Permit CITY OF1IGARD PLUMBING PERMIT
DEVELOPMEN SERVICES PERMIT #: PLM2005 -00541
�.I DATE ISSUED: 10/14/2005
W 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171
, PARCEL: 2S112CB-09900
SITE ADDRESS: 15312 SW KENTON DR ZONING: R -7
SUBDIVISION: ASHFORD OAKS NO. 2 LOT: 113 JURISDICTION: TIG
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
MARGARET VIKE Description Date Amount
15312 SW KENTON DR
TIGARD, OR 97224 [PLUMB] Permit Fee 10/14/200E $36.25
[TAX] 8% State Surcharl 10/14/200E $2.90
Phone : 503 372 - 5054 Total $39.15
Contractor:
OWNER
REQUIRED ITEMS AND REPORTS
Phone:
Reg #:
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 : - forth in OAR
952 - 0001 -0010 through OAR 952 - 0001 -0100. You may obtain copies of these rules or • ireci que-tions to 0 by
calling 503 - 246 -6699 or 1- 800 - 332 -2344. —
/ -
Issued By: r Permittee Signatur•
Call 503 - 639 -4175 by 7:00 a.m. for an inspection that business d. 4 .
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.
Building Fixtures
k.. tifiED Plumbing Permit A� . FOR OFFICE Use ONLY .
ard.or.us
City of Tigard
.. �� �oo" Received /: U 4,...,01.--
13125 SW Hall Blvd., Tigard, OR 97223 O 4 y /3.1./...._, 7 PermitNo.:� I 1a) )
Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 � /�m _ ,k•, ; j W �.H D Other Permit No.:
D ateBy.
24- Hour Inspection Line: 503.639.4175 F TIGAR'' . ii • L r� ri s :
Internet: www.ci.ti CITY O �- Date Ready/By: / ®See Page 2 for
g nn/ISi i Notified/Method: 7 / V Supplemental Information
�lUII Dl(�G
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 dwellings (includes 100 ft. for each utility connection)
,i CATEGORY OF' CONSTRUCTION SFR (1) bath 249.20
1 -and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 350.00
olo 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 3 1.2_ S W kul,vv >n Y Catch basin or area drain . 16.60
City /State /ZIP: p , 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
Y ' ) Y�� )( ( j, /\ Rain drain connector 16.60
111 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
DESCRIPTION OF WORK C , , ^ Backflow preventer Page 2
f Q S i C o-Q v L
J� r] �h� iei1/y-\ (_�- Backwater valve 16.60
-1/4" C & A.rYl U Clothes washer 16.60
Dishwasher 16.60
Drinking fountain 16.60
PROPERTY OWNER - f ' . ❑ TENANT. Ejectors/sump 16.60
Name: �(, ,, Ci K N3 - ` �6S A � v \ � Expansion tank 16.60
Address: 1 S C + J 1 W i �--- ` r— Fixture /sewer cap 16.60
�-� "_��
City /State /ZIP: d 1 Floor drain /floor sink/hub 16.60
Phone: / 5) 3 -l'L S—u Fax: () (cc 20 CI if Garbage disposal 16.60
7 Hose bib 16.60
C ;APPLICANT " ❑ CONTACT PERSON '
Ice maker 16.60
Business name:
Medical gas (value: trap Page 2
Contact name: Medical gas (valulu e: $ ) Pa e 2
r g
Address: Primer 16.60
City /State /ZIP: Roof drain (commercial) 16.60
Phone: ( ) Fax:: ( ) 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: ( ) Fax: ( ) Residential backflow minimum permit fee: $36:25
CCB Lic.:___ __ Plumb' .Lic..no.• .. ___ Plan review (25% of permit fee)
Authorized signatu State surcharge (8% of permit fee)
TOTAL PERMIT FEE
Print name: V I c 4 J Q3 - \r4,, Date:, (0 I ri This 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.
is \Building\Pennits \PLMF- PermitApp.doc 06/05 440-4616T(t0 /02/COM/WEB)
Ay
Plumbing Permit Application - City of Tigard
S.
