Permit ii I � `CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT P ERMIT #: PLM2007 -00483
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 10/29/2007
PARCEL: 25111 DA -04500
SITE ADDRESS: 08752 SW LODI LN ZONING: R -7
SUBDIVISION: APPLEWOOD PARK NO. 2 LOT: 040 JURISDICTION: TIG
PROJECT: HEYDEN
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
HEYDEN, DEREK A + SHANA M
8752 SW LODI LN Description Date Amount
TIGARD, OR 97224 [PLUMB] Permit Fee 10/29/2007 $36.25
[TAX] 8% State Surcha 10/29/2007 $2.90
Phone : 503- 684 -5089 Total $39.15
Contractor:
EXSTREAM LANDSCAPING
11030 SE 92ND CT.
HAPPY VALLEY, OR 64086 REQUIRED ITEMS AND REPORTS
Contact # : PRI 503- 654 -1953
Reg #: PLM 7094
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: ` ` A ` (AO � Permittee Signature: 6*
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.
Plumbing Permit Application
Building Fixtures RECEVED r,. . ' , : FOR OFFICE USE ONLY
Received
City Of Tigard Permit No p
a 13125 SW Hall Blvd., Tigard, OR 97223 ' "'' ./1 tl l Datc /By:�O e l 0? � l ? , 1 - U 7 X5
7 Plan Revie
Ph one: 503 .639.4171 Fax: 503.598 1 0 Other Permit No.:
Date/By:
T IG A FZD Inspection Line: 503.639.4175 Gil Y UI' 11(alD Date Ready/By: 1 See Pa 2 for
Internet: www.tigard -or. g ov
•
o BUILDINGDMI ®N Notified /Method' Suppleme ntal Informatioo
TYPE OF WORK FEE* SCHEDULE
❑ New construction ❑Demolition For special information use checklist
Description Qty. Ea. Total
V] Addition/alteration /replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
- CATEGORY OF CONSTRUCTION . SFR (1) bath 249.20
E'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:
Fire sprinkler ( sq. ft.) Page 2
. JOB, SITE INFORMATION AND LOCATION , . - Site utilities
Job site address: 2)6. S t„) Oar k. Catch basin or area drain 16.60
City /State /ZIP: 1 i gar a. , o q 4 Drywell, leach line, or trench drain 16.60
Suite /bldg. /apt. no.: � Project name: Footing drain (no. linear ft.: ) Page 2
Cross street/directions to job site: +4 i ( 6 i ve 4 sarr her Manufactured home utilities 110.00
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
B r I:CI i 4 ) Backwater valve 16.60
•
Clothes washer 16.60
Dishwasher 16.60
❑ PROPERTY OWNER ❑ TENANT Drinking fountain 16.60
Ejectors /sump 16.60
Name: pert K C V 41,41101 V e ydeii Expansion tank 16.60
Address: , j, $,.L L r Ni A . Fixture /sewer cap 16.60
City /State /ZIP: Tl'wol o R 97 n/ �/'`� Floor drain /floor sink/hub 16.60
Phone: (503 d 39 So 84 Fax: ( ) Garbage disposal 16.60
❑ APPLICANT ❑ CONTACT' PERSON Hose bib 16.60
Ice maker 16.60
Business name: E X7TC4 eel ) 4SC4P4Cf Interceptor /grease trap 16.60
Contact name: r
a� �a,S7Y Medical gas (value: $ ) Page 2
Address: \ \ 03 0 5 f r U d, a 4 Primer 16.60
City /State /ZIP: .u' I h lie 970g.6 Roof drain (commercial) 16.60
Phone: ( ) a±. ' lo L -- Fax: : ( )
Sink/basin/lavatory 16.60
Tub /shower /shower pan 16.60
E -mail:
Urinal 16.60
CONTRACTOR Water closet 16.60
Business name: Z X STfetak 1aAa &P1n� l 1 . i Water heater 16.60
iI 1 Other:
Address: I A � 1 ill _
�-� �� / At/ Subtotal
I Mi nimum permit fee: $72.50
Phone: ( ) Fax: ( b ` -; Residential backflow minimum permit fee. $36.25
CCB Lic.: I Lb'66 Plumbing Lic. no.: - 70414 Plan review (25% of permit fee)
Authorized signature: ,
a /J r �� • State surcharge (8% of permit fee)
/ /� 1 TOTAL PERMIT FEE 4. /5
Print name: Date: This permit application expires if a permit is not obtained within
q.� n G ~ rn ru � � "S �� � ` '��_ v r ,cam p 180 days after it has been accepted as complete.
*Fee methodology set by Tri- County Building Industry Service Board.
I: \Building \Permits\PLMF- PermnApp doc 12/27/06 440- 4616T(10 /02 /COM /WEB)
Plumbing Permit Aprlication - City of Tigard r
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site Utilities Qty. . Fee (ea) Total Square,;Footage; Permit Fee:
Footing drain - I'' 100' 55.00 (1to 2,000 • z *;. $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
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
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: Plan Review for Plumbing Installations.
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
Quantity by (Fixture) Work Performed greater, except systems designed and stamped by licensed
Fixture Type Replace engineer.
Previous Capped Added Existing ❑ 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
- Domestic
Drinking Fountain Isometric or Riser Diagram
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
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
- Bradley *Note: If the fixture work under this permit results in an
- 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 TIGARD
BUILDING DIVISION PERMIT #: PLM 007- 004f33
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 10/2912007
Phone: (503) 639- 4171vMd' ���i�J "'ifI
Inspection Requests (24 Hrs.): (503) 639 -4175 ..W {__..
INSPECTION WORKSHEET FOR DATE: /1/712007 TIME: 7 :0QAM PAGE: 34
SITE ADDRESS: 08752 SW LODI LN CLASS OF WORK:
SUBDIVISION: APPLEWOOD PARK NO. 2 LOT #: 040 TYPE OF USE:
PROJECT NAME: HEYDEN
DESCRIPTION: Batkflow preventer for irrigation.
OWNER: HEYDEN, DEREK A + SI-9lANA M, PHONE #: 503 - 6834 -5083
CONTRACTOR: EXSTREAM LANDSCAPING PHONE #: 503- 654 -1953
Inspection Request Scheduled For: Date: 1117/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
335 Misc. inspection„ 059165 -01 503.522 -3174
&c k f l ow 1 l'/61 .
Corrections/Comments/Instructions:
Ni PASS ❑ PARTIAL APPROVAL ❑ CANCEL n NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: 'f`�`-� i 1 Date: ) h )0 Phone #: (503) 718-