Permit CITY OF TRARD
PLUMBING PERMIT
��� DEVELOPMENT SERVICES PE
DEVELOPMENT PLM2005 -00205
s s� I 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 5/16/2005
PARCEL: 2S111 DB -15700
SITE ADDRESS: 09295 SW SATTLER ST ZONING: R -4.5
SUBDIVISION: KESSLER ESTATES LOT: 014 JURISDICTION: TIG
Project Description: Irrigation backflow.
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
ABSHER, JERRY & ADRIEN Description Date Amount
9295 SW SATTLER
TIGARD, OR 97233 [PLUMB] Permit Fee 5/16/2005 $36.25
[TAX] 8% State Surcharl 5/16/2005 $2.90
Phone : 503 670 - 1817 Total $39.15
Contractor:
DRAKES 7 DEES
16519 SE STARK ST REQUIRED ITEMS AND REPORTS
PORTLAND, OR 97233
Phone : 503- 256 -2223
Reg #: PLM 5259
SUP ALL PHASE & BA(
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 -6 • s 9 or 1- 800 - 332 -234
Issued By: ✓+ - Permittee 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.
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•• ' Flubbin Permit Application FOR OFFICE USE ONLY
City of Tigard �ateieey S i� /dam j �
Permit No. I j
`� 1TZ
13125 SW Hall Blvd., Tigard, OR 9 C E I V �/ a
Phone: 503.6394171 Fax: 503.59 .1ff Amrmr \ DanB Other Permit No.:
24- Hour Inspection Line: 503.639.4175 ' : 11 Y: •
.. Date Ready/By: i °: El See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method: Supplemental Information
_ , t° . .c' � r t `vva..::W ] r; , ; .. ...o-1�.:;: _- -LLB' • ^ l • ' - ,;�r3..LL � � ��r � ';:�'�•- -: � P ...:: : . : - z
i',11 � - ...... .. .__.. _ . � �E''EE• S . . LR.E,.
❑ New construction CI Y10 FERIGARD For special information use checklist.
Addition / alteration /replacem�itUILDA Q:0 ISIoN Description Qty. � Ea. connection)
• ±:;.t•wzxtw„.r °" .:? 41;,,,,..: New 1- 2- family dwellings (includes 100 ft. for each utility connection) • ,Ei;'x r -• . 11 C TEC'„:Oa.RD . ;h '•a, ,: 1 „ r< , -. 7, :. ; ._ 41- S FR 1 bath .
i ..e. '�La.4l'ti. `.Y�3.:f .s+. -u. ..p u:.. a..0, -tom w, -: Ya�'..i" ;.,. . _ >= �';✓ ( ) 249.20
7 11- 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/Idtchen 45.00
❑ Other:
1;�,re -• �g- nay - �.. r. . ti: rc, � d, : „ Fire sprinkler ( sq. ft.) Page 2
"3 "•s� _ 1 'r , 4:. JO$-SI .- e - • - - - ..- c A 1� ;. : m�)C r -.,r:
p p �- • �-- o«Sr .s, .�: r �' � : _,:::::::.Y. Site utilities
Job site address: -1 -1 S. J Sc {k le e Catch basin or area drain 16.60
City/StateJZlPT al' ad a - r e . I -7 2'2. Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: J 1 Project name: A IoJ e V Footing drain (no. linear ft.: ) Page 2
Cross street/directions to job site:
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: ,Lot no.: Water service (no. linear ft.: ) Page 2
Tax map /parcel no.:
Fixture or item
_ ,. F...., 4, . ;.- p�� y : T _ ;y ' .- Absorption valve 16.60
x • -yH " . r t f.' ' i.Y -��G:s. d l�iV '!cal`°' O IQII' ' •1 :..! _
z' - ' "'o. ...:..�r�-.. ... :; t_;, :- . :: :+!': Backflow Page 3�•
((�� t n _ _ - � Pa e2
µ l-�4G4`O..✓ to tLe 4 c / .letr y a 4t . .vt ` Backwater valve 16.60
J Clothes washer 16.60
Dishwasher 16.60
}��+,�.�:�� . =-mss 5, �, .' , .1 .,...,,.. Drinking fountain 16.60
AP "T:Sg. L 3�F OP1 Ti . , .}• , - :.6. :4,i'" t ...._, • 1• " e U' 1 . ^ . y
��� �? - �'.;� :�� �_ir?`.. Ejectors/sump 16.60
Name: pd v' y ' d' Aci r t e A A bsh er Expansion tank 16.60
Address: 9 z t i s ' S -S c it e ir - Fixture/sewer cap 16.60
City/ State/ZIP: \ l9 eel / Nee, g'72-2 y Floor drain/floor sink/hub 16.60
Phonl ) ( • ( Fax: ( ) Garbage disposal 16.60
i_. t P s r s ti _f „ucr, •_. , �,. :, . q .;p K, Hose bib 16.60
:a 1 ACT . , „
�' `� : . -
Ice maker • 16.60
Business name: D t'a.k .e.g 7 Dees t`" C, , Interceptor /grease trap 16.60
Contact name: as v L ( - M e I (-► A . 1 ( Medical gas (value: $ ) Page 2
Address: ' (S) / S. ( . J'- , k S ^1- Primer 16.60
City/State/ZIP: f 44. 1 / O v C. g 7 2 3 3 Roof drain (commercial) 16.60
Phone: ( q ) 2 1 C p t/ 7 Fax: : (. q)) 2.i -O '6 c Sink/basin/lavatory 1 6.60
