Permit CITY TIGARD PLUMBING PERMIT
A DEVELOPMENT SERVICES PERMIT #: PLM2005 -00162
A — 13 125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 4/26/2005
PARCEL: 2S104BC -08100
SITE ADDRESS: 12975 SW OXALIS TERR ZONING: R -7
SUBDIVISION: HILLSHIRE CREST LOT: 003 JURISDICTION: TIG
Project Description: Irrigation backflow preventer.
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
RIDGECREST CONSTRUCTION CO INC Description Date Amount
6600 SW 92ND AVE SUITE 100
PORTLAND, OR 97223 [PLUMB] Permit Fee 4/26/2005 $36.25
[TAX] 8% State Surcharl 4/26/2005 $2.90
Phone : 503 246 - 8808 Total $39.15
Contractor:
CONTOUR LANDSCAPING INC •
12485 SW TOOZE RD REQUIRED ITEMS AND REPORTS
SHERWOOD, OR 97140
Phone : 682 - 1302
Reg #: LIC 5698
SUP ALL PHASE + BAC
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 -24 99 or 1- 800 - 332 -234 � 6/141/U Issued By - Permittee Signature-Pc r
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.
.
P1ufflbin Permit A c a ` ii InED
City of Tigard APR 2 6 2005 D B A , /a' .36 Permit No. an `�6905_o .
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review C �
Phone: 503.639.4171 Fax: 503.50I1p4OOF TIGARD ii ,-, D /By Other Permit No.:
. Ii
24- Hour Inspection Line: 503.6 DING DIVISIO _ 'I t i i Date Ready/By: t ' ai '' / ® See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method: 7 � 6 Supplemental Information
TYPE OF WORK FEE* SCHEDULE
%New construction ❑ Demolition For special information use checklist.
Description 1 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 (1) bath 249.20
!°ri- and 2 -family dwelling ❑ Commercial /industrial SFR (2) bath 350.00
❑ Accessory building ❑ Multi - family SFR (3) bath 399.00
❑ Master builder Each additional bath/kitchen 45.00
0 Other Fire sprinkler ( sq. ft.) Page 2
JOB SITE INFORMATION AND LOCATION
Su) ' �D, On Site utilities
Job site address: t a' 1 q 7 SO) O) P�R • Catch basin or area drain 16.60
City / State/ZIP: '77 .7.0 OA.- Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: I Project name: Footing drain (no. linear ft.: ) Page2
Manufactured home utilities 110.00
Cross street/directions to job site: Manholes 16.60
J Q . Rain drain connector 16.60
Sanitary sewer (no. linear ft.: ) Page 2
Storm sewer (no. linear ft.: ) Page 2
Subdivision: �(.t_&L I Lot no.: bit 3 Water service (no. linear R: ) Page 2
Fixture or item
Tax map/parcel no.: Absorption valve 16.60
DESCRIPTION OF WORK Backflow preventer ' Page 2
..4-1A-v (S Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
IPROPERTY OWNER I ❑ TENANT Drinking fountain 16.60
Ejectors/sump 16.60
Name: ( 1 ,
Expansion tank 16.60
Address: 7 q Fixture/sewer cap 16.60
City / State/ZIP: (/l� ( W x6y/i4, O2 " ( Q '7 as 3 Floor drain/floor sink/hub 16.60
Phone: ( 5 ) a t�
- (b v 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 Water closet 16.60 <- 0 Business name: 1!�p'rr, Water heater 16.60
Address: 14)-1X ' W VV ' O ' �'i "3 Other:
City /State/ZIP: O n 91/ O fee: $72.5 Subtotal
� I ` ` 7, �� Minimum permit fee: $72.50
Phone: (5 Q
�� J�) (3o - Fax: ( ) S �'Wv-e Residential backflow minimum permit fee: $36.25
CCB Lic.: S i. Plumbing Lic. no.:
Plan review (25% of permit fee)
t State surcharge (8% of permit fee)
Authorized signature: o , )M
"'-" TOTAL PERMIT FEE
I Print name:
ti it_. r"il Olvt,)00 Date: y a T5 This permit application expires if a permit is not obtained within
180 days after it has been accepted as complete.
(A,U.fl., *Fee methodology set by Tri -County Building Industry Service Board.
i:\Building\Perrnits1PLM-PerhAtApp.doc 12/03 410.4616T(I0/02/COM/WEB)
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Scheduler Residential Fire Suppression Systems:
Site Utilities Qty. Fee (ea) Total Square Footage: Permit Fee:
Footing drain - l 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 faction 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: $50,001.00 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 (Fixture) Work Performed
Fixture Type: Replace
New Mined Existing Capped 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
Ice Mach /Refiig. Drains increase of sewer EDUs, a sewer permit will be issued and
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
- Service total is >9.
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:
i:t Building Wermib\PLM- PcnnitApp.doc 3/03