Permit CITY TIGARD PLUMBING PERMIT
i DEVELOPMENT SERVICES PE
DEVELOPMENT PLM2006 -00434
44 . - '�� 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 9/19/2006
PARCEL: 2S114BC -01200
SITE ADDRESS: 10050 SW RIVERWOOD LN ZONING: R -4.5
SUBDIVISION: PICKS LANDING NO.1 LOT: 067 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
KEN & MELI HOWELL
10050 SW RIVERWOOD LN Description Date Amount
TIGARD, OR 97224 [PLUMB] Permit Fee 9/19/2006 $36.25
[TAX] 8% State Surcha 9/19/2006 $2.90
Phone : 503- 620 -4462 Total $39.15
Contractor:
OWNER
REQUIRED ITEMS AND REPORTS
Contact # :
Reg #:
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 ru irect questions to OUNC by calling 503 - 246 -6699 or 1- 800 - 332 -2344.
�QQ i
Iss d By: ttA Permittee Signature '.MA
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.
Building Fixtures
Plumbing Permit Applic A - FOR OFFICE E usE ONLY
City of Tigard S FP 1 9 2006 Received 9. i g 6/ Permit No.: • f a) 3
14 v 13125 SW Hall Blvd., Tigard, OR'-97223 Date /By: 7
Phone: 503.639.4171 Fax: 50<598d 0 Plan Review
DatelBy
G - Other Permit No.:
„ t TIGARD
T I G AR D Inspection Line: 503 BUILDING DIV1 SIGN Date ReadyBy: Ia "" -- /{ � el See Page 2 for
Internet: ww.tigard or.gov Notified/Method: ` ! 16 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)
' F CATEGORY OF CO TI
NSTRUCON 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:
Fire sprinkler ( sq. ft.) Page 2
,:.:,J013.-SITE; -INFORMATION AND LOCATION " - Site utilities
Job site address: I (EC) k ' p., wiert x -n or A l Catch basin or area drain 16.60
City /State /ZIP: --- (� (?),\-� t, Oc.__. Q 1 Z2_,4 Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: / v Project name: �� \ Footing drain (no. linear ft.: _) Page 2 tic 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.: ) 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,
F ° * a - - Backflow preventer Page 2
.. ■,C Clp-(2-. s'■ c( - \ ('m \ IN -CX - Backwater valve 16.60
�` �� Clothes washer 16.60
(� Dishwasher 16.60
Drinking fountain 16.60
, ❑` PROPERTY- OWNER - I ., ❑ TENANT
` r Ejectors/sump 16.60
Name: k e. 1 i 1 1 �n (Q \ 1 �1--\
� CA )..xc'. 1 Expansion tank 16.60
C1= j C 1 -
Address: ( \v ( \ ( Fixture /sewer cap 16.60
City/State/ZIP: I \ ('� _- r rya. 0- i Floor drain /floor sink/hub 16.60
Phone: ( 5) (0 .L f LI (O`L Fax: ( ) Garbage disposal 16.60
Hose bib 16.60
,- ❑. APPLICANT ` . ' , 0" CONTACT PERSON
• 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:( ) Fax::( )
Sink/basin/lavatory 16.60
Tub /shower /shower pan 16.60
E -mail: Urinal 16.60
- - , .CONTRACTOR - - - Water closet 16.60
Business name: ()w Rer-- Water heater 16.60
Address: Other:
City /State /ZIP: Subtotal J
Minimum permit fee: $72.50 /1/ gc
Phone: ( ) Fax: ( ) Residential backflow minimum permit fee: $36.25 „gyp
CCB Lic.: Plumbing Lic. no.: Plan review (25% of permit fee)
N State surcharge (8% of permit fee) c 7 .
Authorized signatur _ • l a ..` i f _ TOTAL PERMIT FEE 39, /5
Print name: Date: 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.
1:\ Building \Pennns\PLMF- PexmiWpp.doc 04/06/06 440.4616T(10 /02/COM/WEB)
Plumbing Permit Application - City of Tigard . __ , .,
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Si te 7tilities; ,� ` Qty„ fee (ea) Total . ` S'quare,Footage: . u „ -Permit Fee: , .
