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Permit } CITY TIGARD PLUMBING PERMIT i7c'll�. DEVELOPMENT SERVICES DATE ISSUED: PL 2 -00002 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 SITE ADDRESS: 09346 SW HOME ST PARCEL: 2S1 11 DB 15200 SUBDIVISION: KESSLER ESTATES ZONING: R -4.5 BLOCK: LOT: 009 JURISDICTION: TIG 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 Remarks: Installation of residential backflow prevention device. FEES Owner: Description Date Amount DANA MATSAMOTO 9346 SW HOME ST [TAX] 8% State Surchan 1/4/2005 $2.90 TIGARD, OR 97224 - - - [PLUMB] Permit Fee 1/4/2005 $36.25 Total $39.15 Phone : 503 - 887 -8519 Contractor: CARRUTHERS LANDSCAPE 8124 SW 56TH AVE PORTLAND, OR 97219 -3223 REQUIRED INSPECTIONS P RP /Backflow Preventer Phone : 503 245 9478 Final Inspection Reg #: L1C 5137 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 -0 I - 1100. You may obtain copies of these rules or direct questions to OUNC by calling (503) 24i-6699. 1- sued By: ,, .0 ! `ice Permittee Signature: vv Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day Plunrbing Permit Application Foli.omcr use ONLY City of Tigard D / 4/ 6 / Permit No.: , 1 o00o x- 13125 SW Hall Blvd., Tigard, OR 97223 - Y i7 Plan Review Phone: 503.639.4171 Fax: 503.598.1960 //a�,;rr�;�1 =h Date/By. Other Permit No.: 24- Hour Inspection Line: 503.639.4175 _ �.4 Date Ready/By: El See Page 2 for Internet: www.ci.tigard.or.us Notified/Method: / fa? Supplemental Information TYPE OF WORK FEE* SCHEDULE ❑ New construction ❑ Demolition For special information use checklist Description I Qty. I Ea. I Total ❑ Addition /alteration /replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection) CATEGORY OF CONSTRUCTION SFR "(I)bath 249.20 gI- 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: I / a (.7 e \ f H n vn e, S-E ,. Catch basin or area drain 16.60 City /State/ZIP: ■ v,pr� © p Drywell, leach line, or trench drain 16.60 Suite/bldg. /apt. no.: O 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 - - - Storrn -sewer (no. linear -ft.: ) - - _Page 2 Subdivision: 5 UeA A Vt k rnA s 7 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 I Page 2 � Backwater valve 16.60 lr � z c ' i'7 VV p rem e,1 "t„,� Clothes washer . 16.60 Dishwasher 16.60 Drinking fountain 16.60 ❑ PROPERTY OWNER ❑ TENANT f I fa O � Ejectors /sump 16.60 Name: 'T N '� Expansion tank 16.60 Address: q 34 Co H owe, G f r Fixture /sewer cap 16.60 City /State/ZIP: - ,1.„),,rS, ) 0 (Z Floor drain/floor sink/hub 16.60 ( gy 4 g am/ _ q `� Garbage disposal 16.60 Phone: O / I Fax: ( ) ❑ APPLICANT ❑ CONTACT PERSON 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 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: (tot. r-r t i , t h or s 1,.,�,.� S C« P Water heater 16.60 Address: 13 I �9, !� \A./ 1 ✓j ( b 1 Other: Subtotal City /State /ZIP: ��,�.. q ,,,� op._ 172.I1- 3 > Minimum permit fee: $72.50 Phone: (3 ) 4 S J q S Fax: ( ) z"..4 S 9 ! Residential backflow minimum permit fee: $36.25 3 (o . ,LS n review (25 %ofpermit fee) CCB Lic.: (; (j � J Plumbing Lic. no.: • ! ,--54 P la x,31 /6 State surcharge (8% of permit fee) , r 0 Authorized signature: TOTAL PERMIT FEE -g 5 Print name: S-' e.a keA Ca e' r - v tamer s Date: 'J Zoo 5 This pe 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 t2/03 440- 4616T(10/07/COM/WEB) Plumbing Permit Application - City of Tigard y' _ :40r. Page 2 - Supplemental Information Fee Schedule:' Residential Fire Suppression Systems: Site Utilities. Qty. 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 specially requested inspections - per hour 72.50 and including $50,000.00. Subtotal: $50 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, moving or replacing existing fixtures? If "yes", please indicate work performed by fixture. Failure to accurately report fixtures could result in increased sewer fees * . Quantity by (Fixture) Work Performed Fixture Type: ,Replace New Moved Existing Capped 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 ti 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 Ice Mach./Refrig. Drains increase of sewer EDUs, a sewer permit will be issued and 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 Quantity Total - Bradley 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: i:\ Building \Pemtits\PLM - PermitApp.doc 3/03 CITY OF TIGARD 24 -Hour BUILDING Inspection Line: (503) 639 -4175 MST INSPECTION GiViSION Business Line: (503) 639 -4171 BUP Received / Date Requested / / 3 AM PM BUP Location 3 ` 6 Suite MEC Contact Person Ph ( ) 0 5"-- 941? PLM �S - 66D0 - Contractor Ph ( ) SWR BUILDING Tenant/Owner ELC Footing Foundation ELC Access: Ftg Drain ELR Crawl Drain Slab Inspection Notes: SIT Post & Beam Shear Anchors Ext Sheath/Shear 7,2 Int Sheath/Shear • Framing Insulation Drywall Nailing Firewall , Fire Sprinkler Fire Alarm Susp'd Ceiling Roof Other: Final PASS PART FAIL PLUMBING Post & Beam Under Slab Rough -In Water Service Sanitary Sewer Rain Drains • Catch Basin / Manhole Storm Drain • Shower Pan 4 F Other: 0 PART FAIL HANICAL Post & Beam Rough -In Gas Line Smoke Dampers Final PASS PART FAIL ELECTRICAL Service Rough -In UG/Slab Low Voltage Fire Alarm Final Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. PASS PART FAIL SITE E. Please call for reinspection RE: 0 Unable to inspect — no access Fire Supply Line G� /� ADA f ,{ Approach/Sidewalk Date ! / Inspector Ext Other: ✓ ✓✓ Final DO NOT REMOVE this inspection record from the Job site. PASS PART FAIL