Permit 111 CITY OF
I TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT PERMIT #: PLM2008 -00075
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 2/27/2008
PARCEL: 25111 DA -01600
SITE ADDRESS: 08670 SW LODI LN ZONING: R -7
SUBDIVISION: APPLEWOOD PARK NO. 1 LOT: 012 JURISDICTION: TIG
PROJECT: LEE
Project Description: Installation of residential backflow preventor for irrigation.
CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: COM 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
JACK LEE
8670 SW LODI LN Description Date Amount
TIGARD, OR 97224 [PLUMB] Permit Fee 2/27/2008 $36.25
[TAX] 12% State Surch 2/27/2008 $4.35
Phone : 503- 968 -1188 Total $40.60
Contractor:
NATURAL LANDSCAPING
5606 SW CARMAN DR
LAKE OSWEGO, OR 97035 REQUIRED ITEMS AND REPORTS
Contact # : PRI 503- 675 -0471
Reg #: LIC 7031
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 •' : estions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued B • 4 Permittee Signature: ) /
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.
f
^k-luanbing Permit Application
FOR OFFICE USE ONLY
City of Tigard Received . 7 O Permit No.: r, �/itJ� / 5
Iii (`/ �
q 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review Date/By:
Phone: 503 639.4171 Fax: 503.598.196 Date /By: Other Permit No.:
T 1 G A RD Inspection Line: 503.639.4175 Date Ready /By ® See Page 2 for
Internet: www.tigard - or.gov Notified/Method: t La Supplemental Information • TYPE OF WORK . . FEE* SCHEDULE.
•
❑ New construction ❑ Demolition For special information use checklist.
Description Qty. Ea. Total
❑ Addition /alteration/replacement a Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION - SFR (1) bath 249.20
❑ 1- and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 350.00
El Accessory building ❑ Multi- family SFR (3) bath 399.00
Each additional bath/kitchen 45.00
❑ Master builder ❑ Other:
Fire sprinkler ( sq. ft.) Page 2
- JOB SITE INFORMATION AND LOCATION - Site utilities
Job site address: i ( b� p , 6/ Catch basin or area drain 16.60
City /State /ZIP: itit 6 / � q 72z_ (-1 Drywell, leach line, or trench drain 16.60
Suite/bldg./apt. no.: Project name: � ' _ ,, l Footing drain (no. linear ft.: _ ) Page 2
s ���r"� / ` � �'�`° Manufactured home utilities 110.00
Cross street/directions to job site: M I .r -; Lac 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
DESCRIPTION OF WORK - Backflow preventer Page 2
w x,11- L g-_/,f -_ Backwater valve 16.60
j Clothes washer 16.60
Dishwasher 16.60
Drinking fountain 16.60
fin PROPERTY OWNER ❑ TENANT
Ejectors /sump 16.60
Name: � �
1+L L.CG Expansion tank 16.60
Address: g c70 cJw IA 2_,J Fixture /sewer cap 16.60
City /State /ZIP: - -1 f 0 .172-2-(1 Floor drain /floor sink/hub 16.60
Phone: ( q ( ( �S v Fax: ( )
Garbage disposal 16.60
Hose bib 16.60
❑ APPLICANT -p CONTACT. PERSON
Ice maker 16.60
Business name: LIA Li/2. /it-. l- ftiv0 7j v , - ) 4 ---- Interceptor /grease trap 16.60
Contact name: 67 ,, 10 - 1 ..., 4 . /\ f Medical gas (value: $ ) Page 2
Address: c-60 6 c,„_, c� A D I- Primer 16.60
l 'I , C/
City /State /ZIP: „ /�" q ) t Roof drain (commercial) 16.60
-c c7S
° L�EG o
Phone:) - - ').S - v y / Fax:: ( ) Sink /basin/lavatory 16.60
. Tub /shower /shower pan 16.60
E -mail:
Urinal 16.60
C ONTRACTOR " Water closet 16.60
Business name: Water heater 16.60
Address: Other:
*5't a Subtotal
City /State /ZIP: .