Tub /shower /shower pan 16.60
E -mail:
'`' ; ,."`';'`"_J u .J 4,:. ^ "r'` ). t'.i: _ . . ,. Urinal 16.60 •
^. t r'::r -V `' r : ` � '.# ; it:;'. Ub11'R A CTQ - � } r ,•{ , i< t : . 'T : L;
v 'F. .+.'s. t' _ _. : x. ¢ ._ • . � , .. c.n ' +2 \ r. ., -, . F:S `>E }t 7„ i, i.+B_'r � �. 1.. ' . ..... : .. Water closet 16. 60
Business name: b r �k.e S j> .Q es i In c- Water heater 16.60
Address: 1 4 S) et f, E. s4-„,, k s 1... Other:
City/State/ZIP: p t -I. 6 , ..c‘, l 3 ,. ' e _ q 7 233 Subtotal
$ Z Minimum permit fee: $72.50 3( .2 r
Phone:
( )) .S'- L ..2 y Fa (1'0 -6, - 0 S &" Residen backflow minimum permit fee: $36.25 �O
CCB Lic.: 1 .r'( Plumbing Lic. no.: ( / ) 7 ( Plan review (25% of permit fee)
State surcharge (8% of permit fee) Z , q 0
Authorized signature: p 4,_, TOTAL PERMIT FEE 3 q . iS'
Print name: towL c,_). wl a� . I (f 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.
e\ Building \Permiro\PLM- Pemritnpp.doe 12/03 _ . 440-4616T(I0 /02/COMnvEB)
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Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
y tee' �,.,Z R-I ?c'Q ee ,e40.l ;:`Fo
e9 Y •.. �.�; ° S,girE_ i ±Pee•; •
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
, :ryTW:�•y Q :3� i • • �nf
V'.�llatYQ
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
�,. -'.. } � `' �4 �4 Fee ea ,' additional $100.00 or fraction thereof, to and
1X II e'6I' e n1: 1��:,. �,'� '-':f°. 2' `' Ie4% Fotal
`'- '- = 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 $50,001.00 and up $742.00 for the first $50,000.00 and $1.20 for
Subtotal: each additional $100.00 or fraction thereof.
•
Fixture Work:
Are you capping, moving or replacing existing fixtures? If
"yes ", please indicate work performed by fixture. Failure to
accurately report fixtures could result in increased sewer fees * .
Y ' - k * c^ ya Qti� 7 b' irtfrr,'e `Wo Ff tihed'
r ar 4 'S7' i v k` to j�YC
Y._ ' .;.4 ; - -;,, '1; : Mrl Comments regarding fixture work:
Baptistry/Font
Bath - Tub /Shower
- Jacuzzi/Whirlpool
Car Wash -Each Stall
-Drive Thru
Cuspidor/Water Aspirator
Dishwasher - Commercial
- Domestic
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Drinking Fountain
Eye Wash
Floor Drain/sink - 2"
-3 „
- 4"
Car Wash Drain
Garbage - Domestic
Disposal - Commercial *Note: If the fixture work under this permit results in an
•
Ice MachiRefrig. Drains increase of sewer EDUs, a sewer permit will be issued and
Oil Separator (Gas Station) fees assessed for the sewer increase must be paid before the
Rec. Vehicle Dump Station plumbing permit can be issued.
Shower -Gang
-Stall
Sink -Bar/Lavatory Quantity Total
- Bradley Isometric or riser diagram is required if fixture quantity
- Commercial
q q Y
- Service total is >9.
Swimming Pool Filter
Washer - Clothes
Water Extractor Plan Review
Water Closet - Toilet Plan review is required if fixture quantity total is >9.
Urinal
Other Fixtures:
iABuilding \Pamits\PIM•Pamiu∎pp.doc 3 /O3
•
CITY OF TIGARD ,
BUILDING DIVISION PERMIT #: PLM2005- 00205
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 5/16/2005
Phone: (503) 639 -4171 A ovill
Inspection Requests (24 Hrs.): (503) 639 -4175 ...._. "-L
INSPECTION WORKSHEET FOR DATE: 6/17 /2005 TIME: 7:11AM PAGE: 86
SITE ADDRESS: 09295 SW SATTLER ST CLASS OF WORK:
SUBDIVISION: KESSLER ESTATES LOT #: 014 TYPE OF USE:
PROJECT NAME: ABSHER
DESCRIPTION: Irrigation backflow.
OWNER: ABSHER, JERRY & ADRIEN, PHONE #:
CONTRACTOR: an$REB, .leuat & ADRIEN, PHONE #: 603-2g8-2823
Inspection Request Scheduled For: • Date: 6/17 /2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
325 RP /backflow preventer 009484 -02 971-219-0483 N
Corrections /Comments / Instructions:
i r1
i .II7 r— ,
' s , ail
6
,9V ,, - .. l
• 0 U1) lbi‘j
-*ASS El PARTIAL APPROVAL 111 CANCEL ❑ NO ACCESS
"''' �� ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
l
Inspector: Date: l� l / leY Phone #: (503) 718-