4 '
Footing drain - I 100' 55.00 0 to 2,000 $115.00
Footing drain - each additional 100' 46.40 2,001 to 3,600 $160.00
Sewer - 1st 100' 55.00 3,601 to 7,200 $220.00
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 - l st 100' 55.00 : Valuation:, Perniit Fee:: ". • ., „_ . ',f
$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
, Total
�., additional $100.00 or fraction thereof to and
Fixture oi�Itein Qty.; " Feel(ea)
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 Complex.Str
Are you capping, adding or replacing fixtures? If "yes", A "complex structure" is defined as an installation of a plumbing
please indicate work performed by fixture. Failure to system that meets any of the following criteria.
accurately report fixtures could result in increased sewer fees *. Please check all that apply.
'g. ,' Quantittby (Fixture) Work�Perforined: ❑ Any new commercial building.
Fix "ture.Typ e Replace ❑ Any new exterior plumbing site utilities.
- • . '' Previous Capped Added .Existing ❑ A commercial building with installation, alteration or addition
Baptistry/Font of nine (9) or more new or relocated plumbing fixtures.
Bath - Tub /Shower ❑ Medical gas and vacuum systems for health care facilities
- Jacuzzi/Whirlpool providing services to human beings.
Car Wash - Each Stall ❑ Plumbing installations, alterations or additions to food service
- Drive Thru facilities where new plumbing fixtures, including interceptors,
Cuspidor/Water Aspirator are being installed for the food service area.
Dishwasher - Commercial ❑ Any new residential building containing three (3) or more
- Domestic dwelling units.
Drinking Fountain ❑ Any NFPA 13 -D multipurpose fire sprinkler system.
Eye Wash
Floor Drain /sink - 2" Submit 2 sets of plans with any of the above.
-3"
-4 "
Car Wash Drain ,.,,ISOnietric Or Riser _Diagr'am - .
Garbage - Domestic ❑ Isometric or riser diagram is required for new buildings
Disposal - Commercial three (3) or more stories in height.
- Industrial
Ice Mach. /Refrig. Drains
Oil Separator (Gas Station) Comments regarding fixture work:
Rec. Vehicle Dump Station
Shower -Gang
-Stall
Sink - Bar/Lavatory
- Bradley
- Commercial
- Service
Swimming Pool Filter
Washer - Clothes *Note: If the fixture work under this permit results in an
Water Extractor
Water Closet - Toilet increase of sewer EDUs, a sewer permit will be issued and
Urinal fees assessed for the sewer increase must be paid before the
Other Fixtures: plumbing permit can be issued.
i:\ Building \Permits\PLM- PennitApp.doc 07/06/05
CITY OF TIGARD .
BUILDING DIVISION PERMIT #: PLM2006-00434 •
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 9/19/2006
Phone: (503) 639-4171 14'4101411111'
Inspection Requests (24 Hrs.): (503) 639-4175
INSPECTION WORKSHEET FOR DATE: 10/12/2006 TIME: 7:01AM PAGE: 70
SITE ADDRESS: 10050 SW RIVERWOOD LW CLASS OF WORK:
SUBDIVISION: PICKS LANDING NO.1 LOT #: 067 TYPE OF USE:
PROJECT NAME: HOWELL
DESCRIPTION: Installation of residential backflow prevention device for irrigation. •
OWNER: HOWELL, KEN & MELINDA PHONE #: 503-6204462
CONTRACTOR: OWNER PHONE #:
Inspection Request Scheduled For: Date: 10/12/2006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
399 Plumbing final 038056-01 503.620-4462
Corrections /Comments/ Instructions:
Af __!..c.‘11
AM"
amv ,41 y -
... PARTIAL APPROVAL ri CANCEL I I NO ACCESS
I I FAIL n CALL FOR INSPECTION I ADDITIONAL FEES ASSESSED
Inspector: Ili *C.-7 • I
Date: //./ Phone #: (503) 718-
_ _ _