Permit 'A-
CITY OF TIGARD r
PLUMBING PERMIT
COMMUNITY DEVELOPMENT PERMIT #: PLM2007 - 00393
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 8/27/2007
PARCEL: 2 S 115AA -08 000
SITE ADDRESS: 10516 SW TITAN LN ZONING: R-4.5
SUBDIVISION: BERKLEY ESTATES LOT: 012 JURISDICTION: TIG
PROJECT: MILLER
Project Description: Install backflow device. Job NO. 071364
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
MILLER, DONALD A +
DIANA I Description Date Amount
10516 SW TITAN LANE [PLUMB] Permit Fee 8/27/2007 $36.25
TIGARD, OR 97224 [TAX] 8% State Surcha 8/27/2007 $2.90
Phone : Total $39.15
Contractor:
DENNIS' 7 DEES LANDSCAPING
7355 SW JOHNSON CREEK BLVD
PORTLAND, OR 97206 REQUIRED ITEMS AND REPORTS
Contact # : PRI 503- 777 -7777
FAX 503- 777 -2399
Reg #: LIC 5009
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 o . JJ i/i �/ / Permittee Signature: 1,0/ted 7l41 •
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 Application 2007 FOR OFFICE USE ONLY
qq
CI an
of Tigard F , Received 2404
g Permit No
13125 SW Hall Blvd., Tigard, OR 97223 Date a� �L '�
Review
Phone: 503.639.4171 Fax: 503.598.1960 (,i 1 / Re
Plan Re
' . - ' ' Date/By: Other Permit No.:
24- Hour Inspection Line: 503.639.4175 Pat t ■ • • , a_ . A Date Ready /By: )ur See Pa 2 for
Internet. www.ci.tigard.or.us - 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: LANDSCAPE New 1- 2- family dwellings (includes 100 ft. for each utility connection)
CATEGORY 'OF CONSTRUCTION ' • SFR (1) bath 249.20
I- and 2- family dwelling 0 Commercial/industrial
❑ Multi- family SFR (2) bath 350.00
Accesso ry building buildin SFR (3) bath 399.00
El Master builder Each additional bath/kitchen 45.00
❑ Other: Fire sprinkler ( sq. ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities
Job site address: /4500 56u / I �N v ` L/1 Catch basin or area drain 16.60
City /State /ZIP: �66 o Q/e 61.e7.9-c9-1/ Drywell, leach line, or trench drain . 16.60
Suite/bldg. /apt. no.: I Project name: pl i (l, - ` OA 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
t
Waer service (no. linear ft.:
Subdivision: Lot no.: ) - Page 2
Fixture or item
Tax map /parcel no.: -
Absorptionvalve 16.60
DESCRIPTION. OF `WORK
Backflow preventer 1 Page 2
INSTALL BACKFLOW DEVICE Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
• PROPERTY OWNER_ .. -. . • • Drinking fountain 16.60
❑ TENANT: .
Name: ODh /1/41././W-- Ejectors/sump 16.60
Expansi on tank 16.60
Address: ��'lr/it t v '' L Fixture /sewer cap 16.60
City /State /ZIP: Floor drain/floor sink/hub 16.60
Phone: (5()3) (p3 9 /7EIq 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
Sink/basin/lavatory 16.60
Phone:
( ) I Fax:: ( )
Tub /shower /shower pan 16.60
E -mail:
Urinal 16.60
• CONTRACTOR ' - Water closet 16.60
Business name: DENNIS' SEVEN DEES LANDSCAPING, INC Water heater 16.60
Address: 7355 SE JOHNSON CREEK BOULEVARD Other:
City /State /ZIP: PORTLAND, OR 97206
Subtotal
Minimum permit fee: $72.50
Phone: (503 ) 777 Fax: (503 ) 777 Residential backflow minimum permit fee: $36.25 36.- 25
CCB Lie.: Plan review (25 % of permit fee)
5009 Plumbing Lie. no.: 05LIBDI
State surcharge (8% of permit fee) a ,go
Authorized signature: L/� • /
f C -pi TOTAL PERMIT FEE 1/, / S
Print name: DEAN SNODGRASS Date: , /7 / c J7 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:\BuildinglPermits\PLM- PermitApp doc 12/03 440-46 16T( 10/02/COM/WEB)
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site Utilities-, ., Qty. Fee (ea) Total„ Square Footage: Permit Fee: ' . .
Footing drain - 1 100' 55.00 0 to 2,000 $1 15.00
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
Qty. ::Fee ( ea) Total . additional $100.00 or fraction thereof, to and
Fixture or'Item 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 r, x) 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 * .
_Quantity.by (Fixture) Work Perfomted
Fixture Type: Replace: '
• . . New • Moved ; eitisting 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 increase of sewer EDUs, a sewer permit will be issued and
Ice Mach. /Refrig. Drains
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 Ouantity Total
- Bradley Isometric or riser diagram is required if fixture quantity
- Commercial total is >9.
- Service
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:
CITY OF TIGARD
BUILDING DIVISION PERMIT #: PLM2007 -00393
13125 SW Hall Blvd., Tigard, OR 97223 Ad. DATE ISSUED: 8/27/2007
Phone: (503) 639 -4171
Inspection Requests (24 Hrs.): (503) 639 -4175 °'I ��
INSPECTION WORKSHEET FOR DATE: 10/23/2007 TIME: 7 :00AM PAGE: 38
SITE ADDRESS: 10516 SW TITAN LN CLASS OF WORK:
SUBDIVISION: BERKLEY ESTA1 ES LOT #: 012 TYPE OF USE:
PROJECT NAME: MILLER
DESCRIPTION: Install bac:Mow device. Job NO. 071364
OWNER: MILLER, DONALD A ¢, PHONE #:
CONTRACTOR: DENNIS' 7 DEES LANDSCAPING PHONE #: 503 -777 -177
Inspection Request Scheduled For: Date: 10/23/2007 Pour Time: t i • 4
Code # Inspection Description Confirm # Contact # M- -s -ge v
r
395 Misc. inspection 058132 -03 503-777-7777 Y i '
Corrections /Comments /Instructions: ra S
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[SS ARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: V (" (/ Date: t 6 /W °--7 Phone #: (503) 718- 2i2-2(