Permit CITY OF TIGARD PLUMBING PERMIT
auwY�� DEVELOPMENT SERVICES PERMIT #: PLM2005 -00437
9/6/2005
-` I - ' 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 2S109A
PARCEL: 2S 109A6 -11100
SITE ADDRESS: 13116 SW ST. JAMES LN ZONING: R -7
SUBDIVISION: RAVEN RIDGE LOT: 040 JURISDICTION: TIG
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
STEVEB B. ALLEN Description Date Amount
13116 SW ST. JAMES LN.
TIGARD, OR 97224 [PLUMB] Permit Fee 9/6/2005 $36.25
[TAX] 8% State Surcharl 9/6/2005 $2.90
Phone : 503 -579 -0269 Total $39.15
Contractor:
OWNER 3
REQUIRED ITEMS AND REPORTS
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Phone: ,
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Reg #: 147 " O 6 O
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This permit is issued subject to the regulations con ained i 'i e iga-, Ii . _,raiapa d ,tate'o 1:e lty Codes
and all other applicable laws. All work will be done in accordance with approved�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 -66 1- 00- 332 -2344.
Issued By: Permittee Signature: i97 -
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.
•
Inspections Required for: PLM2005 -00437
✓ Code I Inspection Description I PASS Date 1 By I ✓ Code 1 Inspection Description I PASS Date I By
BUP - Building Permit ELC - Electrical Permit
405 Excavation 105 Underground/slab cover
410 Fill 110 Temporary electrical service
415 Grading 115 Electrical service
205 _ Footing 120 Electrical rough -in
805 MFG - Structure grading/footing 125 Wall cover
210 Foundation walls 130 Ceiling cover
215 Footing drain 135 Low voltage
220 - Slab 140 Sign installation
310 Crawl drain 145 A/C or heating unit circuit
225 _ Post/beam structural 150 Hot tub /spa/pool
230 Underfloor insulation 195 Misc. inspection:
235 Shear walls /anchors 199 Electrical final
240 Exterior sheathing
245 Firewall
250 Roof nailing ELR - Restricted Energy Permit
255 Wtr proofing basement walls 135 Low voltage
260 Tilt -up panel 195 Misc. inspection:
265 Masonry 199 Electrical final
270 Reinforcing steel (rebar)
•
275 Framing
810 MFG- Structure set -up MEC - Mechanical Permit
280 Insulation 605 Post/beam mechanical
285 Drywall nailing 610 Gas line
287 Suspended ceiling 615 Mechanical rough -in
295 Misc. inspection: 620 Hydronic piping
•
899 MFG - Structure final 625 Duct work
• . 498 Grading final 630 Fire damper
299 Final inspection 635 Smoke detector shutdown
640 Exhaust hood
695 Misc. inspection:
699 Mechanical final
BUP - Fire Protection System Permit
905 Sprinkler underfloor /slab PLM - Plumbing Permit
910 Sprinkler rough -in 305 Plumbing underslab
915 Fire alarm rough -in 310 Crawl drain
920 Suppression trip test 315 Post/beam plumbing
995 Misc. inspection: 320 Plumbing rough -in
998 Alarm final X 325 RP/backflow preventer
•
999 Sprinkler final 330 Water service
335 Rain drain
340 Storm drain
SIT - Site Work Permit 505 Sanitary sewer
405 Excavation 345 Culvert/catch basin
410 Fill 350 Septic tank
415 Grading _ 395 Misc. inspection:
205 Footing X 399 Plumbing final
210 Foundation walls
215 Footing drain _
420 Sprinkler supply lines SWR - Sewer Permit
495 Misc. inspection: - 505 Sanitary sewer
498 Grading final 595 Misc. inspection:
499 Final inspection 599 Final inspection
•
l: \Building \IVR \InspCard- AOP.doc 06/17/2005
CITY OF TIGARD PLUMBING PERMIT
� DEVELOPMENT SERVICES PLUMBING
PLM2005 -00437
Ail ..� I � 13125 SW Hall Blv Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 9/6/2005
PARCEL: 2S109AB -11100 .
SITE ADDRESS: 13116 SW ST. JAMES LN ZONING: R -7
SUBDIVISION: RAVEN RIDGE LOT: 040 JURISDICTION: TIG
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
STEVEB B. ALLEN Description Date Amount
13116 SW ST. JAMES LN.
TIGARD, OR 97224 [PLUMB] Permit Fee 9/6/2005 $36.25
[TAX] 8% State Surcharl 9/6/2005 $2.90
Phone : 503 - 579 - 0269 Total $39.15
Contractor:
OWNER
REQUIRED ITEMS AND REPORTS
Phone :
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 rules or direct questions to OUNC by
calling 503 - 246 -669 1 00- 332 -2344.
Issued By: Permittee Signature: d3'1
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.
9- 6- 05;10:21AM;INTEL ;9712147804 # 1/ 3 .
a. 4
t- 'RECEIVED
Plumbing Permit Application 0 6 2tii 1 FOR OFFICE USE ONLY
City of Tigard Received cp J� ��� /�
13125 SW Hall Blvd., Tigard, OR 97223 CITY OF TIGAF Date/By: / t1/1573.6 Permit No: 020 cc", 7
Date/By: Other Permit No.:
Plan Review
Phone: 503.639.4171 Fax: 503.598.1960
BUILDING DfVl�;,nt��;�.L,�•� ;\ D
24 Hour Inspection Line: 503.639.4175 . ` f Date Ready /By: 63 See Page 2 for
Internet www.ci.tigard.or.us N Supplemental ...,. : t ntal Information
:
. , •. . , Informs
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•, -_ - - : -fir;.. • '1P�`,:OF!Uil`{ti .:. _�.. �;: =FED" - tea."... "
❑ New construction ❑ Demolition For special information use checklist.
