Permit OF CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT PERMIT #: PLM2007 -00094
TIGARD 13125 SW Hall Blvd., Tigard, OR - 97223 - 503.639.4171 DATE ISSUED: 3/6/2007
PARCEL: 25111 AD -18800
SITE ADDRESS: 14911 SW JONAGOLD TERR ZONING: R -4.5
SUBDIVISION: LADY APPLE LOT: 012 JURISDICTION: TIG
PROJECT: LADY APPLE
Project Description: Backflow preventer for irrigation.
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
BEACON HOMES NW INC
12703 SW 67TH AVE Description Date Amount
TIGARD, OR 97223 [PLUMB] Permit Fee 3/6/2007 $36.25
[TAX] 8% State Surcha 3/6/2007 $2.90
Phone : 503 -570 -8828 Total $39.15
Contractor:
CONTOUR LANDSCAPING INC
12485 SW TOOZE RD
SHERWOOD, OR 97140 REQUIRED ITEMS AND REPORTS
Contact # : PRI 503- 682 -1302
FAX na
Reg #: LIC 5698
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 By: - / Permittee Signature: W1 4 AO
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.
j ,
:'Plumbing Permit Application FOR o,
DateBy l FIC1 USE oi\I ,
City of Tigard Received,
lig `f ��� '� ,3 ' `J Permit No:: ���`' ���"�' y / 7 /'4 f � 9Y
n 13125 SW Hall Blvd., Tigard, OR_97223._ J �f
Ill Phone: 503.639.4171 Fax: 503.598.196 AR O 6 20 07 nateBweW
Date/By. Other Permit No.:
Inspection Line: 503.639.4175
Ti G A ti D Ready/By: Juris. ® See Page 2 for
Internet: www. or.gov c ry OF' I�7AFl u Notified/Method:
/ �ry y{ fiy'yt{�{ }i54�. Supplemental Information
„
8;, ., i. " -' Y , .' � " ,; a t 'DINOLI 11 _ .a ` gY+ ' b,ti ". r,!•yr .:
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° •N.,, '•r ;_ ' . .TYEE' :VVORKBUI _ ::k t�; : ,:a r : .: , �:f ., = FEE SCHEDULE s r ' x
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ew construction ❑ Demolition For special information use checklist.
Description I Qty. I Ea. 1 Total
❑ Addition /alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
i. ` O CON "_= ` tw: a.
a`,,t:ti . : °ii ,� :�� ''",CATEGORY" F .MRc)I.ON;;4 .' , r:. t
+. �; �,,��t.Y. „.�« �.� ... ;, ��- ���, �. �m:u.....�„�,.m2�:: �,,... A ��;,?�� �i�"r«���w',n�� SFR (l) bath 24920
land 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
°i Sy: 'l: EY; 5 •l .. - _ ;� _ - �,. - . -_.. ,� ...-:,_•� �,>
„, s p ° , v` -- ", JOB A S ITE',NFORIATIOIV; AND LOATIQIV` ,, • "gy' "�' , s,4 .- r
m � I � . . .�». , ..,�_. w; �F. ; � Site utilities
Job site address: I ,jCI I I iJ jOvtin (AI) � �� Catch basin or area drain 16.60
City / State/ZIP: I I . ✓0irl-. Drywell, leach line, or trench drain 16.60
� Footing drain (no. linear ft.: ) Page 2
Suite/bldg./apt. no.: I Project name: / ���U ∎ i
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 :/ go. Water service (no. linear ft.: ) Page 2
Tax map/parcel no.:
Fixture or item
Y« . q,. a r .,,. ,- A bsorption valve 16.60
„4,'i'$ s ,f ' ,. : i '1 D ES CR I PTI 1V ' . ' ;� . t,, 4 ' • v� Back flow preventer Page 2
s��LZAA it °/ W • � Backwater valve 16.60
v Clothes washer 16.60
Dishwasher 16.60
�.r�i�W ,, .. �` > #_' °�;'�i�" �,,r ,c•�:: 4 § -, ,,, . :. «�,.�. „(.r•:��, Drinking fountain
16.60
" ®j4ibPERTI' OWNER 1ti,: ,1-: „_ 4 V i D .TENANT, / 1 t =e .
