Permit •
1
II
1 . �, CITY OF TIGARD
PLUMBING PERMIT
I ° COMMUNITY DEVELOPMENT PERMIT #: PLM2007 -00392
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 8/27/2007
PARCEL: 25111 CB -01713
SITE ADDRESS: 10185 SW HOODVIEW DR ZONING: R -3.5
SUBDIVISION: HOOD VIEW LOT: 012 JURISDICTION: TIG
PROJECT: BOELLING /JOHNSON
Project Description: Install backflow device. Job NO. 071397
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
KAREN /ROBE BOELLING /JOHNSON
10185 SW HOODVIEW DR. Description Date Amount
TIGARD, OR 97224 [PLUMB] Permit Fee 8/27/2007 $36.25
[TAX] 8% State Surcha 8/27/2007 $2.90
Phone : 503 -639 -7889 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 que .tions OUNC by .fling 503.246.6699 or 1.800.332.2344.
j/
IssueQ = // P Signature: ___,O., ififia(atft 0
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.
.i
�i ' i' i fir—� 07(3 l
Plumbing Permit Application a , C-1 f:',.- `
£N \ F OR OFFICE : .USE ONLI ;
City of Tigard Eie? 13125 SW Hall Bvd., Tigard, OR 97223 AlU j 20Y D 2 q- O7 SL ' Permit No. Phone: 503 639.4171 Fax 503.598.1960
P i'� Date/By: Other Permit No..
24- Hour Inspection Line: 503 639.4175 al-t -./ or ris.
•
� ' , Date Ready /By: ® See Page 2 for
Internet: www.ci.tieard.or.us pj t�;1i\11;�;- , ∎.1 , - "\li°F?. t 1 I( -`, Notified/Meth � 4,Supplement
� Supplemental Information
TYPE :OF'WORK '° Z -:- : FEE *:,SCHEDULE "
❑ New construction ❑ Demolition For special information use checklist.
Description Qty. j Ea. Total
❑ Addition/alteration/replacement 0 Other: LANDSCAPE New I - 2 - family dwellings (includes 100 ft. for each utility connection)
- `•CATEGORY ^ OF - - CON _ STRUCTION 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
❑Master builder Each additional bath/kttchen 45 00
❑ Other:
Fire sprinkler ( sq. ft.) Page 2
�` - ' :JOB S ITE INFORMATION - A N D LOC :
„ _, � "- �" - • ` . � Site utilities
Job site address: /6/15 5 iJ 00/9 U(1 t tJ VA— Catch basin or area drain 16.60
City /State /ZIP: 774i' Qk C 2- Drywell, leach line, or trench drain . ' 16.60
—
Suite/bldg. /apt. no.: Project name: 1 5 ( 01,6( /1& dO /0 sU& 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
a ,§ DESCRIPTION OF WORK "r "k''
. -.: Backflow prey enter 1 Page 2
INSTALL BACKFLOW DEVICE Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
;; µ i ,: w < , _ ', ,, Drinking fountain 16.60
, °OWNER =� ^r''' ' " ia;. _ :l TEN ANT .. ; :Q'
'� � Ejectors /sump 16.60
Name: &U-II/1 6 i /a/c --9 °E dvf t v 1 S6/1 / 3Ci/
I Expansion tank 16.60
Address: •J 'lAkt_ i> ' i Fixture /sewer cap 16 60
City /State /ZIP: Floor drain /floor sink/hub 16.60
Phone: ( ) Fax: ( ) Garbage disposal 16.60
, ._ > Hose bib 16.60
' ®. APPLICANT4 ❑CONTACT P ERSO N , .: '' „
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: Sink/basin/lavatory 16.60
( ) Fax: ( )
Tub /shower /shower pan 16.60
E -mail:
Urinal 16.60
C ONTRACTOR , ' , > r )' : Water closet 16.60
Business name: DENNIS' SEVEN DEES LANDSCAPING, INC Water heater 16.60
Address: 7355 SE JOHNSON CREEK BOULEVARD Other:
City /State /ZIP: PORTLAND, OR 97206
Subtotal
Minimum permit fee: $7250 �J
/
Phone: ( 503 ) 777 - 7777 Fax: (503 ) 777 - 2399 Residential backflow minimum permit fee. $36.25 lD•
CCB Lic.: Plan review (35 of permit fee) ----- 5009 Plumbing Lie. no.: 05LIBDI
State surcharge (8% of permit fee) 0
Authorized signature: th�y/ /r"br TOTAL PERMIT FEE L-j Print name: DEAN SNODGRASS Date: SS ( - 7 dr 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.
■' 'Building \Permits\PLM -PermitApp doc 12/03 440- 4616T(I0 /02 /COht/WEB)
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Sup • ression Systems:
Site „qty. Fee (ea) Total S Foota . : Permit Fee ._.‘
,
Footing drain - 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
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
Tiitu re:.o rite*
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 •P`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
Performed
Fixture Type Replace s',.
: New Moved 14 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"
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
.
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
-Bradle Isometric or riser diagram is required if fixture quantity
-Commercial
-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
C f ( t
CITY OF TIGARD
BUILDING DIVISION PERMIT #: PLM2007-00392
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 8/27/2007
Phone: (503) 639 -4171
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 9/14/2007 TIME: 7:00AM' �. . PAGE: 51
SITE ADDRESS: 10186 SW HOODVIEW DR CLASS OF WORK:
SUBDIVISION: HOOD VIEW LOT #: 012 TYPE OF USE:
PROJECT NAME: BOELLING /JOHNSON
DESCRIPTION: • Install backflow device. Job NO. 071397
OWNER: BOELLING/JOHNSON. KAREN /ROBERT PHONE #: 603.639 -7889
CONTRACTOR: DENNIS' 7 DEES LANDSCAPING PHONE #: 603 - 777 - 7777
Inspection Request Scheduled For: Date: 9114/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
395 Misc. inspection 055685.01 503- 777 -7777 Y
Corrections/Comments/Instructions:
PASS I I PARTIAL APPROVAL ❑ CANCEL I NO ACCESS
FAIL n CALL FOR INSPECTION I I ADDITIONAL FEES ASSESSED
Inspector: !/ 111\4,J Date: 'I j I y jn�7 Phone #: (503) 718-