Description I Qty. I_ Ea. I Total
❑ Addition/alteration/replacement ® Other: Residential Backflow New 1-2-family dwellings (includes 100 ft. for each utility connection)
�=-:=•:_ r 400 CQN_S RT Q _: ' = zg � ms: s.,` SFR(I)bath 249.20
❑ 1- and 2- family dwelling TT ❑ Colnmercial/industrial SFR (2) bath 350.00
El Accessory building ID Multi-family SFR (3) bath 399.00
1:1 Master builder Each additional bath/kitchen 45.00
® Other: Landscaping Page 2
Fire s sprinkler ( sq. ft.)
-::.<. t.. -.: � _ z,. -: -x _ -..,,, i 3: P g
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,:rOB: -cS =)(F 9� O A L C 'I O #. R;
1 : ' '' Site utilities
Job site address: 13116 SW St James Ln Catch basin or area drain 16.60
City/State/ZIP: Tigard, OR 97224 Q _ J I.,. Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: n/a Project name: Residential B ow 1 Footing drain (no. linear ft.: ) Page 2
anufactured home utilities 110.00
Cross street/directions to job site: 131" Terrace & St James Ln
Manholes 16.60
Rain drain connector 16.60
Sanitary sewer (no. linear ft.: ) Page 2
Storm sewer (no. linear ft.: , ) Page 2
Subdivision: Raven Ridge I Lot no.: 40
Water service (no. linear ft.: ) Page 2
Tax map /parcel no.:
Fixture or item
- _ -,„,-''''''''',.......,----',:,:41,'S . , . .. ,_ Absorption valve 16.60
.
- _ '.IIiESC ,UL
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=.' .' __ T_ - i.:.;�. _.:; � -:. ..• : Backflow preventer
T .�..<'.'' .. :; _'._; =;' �._: = °:': - Page 2 .7_7,5s-
Install backflow device for landscape irrigation system Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60 '
:t-'' - 4_ ;I_�. ,B kiiiii i. o. " - -'R. ::•I ,:°ts. .. = :[I; TENA T `' `,.P, :, Drinking fountain 16.60
_.. ..: 7...., _. Ejectors sump 16.60
Name: Steven B Allen Expansion tank 16.60
Address: 13116 SW St James Ln Fixture/sewer cap 16.60
City/ State/ZIP: Tigard, OR 97224 Floor drain/floor sink/hub 16.60
Phone: (503)579 -0269 Fax: (5C3) 16,13- 6o3410 Garbage disposal 16.60
- - t ... 5. _ Hose bib 16.60
t Ice maker 16.60
Business name:
Interceptor /grease trap 16.60
Contact name: Medical gas (value: $ ) Page 2
Address: Primer 16.60
City /State21P: Roof drain (commercial) 16.60
Phone: ( ) I Fax: : ( )
Sink/basin/lavatory 16.60
Tub /shower /shower pan 16.60
E -mail: _ Urinal 16.60
; may :.4._�. _ _ :t?...', .._ " -- _ r:'C` : T.'_, ',:nd. - a:: _ •
■
?�`• �r_��':_': ;: .��_ =, ;:,:;` :._. ....�. ����i � ��• sip::: � _ '- :�3' . - r� ' � ' �: :=a I Water closet 16.60
Business name: 01 .010 6 Water heater 16.60
Address: Other:
City / State/ZIP:
Subtotal Z.7. YS
Minimum permit fee: $72.50
Phone: ( ) Fax: ( ) Residential backflow minimum permit fee: $36.25
CCB Lic.: Plumbing Lic. no.: Plan review (25% of permit fee)
State surcharge (8% of permit fee)
Authorized signature: 1 1 - ,3/ /�/��
e l t? 17 � � TOTAL PERMIT FEE 1 3 ea - 2 S
Print name: Steve , g len I Date: 9/6/05 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.
is ,g4Prm.iu4P11,4- PennitApp.doc 06/05 440.4616T(I0/O2/COM/.HB)
9- 6= 05;10 :21AM;INTEL ;9712147804 # 2/ 3
n ,
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Qty s :'Fed ea), ota . .. 3
>tte •tillixes• - r:.._:. aeota':•: out;
l
CPU.
Footing drain - 1" 100' 55.00 0 10 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 e;`:_ =zn : =Y _. , ...:..
Vsa us fig- .; L;t;: .e lr::F : • *: - • 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
: �.r.t - Q-#.7 g ,, additional $100.00 or fraction thereof, to and
XtIITT a� I; ; )`_ 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) 4- 27.55 Z 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 $50,001.00 and up $742.00 for the first $50,000.00 and $1.20 for
Subtotal: y7 r each additional $100.00 or fraction thereof.
Fixture Work: . '.- -� r �. >, .. ��.
:: l e . i -tolr�Ct . t1 chine '_�-"
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.
a._ -- ; •• ❑ Any new commercial building.
: .` -• �_���. .... _:.:;'_ ua tlt` =ti Fix`t seP,Wiirk effo'ithal -
;O. :�, ..:._ _„ ❑ Any new exterior plumbing site utilities.
= :: :: ° �= �•; .z: • : 42- ❑ 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 I 3-D multipurpose fire sprinkler system.
Eye Wash
Floor Drain/sink - 2" Submit 2 sets of plans with any of the above.
-3"
Car Wash Drain .Isti>irit c _
ti' Dia
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 increase of sewer EDUs, a sewer se will be issued and
Water Closet - Toilet p
urinal fees assessed for the sewer increase must be paid before the
Other Fixtures: plumbing permit can be issued.
iABu i kl ingTemnu'PLM -Pemu t App.do. 07/06/05