Minimum permit fee: $72.50
Phone: ( ) Fax: ( ) Residential backflow minimum permit fee: $36.25
CCB Lic.: / ✓ 3 ! 9/7g709 Plumbing Lic. no.: Plan review (25% of permit fee) '
/ State surcharge (12% of permit fee) ,t 3
Authorized signature: �� TOTAL PERMIT FEE d , 60
Print name: CU 6 )G /��
�o, j_. r:t - Date: . /z /vg This permit application expires if a permit is not obtaine within .
d' 180 days after it has been accepted as complete.
*Fee methodology set by Tri- County Building Industry Service Board.
1:\Building\Permits\PLM- PermitApp.doc 12/27/06 440- 4616TO0 /02 /COM/WEB)
Plumbing Permit Application - City of Tigard
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: $50,001.00 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, adding or replacing fixtures? If "yes ", Plan Reviewfor Plumbing Installations
please indicate work performed by fixture. Failure to Plan review is required for any of the following.
accurately report fixtures could result in increased sewer fees * . Please check all that apply.
Quantity by (Fixture) Work Performed ❑ Any new commercial building with water service 2" and
• Fixture.Type: Replace greater, except systems designed and stamped by licensed
. • Previous Capped Added • Existing engineer.
Baptistry/Font
Bath Tub /Shower ❑ New exterior plumbing site utilities for any complex structure
Jacuzzi/Whirlpool as defined in OAR918- 780 -0040.
Car Wash Each Stall ❑ Medical gas and vacuum systems for health care facilities.
Drive tall CI Any multipurpose fire sprinkler system.
Cuspidor/Water Aspirator ❑ Any complex structure as defined in OAR918- 780 -0040.
Dishwasher - Commercial
Domestic Submit 2 sets of plans with any of the above.
Drinking Fountain
Eye Wash ,Isometric, or Riser Diagram
Floor Drain/sink - 2" ❑ Isometric or riser diagram is required for new buildings
that meet the qualifications above.
- 4"
Car Wash Drain
Garbage - Domestic Comments regarding fixture work:
Disposal - Commercial
- Industrial
Ice Mach. /Refrig. Drains •
Oil Separator (Gas Station)
Rec. Vehicle Dump Station
Shower -Gang
-Stall
Sink -Bar/Lavatory *Note: If the'fixture work under this permit results in an
- Bradley un p
• - Commercial increase of sewer EDUs, a sewer permit will be issued and
- Service fees assessed for the sewer increase must be paid before the
Swimming Pool Filter plumbing permit can be issued.
Washer - Clothes
Water Extractor
Water Closet - Toilet
Urinal
- Other Fixtures:
i:\ Building \Permits\PLM- PermitApp.doc 12/27/06
CITY OF TIGARC-
BUILDING DIVISION PERMIT #: RA42008 -00075
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 2/27/2008
Phone: (503) 639 -4171 M
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 5/2/2008 TIME: 7:00AM PAGE: 21
SITE ADDRESS: 00070 SW LODI LN CLASS OF WORK:
SUBDIVISION: APPLEWOOD PARK NO. 1 LOT #: 012 TYPE OF USE:
PROJECT NAME: LEE
DESCRIPTION: Installation of residential baclflow preventor for irrigation.
OWNER: LEE, JACK PHONE #: sf33- 968•1188
CONTRACTOR: NATURAL LANDSCAPING PHONE #: 503.075.0471
Inspection Request Scheduled For: Date: 6/2/2008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
3 ,93 Plumbing final 00026 -01 603-675-0471 l 4
Corrections /Comments /Instructions:
�Q
•
'1 t e_ fig- e---t-e- \
►�� PASS n PARTIAL APPROVAL ❑ CANCEL NO ACCESS
n FAIL n CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: likivr\A.../i l \ \ va.__, Date: ,�I 71 f7 Phone #: (503) 718-
,