. e , c7 Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
Er OWNER I ❑ TENANT Drinking fountain 16.60
. Ejectors /sump 16.60
Name: Al v - 1. 4 4,11 c ) Expansion tank 16.60
Address: 1 ci76,0 5 v f.E,,,,,,tki.Ai'L ` T , Fixture /sewer cap 16.60
City /State /ZIP s 1 1 G4y.b pa_ - 72.2. 1/4- Floor drain /floor sink/hub 16.60
Phone: ( Fax: ( ) Garbage disposal 16.60
Lg' APPLICANT Hose bib 16.60
❑ CONTACT-PERSON
Ice maker 16.60
Business name: ,Fp(nvi S1, iii ___ r--A _ Interceptor /grease trap 16.60
Contact name: _LA'1 n <L,, � 1A-1--(A__ Medical gas (value: $ ) Page 2
�•
Address: ( ss 5 j �{ � � ` , Primer 16.60
City /State /ZIP: ( �b l Ott- G1'7 7-2-it Roof drain (commercial) 16.60
Phone: (S 2 , ) 639 _ 133 Fax:: 0 3) 6„3i - Z( Sink /basin lavatory 16.60
Tub /shower /shower pan 16.60
E -mail:
Urinal 16.60
•
CONTRACTOR Water closet 16.60
Business name: Water heater 16.60
Address: Other:
Subtotal
City /State /ZIP:
Minimum permit fee: $72.50
Phone: ( ) G 7//CA" ( ) Residential backflow minimum permit fee: $36.25 3r, , �5
CCB Lic.: t"31 ( 4 1 Plumbing Lic. no.: Plan review (25% of permit fee)
!OAP
State surcharge (12% of permit fee) I .35
Authorized signature: - TOTAL PERMIT FEE it). l
Print name: ���s 1p_5 5 - t„4 Date: O pt cfL 019 This permit application expires if a permit is aot obtained within
180 days after it has been accepted as complete.
*Fee methodology set by Tri -County Building Industry Service Board.
I:\Building\PermitsWPLM- 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`eUtilities Qtr'.` Fee,(ea) Total' ' Square Footage: Permit 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
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 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
and including $50,000.00.
specially requested inspections - per hour 72.50
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:
Are you capping, adding or replacing fixtures? If eyes ", Plan Review for Plumbing Installations
please indicate work performed by fixture. Failure to Plan review is required for any of the following.
accurately report fixtures could result in increased sewer fees Please check all that apply.
• Quantity by (Fixture) Work Performed ❑ Any new commercial building with water service 2" and
Fixture Type: Replace greater, except systems designed and stamped by licensed
Previous Capped Added Existing engineer.
Baptistry /Font
Bath - Tub /Shower CI New exterior plumbing site utilities for any complex structure
as defined in OAR918- 780 -0040.
-Jacuzzi/Whirlpool
CI Car Wash Each Stall Medical gas and vacuum systems for health care facilities.
Drive Thru CI Any multipurpose fire sprinkler system.
Cuspidor/Water Aspirator ❑ Any complex structure as defined in OAR918- 780 -0040.
Dishwasher - Commercial
Domestic Submit 2 sets of plans with any of the above.
Drinking Fountain
Eye Wash Isometric or Riser Diagram
Floor Drain/sink - 2" ❑ Isometric or riser diagram is required for new buildings
3„ that meet the qualifications above.
- 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 OF TIGARD .
BUILDING DIVISION PERMIT #: PLM2008-00137
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 4/2/2008
Phone: (503) 639-4171
Inspection Requests (24 Hrs.): (503) 639-4175 a" IL
INSPECTION WORKSHEET FOR DATE: 413/2008 TIME: 7:02AM PAGE: 27
SITE ADDRESS: 16860 SW HIGHLAND CT CLASS OF WORK:
SUBDIVISION: SUMMERFIELD NO.6 LOT #: 309 TYPE OF USE:
PROJECT NAME: GIBSON
DESCRIPTION: Installing backffrw preventer.
OWNER: GIBSON, GLORIA PHONE #:
CONTRACTOR: JOHN SLAUGHTER LANDSCAPING PHONE #: 503-639-1336
Inspection Request Scheduled For: Date: 4/3/2009 Pour Time:
Code # Inspection Description Confirm # Contact # Message
399 Plumbing final 067836-01 603-639-1336
Corrections/Comments/Instructions:
•
CA cc c- 91,,)
X PASS PARTIAL APPROVAL 111 CANCEL I I NO ACCESS
FAIL CALL FOR INSPECTION El ADDITIONAL FEES ASSESSED
Inspector: C Date: L i ) 37 Phone #: (503) 718-
_ . _