Permit di CITY OF T I G A R D PLUMBING PERMIT
COMMUNITY DEVELOPMENT PERMIT #: PLM2008 -00081
TIGAR 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 3/3/2008
PARCEL: 2S104AC -14200
SITE ADDRESS: 12958 SW HILLSIDE TERR ZONING: R -4.5
SUBDIVISION: HILLSIDE ESTATES LOT: 007 JURISDICTION: TIG
PROJECT: HILLSHIRE ESTATES
Project Description: Installation of residential 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
CHUCK ARNETT CUSTOM HOMES Description Date Amount
7288 SW 171
ALOHA, OR 97007 [PLUMB] Permit Fee 3/3/2008 $36.25
[TAX] 12% State Surch 3/3/2008 $4.35
Phone : 503 -481 -7432 Total $40.60
Contractor:
TERRA -SOL LANDSCAPING
HEDGES
TUAL ATI N, OR 97062 2 REQUIRED ITEMS AND REPORTS
TUALATIN,
Contact # : PRI 503 - 691 - 6105
Reg #: LIC 5019
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of O' • •ecial' Codes and all other
applicable laws. All work will be done in accordance with approved plans. This permit will e - ork is of started within 180 days of
issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law r wires you to ollo rules adopted by the Oregon
Utility Notific tinter. Those rules are set forth in OAR 952 - 0001 -0010 through R 952 - 0001 -0100 You may obtain copies of
these rul or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Iss ed By: ,, 1 , Permittee Signatbr : .....
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 comp of the project.
Approved plans are required on the job site at the time of each inspection.
,
Nu. 1,. Permit Application
. 7 - .. .
2
FOR OFFICE USE ONLY
raj' 0113' Of Tigard Date /B d 1e ✓ 2 i/ Q� � Permit No.: It / g/
V 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 Date /By: Other Permit No.:
T I G A RD Inspection Line: 503.639.4175 Date Ready /By: Jur la See Page 2 for
1 Internet: www.tigard- or.gov Notified/Method: //Q Supplemental Information
TYPE OF WORK FEE* SCHEDULE ,
Iew construction ❑ Demolition For special information use checklist
Description I Qty. Ea. Total
❑ Addition/alteration/replacement El 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
� Accessory building ❑ Multi- family SFR (3) bath 399.00
Each additional bath/kitchen 45.00
El Master builder El Other:
Fire sprinkler ( sq. ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities
Job site address: 12 55 c .,..,) 4, , , ta K. {(j,k(\, Catch basin or area drain 16.60
City /State /ZIP: _ Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: f 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
Storm sewer (no. linear ft.: ) Page 2
Subdivision: Lot no.: Water service (no. linear ft.: ) Page 2
Fixture or item
Tax map /parcel no.:
A orptio ,valve , 16.60
DESCRIPTION OF• WORK Backflow prevente/ Page 2
13 z c .� ' ' 'i L, al `�/ . Backwater valve 16.60
J Clothes washer 16.60
Dishwasher 16.60
PROPERTY OWNER I TENANT Drinking fountain 16.60
� Ejectors /sump 16.60
Name: - ,Ai_ C Expansion tank 16.60
Address: Fixture /sewer cap 16.60
City /State /ZIP: 1 Floor drain /floor sink/hub 16.60
Phone: ++ ���� " El - 74;3 t
_- Fax: ( ) Garbage disposal 16.60
❑ ❑ CONTACT PERSON
APPLICANT Hose bib 16.60
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
Sink/basin /lavatory 16.60
Phone:( ) I Fax::( )
Tub /shower /shower pan 16.60
E -mail:
Urinal 16.60
CONTRACTOR Water closet 16.60
�
Business nam/ Water heater 16.60
�I . v � udJS v u� - VJ l ��
Address: 2_, ai !r - 5 (--\- q 0-Gt \2 s Da--. Other:
City /State /Z Subtotal
� A � � �� O �' Minimum permit fee: $72.50 2 , -
Phone:. •; ) Zj5 (- (p (Q Fax: ( ) Residential backflow minimum permit fee: $36.25
CCB Lic: '(0 ( 9 1� g i f (� Plumbing Lic. no.: Plan review (25% of permit fee) er
State surcharge (12% of permit fee) g • 3
- Author' • . i • tune: TOTAL PERMIT FEE 40 , Se
' ,, t Print name: t wt net 1 rt.., 1Mto+�l Date: 3 /3 8 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\PLM- 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) Total ,Square. Footage: • , Permit Fee:
Footing drain - l s` 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 Q 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
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: $50,001.00 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 "yes ", Plan Review for PlumbingInstallations
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 ❑ New exterior plumbing site utilities for any complex structure
as defined in OAR918- 780 -0040.
- Jacuzzi /Whirlpool
Car Wash - Each Stall ❑ Medical gas and vacuum systems for health care facilities.
Drive Stall ❑ 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
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
•
1, BUILDING DIVISION
PERMIT #: PLM2008-00081
I 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 3/3/20013
Phone: (503) 639-4171 -agfidio ,t;RN
Inspection Requests (24 Hrs.): (503) 639-4175
INSPECTION WORKSHEET FOR DATE: 316/2008 TIME: 7:00AM PAGE:
SITE ADDRESS: 12958 SW HILLSIDE TERR CLASS OF WORK:
SUBDIVISION: HILLSIDE ESTATES LOT #: 007 TYPE OF USE:
PROJECT NAME: HILLSHIRE ESTATES
DESCRIPTION: Installation of residential backflow preventer for irrigation.
OWNER: CHUCK ARNETT CUSTOM HOMES, PHONE #: 503-481-7432
CONTRACTOR: TERRA-SOL LANDSCAPING PHONE #: 503-691-6105
Inspection Request Scheduled For: Date: 3/6/2008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
399 Plumbing final 06621101 503-691-6105
Corrections/Comments/Instructions:
, 4- A k R2 ..
LA
cAft
•
54 PASS fl PARTIAL APPROVAL fl CANCEL I I NO ACCESS
FAIL El CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED
Inspector: 061/1/-A---f Date: 3 L 03 Phone #: (503) 718- •
. •,. , •.. • .