Permit C ITY OF TIGARD PLUMBING PERMIT
' ,, l DEVELOPMENT SERVICES PERMIT #: PLM2005 -00121
E��l 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 3/23/2005
PARCEL: 2S 109 BA -09000
SITE ADDRESS: 13743 SW LEAH TERR ZONING: R -7
SUBDIVISION: DAFFODIL HILL LOT: 016 JURISDICTION: TIG
Project Description: Installation of residential backflow prevention device 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
GOODLET /MARSHALL BLDG & DEV. CO. Description Date Amount
PO BOX 91551
PORTLAND, OR 97219 [PLUMB] Permit Fee 3/23/2005 $36.25
[TAX] 8% State Surcharl 3/23/2005 $2.90
Phone : 503 297 - 1881 Total $39.15
Contractor:
CATANDELLA IRRIGATION +
BACKFLOW REQUIRED ITEMS AND REPORTS
5334 SE DEL RIO CT
HILLSBORO, OR 97123
Phone : 356 - 8022
Reg #: PLM 7022
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 0. : • low rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-P 001-0010 thro► •h O R 952 - 0001 -0100. You may obtain copies of these rules or direct questions to OUNC by
caling 503- 246 - 6699 • -811- , ' -2344. 4
Iss L ed By: /1 _/_ __ i . /' Permittee Signature:
II 0 - 639 -4175 by 7:00 a.m. for an inspection th.t • usiness da
Ca 5 3 y day.
p y
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
Plumbing Permit Application FOR'.OFFICE USE ONLY 3..,
City of Tigard Received 1� ! p ermit No. , � /
13125 SW Hall Blvd., Tigard, OR 97223 flan Re : / NOM j� ..411.. �/ l
Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 4,,vahuit p : N lit Date/B Y Other Permit No.:
24- Hour Inspection Line: 503.639.4175 � I Date Ready /By: Juris• El See Page 2 for
Internet: www.ci.tigard.or.us
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Notified/Method: men Information
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New construction ❑ Demolition For special information use checklist.
Description Qty. Ea. I Total
❑ Addition/alteration/replacement ❑ Other: New 1-2-family dwellings (includes 100 ft. for each utility connection)
`.4 {.ga - _ <;;y.� . ``'�.�'�`.;'. :p,�,..�. }e,,�,;� t.u�r�az: • +r„ Y.-.,�;,Yn :ss „�,n�,;r- «�s;�, -
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'i . . '- „ C GORY OF OI ST ,,
_RUCT N °,.-� �,. ^ ,: , � � _ 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
❑ Master builder ❑ Other:
;:m.'° r =_ as . s- g. : -> .,. Fire sprinkler ( sq. ft.) Page 2
' - .4:' i JOB i O RMr irlA i1ND 1 GM ' 0 y . ;tN . , ' Site utilities
_. �s .'w � .,�. ?''., ?,�. ,�,�^s �. �C�_ ,� <:��. �s�t_�.� .,:ma��:� .,'�`'� ,.
Job site address: t S - 3 Li 3 1 Q. a_ 4, - 7 - p - r Catch basin or area drain 16.60
City/State /ZIP: ;; l ,,, O,J_ Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: I- Project name: 1 u i l Footing drain (no. linear ft.: ) Page 2
� ° ' Manufactured home utilities 110.00
Cross street/directions to job site:
Manholes 16.60
`�,, _ +
�+ lra.^-�ec ABS. d- I�K_.0..ke Q 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
Tax map /parcel no.: Fixture or item
. :e -
Abso lion valve 16.60
-, W �, 4 bESGaireN OF 1,
ar 4., - ,nom„ s.. e.:. �: ,r 1 , , ..:e . ., . , .. ek 1 . 1 _4& Backflow preventer Page 2
1r r ; C /a.�;, r)J\ 'G..G(Z.�` 0- Backwater valve 16.60
Clothes washer . 16.60
Dishwasher 16.60
x =` �� :- �� t Drinking fountain 16.60
t P ROPERTl OV(�NER. .4` . n . �T NANTI , -,,,
,,..,,��- . ,�: E d , x.,> Electors /sump 16.60
Name:
Expansion tank 16.60
Address: Fixture /sewer cap 16.60
City/State /ZIP: Floor drain/floor sink/hub 16.60
Phone: (_ ) Fax: ( ) Garbage disposal 16.60
f _.: ; ; «x..* - : ,:x < m' ' e 1. "-",: ,,''. xE Hose bib 16.60
1 at not r p T- .. F,s R . , ON SON
�` Ice maker 16.60
Business name: e� •--- . . - IS C N 1 14: o� a � 4. (k nth Interceptor /grease trap 16.60
Contact name: -T'��n lc^,- n Lp l e� T Medical gas (value: $ ) Page 2
Address: s Primer 16.60
City/State/ZIP: Roof drain (commercial) 16.60
Phone: ( ) f Fax: : ( ) Sink/basin /lavatory 16.60
Tub /shower /shower pan 16.60
E -mail:
Y; �r ` v ' u . . W -. ".�, - :`.< „; :c ,� z. , =r ..' s .: ., v.,s ., Urinal 1 6.60
r, a :��s: it. >,. C O Nr '[ Ri�C ¢ OR ° z - , r ,
`ir ; ,�;� : +;'�*� .� ,. ra�.,�- � �� ..N# �: su,a ,' <r��:��° . s: �"�'��°' Water closet • 16.60
Business name: �. (c.,_, �vt" , k�( O Water heater 16.60
Address: 5 S 6 D �, o C't Other:
City/State /ZIP: ,` k \,.) o r e D(�, R T l 23 Subtotal
Minimum permit fee: $72.50
Phone: (5 0)3 - ��? -3 c' S Z Fax: ( ) Residential backflow minimum permit fee: $36.25 46.. a
- CCB-tic.: - - � �� & - - Plumbing Lic. no.: -` `` `-
- - -Plan-review-(-25%-of-permit-fee)- - --
Authorized signature: ��� / r ` ( �T State surcharge (8% of permit fee) a. C / O
i r✓ C ✓ cam- ` ` v TOTAL PERMIT FEE g, / s
Print name: VL4.- c - • Date: 'I 4W 3 s' This permit application expires if a permit is not obtained within - 180 days after it has been accepted as complete.
O *Fee methodology set by Tri -County Building Industry Service Board.
i:\Building\Pernu \PLMF- PermitApp.doc 12/03 440- 4616T(10 /02 /COM/WEB)
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
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11�G tllltleS � . '` ," ``` Qf Y e:� � " t : s Sqz ,
S oars ±oota a . Pfiermt
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
aluathon 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
Y'. extra r ` a " ' Q£y ee ( ) Totals ? additional
$1 000 0r fraction thereof, to and
including
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
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:
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 "(Fixtur
F,xt Type g nA 0140
i apps 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"
-3"
-4"
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
Ice Mach. /Refrig. Drains
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 Isometric or riser diagram is required if fixture quantity
- Commercial total is >9.
- Service 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:
is \ Building \Permits\PLM- PetmitApp.doc 3/03