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Permit
IN 1 �� CITY OF TIGARD PLUMBING PERMIT COMMUNITY DEVELOPMENT PERMIT #: PLM2008 -00017 TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 1/22/2008 PARCEL: 2S 103CD - 07700 SITE ADDRESS: 11715 SW TERRACE TRAILS DR ZONING: R -4.5 SUBDIVISION: CREEKSIDE PARK LOT: 007 JURISDICTION: TIG PROJECT: RONE Project Description: Backflow preventer for irrigation. 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: ft Owner: FEES RONE, CLIFFORD G AND CHARMINE L Description Date Amount 11715 SW TERRACE TRAILS DR [PLUMB] Permit Fee 1/22/2008 $36.25 TIGARD, OR 97223 [TAX] 12% State Surch 1/22/2008 $4.35 Phone : Total $40.60 Contractor: MONTERREY IRRIGATION 4715 SE PORTLAND, , OR 97266 AVE. PO RTL REQUIRED ITEMS AND REPORTS PO Contact # : PRI 503 -539 -0677 Reg #: PLM 8428 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 503.246.6699 or 1.800.332.2344. Issued By: #_,_., 1 I / Permittee Signature: .f / l jg ' . O 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 Appli „„ :.:.j, EIVED Building Fixtures FOR OFFICE USE ONLY City of and JAN 2 2 NUB Received „- - ty f Ti g Date/By:/ t7z 315 Permit No.ar Il aO� 0/ a 13125 SW Hall Blvd., Tigard, O �'G D Plan R / �_ / • Phone: 503.639.4171 Fax: Other Permit No.: Inspection Line: 503.639.417M. I � { �ron isioN Date/By: T I G A R D Date Ready/By: kris: ® See Page 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 (1) bath 249.20 fai- 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 ❑ Other: Fire sprinkler ( sq. ft.) Page 2 JOB SITE INFORMATION AND LOCATION h Site utilities Job site address: !' .L/ SW Terrace fru j CS DR_ Catch basin or area drain 16.60 City/State /ZIP: / f c A - D 0 IL 9' ,2 ?_3 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.: ) 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 _TN 5 T4 ci, I 0 #L/ rt7 Backwater valve 16.60 .--S d -Le" g- cSJ - _ J1 Clothes washer 16.60 Dishwasher 16.60 ❑ PROPERTY OWNER I ❑ TENANT Drinking fountain 16.60 5 ' 4 Ejectors /sump 16.60 Name: Expansion tank 16.60 Address: Fixture /sewer cap 16.60 City /State /ZIP: Floor drain/floor sink/hub 16.60 Phone: ( ) 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: ( Y I Fax: : ( ) - Sink/basin/lavatory 16.60 Tub /shower /shower pan 16.60 E -mail: i . 4 C ONTRACTOR Urinal 16.60 Water closet 16.60 Business niiitte f) fi re n e E � - � �n/ / re. } AVA,/ Water heater 16.60 Address: y / c- S<� T./ *µ P Other. Subtotal City /State /ZIP: / /j y �- � n °� "� � / © / ` �r � ��" Minimum permit fee: $72.50 Phone: (5p 3 ) 539.cpt 7. 4 _ Fax: ( ) Residential backflow minimum permit fee: $36.25 CCB Lic.: Q / 3 , �� (f l A � , 7 j y Plumbing Lic. no.: Plan review (25% of permit fee) � U ( r� State surcharge (12% of permit fee) I-4 35 Authorized signature: �jJID jS TOTAL PERMIT FEE L/a, /00 rint name: Date: / ..1... 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: 1Building \Permits\PLMF- PermitApp.doc 12/27/06 440- 4616T(10 /02/COM/WEB) Plumbing Permit Application - City of Tigard s, - Page 2 - Supplemental Information Fee Schedule: Residential Fire Suppression Systems: Site Utilities Qty. Fee (ea) Total Square Footage: Permit Fee: Footing drain - 1 s~ 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 Valuation: Permit Fee: 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 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 specially requested inspections - per hour 72.50 and including $50,000.00. 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 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: i:\ Building \Permits\PLM- PermitApp.doc 12/27/06 CITY OF TIGARD . BUILDING DIVISION PERMIT #: Pi.M00�00017 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 1/2280 l Phone: (503) 639 -4171 u ( Inspection Requests (24 Hrs.): (503) 639 -4175 "' I.. INSPECTION WORKSHEET FOR DATE: 1/20/2008 TIME: 7 :00AM PAGE: 57 SITE ADDRESS: 11715 SW TERRACE TRAILS DR CLASS OF WORK: SUBDIVISION: CREEKSIDE PARK LOT #: q07 TYPE OF USE: PROJECT NAME: ROME= DESCRIPTION: Baukflowe preventer for irrigation. OWNER: ROME, CLIFFORD G AND, PHONE #: CONTRACTOR: MONTERREY IRRIGATION PHONE #: 503. 539.0677 Inspection Request Scheduled For: Date: 1/28/2008 Pour Time: Code # Inspection Description Confirm # Contact # Message 399 Plumbing final 064003 -01 503-539-0677 N Corrections/Comments/Instructions: rr J p_,0 i c,z. T r Se e. " e�1 `2-e,p a tir r ex. (1— C g PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS ❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: () d L's-' \AA. ` Date: I 1 /0 Phone #: (503) 718-