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 $1 15.00 i
0 ' 0
3,600 $1
3
2,001 to , $160.00 "
Footing drain - each additional 100' 46.40 2, /
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 - e. . additional 100' 46.40
Storm & Rain Drain - Is 00' 55.00 Valuation: ' . ' Permi Fee: . -
$1.00 to $5,000.00 Minirtdm fee $72.50
Storm & Rain Drain - each a ' ' ' ' onal 100' 46.40 $5,001.00 to $10,000.00 $72 0 for the first $5,000.00 and $1.52 for each
Fixture or Item- Qty. Fee (ea) Total a' iitional $100.00 or fraction thereof to and
ncluding $10,000.00.
Commercial Back Flow Prevention Devi , 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: $50,001.00 and o $742.00 for the first $50,000.00 and $1.20 for
each additional $100.00 or fraction thereof.
Fixture Work: P lan Review for Comp Structures
Are you capping, adding or replacing fixtures? If "yes ", • "complex structure" is defined as an installation of a plumbing
please indicate work performed by fixture. Failure to - stem that meets any of the following criteria
accurately report fixtures could result in increased sewer fees *. Ple..•e check all that apply.
Quantity by (Fixture) Work Performed ❑ A' new commercial building .
El Type: Replace Any ' -w exterior plumbing site utilities.
Previous Capped Added Existing ❑ A corn • cial building with installation, alteration or addition
Baptistry/Font of nine (9) : more new or relocated plumbing fixtures.
Bath - Tub /Shower ❑ Medical gas . -A vacuum systems for health care facilities
- Jacuzzi/Whirlpool providing servic- to human beings.
Car Wash - Each Stall ❑ Plumbing installatio , alterations or additions to food service
- Drive Thru facilities where new p • • bing fixtures, including interceptors,
Cuspidor/Water Aspirator are being installed for the • i • service area.
Dishwasher - Commercial ❑ Any new residential buildin • .ntaining three (3) or more
- Domestic dwelling units. ` _
Drinking Fountain
Eye Wash ❑ Any NFPA 13 - D multipurpose fir prinkler system.
Floor Drain /sink 2" Submit 2 sets of plans with any t the above.
-3"
4" ,
Car Wash Drain Isometric or Riser D
Garbage - Domestic ❑ Isometric or riser diagram is required for ne . buildings
Disposal - Commercial three (3) or more stories in height.
- Industrial
Ice Mach./Refrig. Drains
Oil Separator (Gas Station) Comments regarding fixture work:
Rec. Vehicle Dump Station
Shower -Gang
-Stall
Sink - Bar /Lavatory
- Bradley
- Commercial
- Service
Swimming Pool Filter
Washer - Clothes *Note: If the fixture work under this permit results in an
Water Extractor
Water Closet - Toilet increase of sewer EDUs, a sewer permit will be issued and
Urinal fees assessed for the sewer increase must be paid before the
Other Fixtures: - plumbing permit can be issued.
i:\ Building \Permits\PLM- PermitApp.doc 07/06/05
CITY OF TIGARD
BUILDING DIVISION
- 1, PERMIT #: PLM2006.00541
13125 SW Hall Blvd., Tigard, OR 97223 ) . DATE ISSUED: 10/14/2005
Ad 0
Phone: (503) 639-4171 \
J .
irellill!i 1 I
Inspection Requests (24 Hrs.): (503) 639-4175 ....10■ -......
INSPECTION WORKSHEET FOR DATE: TIME: PAGE: 57
SITE ADDRESS: 15312 SW KENTON DR CLASS OF WORK:
SUBDIVISION: ASHFORD OAKS NO. 2 LOT #: 113 TYPE OF USE:
PROJECT NAME: '
DESCRIPTION: Barkflow preventer for irrigation.
OWNER: VIKE, MARGARET PHONE #: 503-372-5054
CONTRACTOR: VIRWARGARET PHONE #:
Inspection Request Scheduled For: Date: 10/31/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
325 RP/backflow preventer 019826-01 503-730-8990 N
Corrections /Comments/ Instructions:
I ONB
I BMINFAIMIlie ri (A
W
47
i
PARTIAL APPROVAL
7_ CANCEL _ _ _ _ __ _ 7 _NO_ACCESS
FAIL 7 CALL FOR INSPECTION 0 ADDITIONAL FEES ASSESSED
Inspector: i h ( l 4 Date: b. bli Phone #: (503) 718-
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