Permit CI TY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT PERMIT #: PLM2008 -00120
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 3/21/2008
PARCEL: 1S135AB-03403
SITE ADDRESS: 09055 SW OAK ST ZONING: R -4.5
SUBDIVISION: ASHBROOK FARM LOT: 009 JURISDICTION: TIG
PROJECT: LYONS
Project Description: Connect existing house to storm service. Tap done under ENG2008 -00033
CLASS OF WORK: OTR GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS:
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: 100 ft
Owner:
FEES
GREG LYONS
9055 SW OAK ST Description Date Amount
TIGARD, OR 97223 [PLUMB] Permit Fee 3/21/2008 $72.50
[TAX] 12% State Surch 3/21/2008 $8.70
Phone : 503- 998 -4001 Total $81.20
Contractor:
QUALITY EXCAVATION SYSTEMS
6183 SUNNYVIEW RD
SALEM, OR 97305 REQUIRED ITEMS AND REPORTS
Contact # : PRI 503- 363 -4323
FAX 503- 363 -4421
Reg #: LIC 110860
PLM 24 -349PB
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
thes t questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Is ed By: Permiftee 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.
° Plumbing Permit Application 'It)0;,g -3
Building Fixtures FOR OFFICE USE ONLY
City of Tigard Received �y Permit o.: Avg y � ^
IIIII 13125 SW Hall Blvd., Tigard, OR 97223 DatDate/By: Ai 0 b / p i N ' /[GYRO `i��/7/
C Plan Review Other Permit No.:
Phone: 503.639.4171 Fax: 503.598.1960 Date/By:
Inspection Line: 503.639.4175
TIGARD Ready /By: Read B Y g : in Pa e 2 for
Internet: www.tigard - or.gov Notified/Method: / Supplemental Information
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- 2- family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (I) 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:
Fire sprinkler ( sq. ft.) Page 2
JOB SITE INFORMATION AND O LOCATION Site utilities
Job site address: 905_5 6 ) 0 ..I/., 7t re-61- Catch basin or area drain 16.60
City/State /ZIP: T o K Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: (Project name: Footing drain (no. linear ft.: ) Page 2
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.:MO) 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
LOwpnIR* '64 1;1 ifnal Sot Backwater valve 16.60
/ r Clothes washer 16.60
S ;,�c A 8 t� , � �-� �tc�l �as � �
Dishwasher 16.60
i" 12 , kW o we,- y Drinking fountain 16.60
❑ PROPERTY OWNER I ❑ TENANT
�+ Ejectors /sump 16.60
Name:
G t C 61Ct Lyons Expansion tank 16.60
Address: 9 S , S W o Au 3 t re e--+- Fixture/sewer cap 16.60
City/State /ZIP: 7 ' 1 i 00 CZ. Floor drain/floor sink/hub 16.60
Phone: (513) 99 � ,0l Fax: ( ) Garbage disposal 16.60
❑ APPLICANT ❑ CONTACT PERSON Hose bib 16.60
Ice maker 16.60
Business name: Interceptor /grease trap 16.60
Contact name: Medical gas (value: $ ) Page 2
Address: Primer 16.60
City/State/ZIP: Roof drain (commercial) 16.60
Phone: ( ) I Fax: : ( ) Sink/basin/lavatory 16.60
Tub /shower /shower pan 16.60
E -mail: Urinal 16.60
CONTRACTOR 1 Water closet 16.60
Business name: � U 0,4\11 C 7 nit /d.Tt nv� ,...y.5-i-r-47.,$ Water heater 16.60
Address: l Vg� 4 S /)yVle ,G� Other: Subtotal
City/State/ZIP: / _
if VIA 7.30 Minimum permit fee: $72.50
Phone: ( 503) 3 _ 43 3 Fax: (5g3) 363-992.1 Residential backflow minimum permit fee: $36.25 ��' SU
CCB Lic.: //Q � � / /!! /O 9 Plumbing Lic. no.: �(� _ 317 / ���
Plan review (25% of permit fee) - -
Authorized signature: i / /� . r ` 7� ( �� State surcharge (12% of permit fee) $. 7v
�. ��" �� _ �_ TOTAL PERMIT FEE 8l . PO
Print name: De r r; C L 601 f � e .. Date: 3 ,, -Q ir 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\PLMF- PermitApp.doc 12/27/06 440-4616T(10/02/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
Storm & Rain Drain - 1st 100' 55.00 Valuation: Permit Fee:
$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
and including $50,000.00.
specially requested inspections - per hour 72.50
Subtotal: $50 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:
• is\ Building \Pumits\PLM- PermiiApp.doc 12/27/06
" CITY OF TIGARD • ,
BUILDING DIVISION PERMIT #: PIJvI'200B -00120
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 3/2 I /2008
Phone: (503) 639- 4171 �.dr�,� I
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 3/27/2008 TIME: 7:03AM PAGE: 30
SITE ADDRESS: 0905x, SW OAK ST CLASS OF WORK:
SUBDIVISION: ASI-1E3RO0K FARM LOT #: 009 TYPE OF USE:
PROJECT NAME: LYONS
DESCRIPTION: Connect existing housr'to storm service. Tap done under ENG200B -00033
OWNER: LYONS, GREG PHONE #: 503 - 990-4001
CONTRACTOR: QUALITY EXCAVA1 ION SYSTEMS PHONE #: 503
Inspection Request Scheduled For: Date: 3/27/2008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
340 nrt4 n CV - AA4 1 D.r. \+-/. 06/425-01 603851 -4410 • N
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Corrections /Comments /Instructions: r 1 Ca C vaw 1 Jar- ✓ 4-- $av .rrrtC/ Jo-1 Ut �l.�d' Let +.Met Tb ec • �✓���,
e-J21) ✓w C.1 F— et 0_407 Ala 1° v6Ja.A.
C.ar_e_ �1
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: uv>.A.13 i \ \ %`P-w Date: Phone #: (503) 718-