h ^ri t,.� ? .--N .iu � ... . ,,hr,exi u,• _ n• „�f w' ., '7i -n_ ..w., J eta. . .,, v -h, .� � . �»:`.)n'b,�
Name: �^_ ' I Ejectors/sump 16.60
,1 I I v v hey �v W Expansion tank 16.60
Address: Ia' 7 O 3 . S (A) 6 '7 Ave Fixture/sewer cap 16.60
City /State /ZIP: ') 6 k4i Q.(L Floor drain/floor sink/hub 16.60
Phone: (- 5 D 6',s, Fax: ( ) Garbage disposal 16.60
` .M .p" ; $_' : ;, ., : - c e •*. .. S `.H . .. .. k ,ir 5. ..., r:• r. .lie," Hose bib 1
'''.� +' .3i ®` APPLIC : „,- !' ® ; 5 6.60
.+;�'�L ;� ..:� ` ,... - A�`.'. ,_., ,.F;:`' „1,12,,,:.] ;.�, ,. ° � CON1' . ACT,.PERSON`:: =<<
Ice maker 16.60
Business name: G B-yt,15t .N L. j ,, 56 itep vv t J
\J Interceptor /grease trap 16.60
Contact name: i� ? 5 Sw 7b0 �_ AD Medical gas (value: $ ) Page 2
Address: 1i 4 (,0 , 02 9 i tyc Primer 16.60
City /State/ZIP: 4 60-),ky1001,\-) Roof drain (commercial) 16.60
Sink/basin/lavatory 16.60
Phone: ("';) . - t 3 C2 2 Fax:: ( )
Tub /shower/shower pan 16.60
E -mail:
;., ,,,,., .. ;y �#, ,c,,,,,,,'...%,, Urinal 16.60
: : , ',.. -,'' {,. ,_ , n;� C ONTRACTOR ", ; v i. , ' ' 1. , .
, 'C, .,
s,i t= . . .. Water closet ' 1
16.60
Business name: CO) JTo u R LA1D,Sc,1 J Water heater 16.60
Address: f a g .5 w T� - E.. Other:
d Subtotal
City /State/ZIP: I OR '1 1 c� u
a / Minimum permit fee: $72.50
Phone:
() g , - 13 Q >- Fax: ( ) S p -. Residential backflow minimum permit fee: $36.25
CCB Lic.: ` C) , Gi
Authorized signature: y\ Plumbing Lic. no.: Plan review (25% of permit fee)
l ( , fit' ng G p3 State surcharge (8% of permit fee)
TOTAL PERMIT FEE
Print name: P � L j - i, 60 Jyt-) Date: e ( ) 3. 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 06/26/06 40- 4616T(I0/02/COM/WEB)
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
� ;. � � 'z �
.S1te hhtI s as k Q ty #Fee (ea) Total; I '# i
� . n h � . m., 1;P:�
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 "� , �
Storm & Rain Drain - 1st 100' 55.00 H itit ahon „� 43
$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
r K ° °�x' r r � r'Total " additional $100.00 or fraction thereof to and
UtUte,. , oritem M: , ° a Qb't rFee (eaj ° 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 Back flow 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: $50,001.00 and up $742.00 for the first $50,000.00 and $1.20 for
each additional $100.00 or fraction thereof.
•
Fixture Work: >;
�;_ ��'YP1an�Revieviw -�, for ; Plumbing:Installat_ons;,��,, • . t
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
greater, except systems designed and stamped by licensed
, ure - ,'Quantify by (Fixfdre) Wo�li�P,erformed::li
FutT ; q , c $, °. f Py ' =a' T t. >M`` " -'o, 's12C c e2° engineer.
'y P y
Nevi c ppea = nueed x Ei i;l ❑ 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
.:
Drinking Fountain
-Domestic *."VP
Drinking O;t Da Idffi` ? '� � 4
Eye Wash • ❑ - Isometric or riser diagram is required for new buildings
Floor Drain /sink - 2" that meet the qualifications above.
-3"
-4"
Car Wash Drain Comments regarding fixture work:
Garbage - Domestic
Disposal - Commercial
- Industrial
Ice Mach./Refrig. Drains
Oil Separator (Gas Station)
Rec. Vehicle Dump Station
Shower -Gang
- Stall *Note: If the fixture work under this permit results in an
Sink - Bar/Lavatory increase of sewer EDUs, a sewer permit will be issued and
- Bradley fees assessed for the sewer increase must be paid before the
- Commercial
Service plumbing permit can be issued.
Swimming Pool Filter
Washer - Clothes
Water Extractor
Water Closet - Toilet
Urinal -
Other Fixtures:
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