Permit CITY TIGARD PLUMBING PERMIT.
, 14, DEVELOPMENT SERVICES PERMIT #: PLM2005 -00134
ca l 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 4/6/2005
PARCEL: 2S 111 BC -01700
SITE ADDRESS: 10265 SW VIEW TERR ZONING: R -3.5
• SUBDIVISION: GREENBRIER LOT: 001 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 •
STACK, RICHARD W JUDITH C Description Date Amount
10265 SW VIEW TERR
TIGARD, OR 97224 [PLUMB] Permit Fee 4/6/2005 $36.25
[TAX] 8% State Surchari 4/6/2005 $2.90
Phone : 503 639 - 4537 Total $39.15
Contractor:
ESAU RODRIGUEZ
8016 SE 65TH AVE REQUIRED ITEMS AND REPORTS
PORTLAND, OR 97206
Phone : 503- 260 -4927
Reg #: LIC 14783
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 u to follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952- 01 -0010 through OAR 952 - 0001 -0100. You may obtain copies of these rules . direct questions to OUNC by
call ng 503 - 246 -6699 0 - 0 - 332 -2344.
.
Iss ed By: Permittee Signature: d, u „_�
Call 503 - 639 -4175 by 7:00 a.m. for an inspection that busine- s 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.
BtRiltint'' g Fixtures
.. ,
Plumbing Permit Applicatibn FOR OFFICE USE ONLY
City of Tigard
A Received A I Permit No ,
Date/By. 7 I 4 06
Plan Review /
, / i351
ali5
13125 SW Hall Blvd., Tigard, OR 97223
Phone: 503.639.4171 Fax 503 598.1960 1 474 - Ali-Al A Date/By: Other Permit No.:
24- Hour Inspection Line: 503.639 4175 • 4 , Date Ready/By
_ El See Page 2 for
, ......
Internet: www ci.tigard.or.us Notified/Method / (a., Supplemental Information
" ' '' ``;'' ''. - ...- ' •-' ''' ' ' ''''' '' TYPE OF WORK" =
...' 7"- '": ' - "I'' , '' ' k' -. . --: ''':,'''' -: .''' - ' ', ''' ::''''-:,-- -: FEE* SCHEDULE
- . 4 - ,.I. , ' .‘`i' . . ',. ''':'';'=.• ''''` '•'- ' ' . 1 , .. •:`^.-, ',..-'•'• • ''''''','? --'• — Y. ''' ' '-' ' ',? —,,,,•-' • ,- ', • ;, .-,, -.,,, :- .- .. ', t.. ^ . • ' -
0 New construction 0 Demolition For special information use checklist.
Descnption I Qty. I Ea I Total
Addition/alteration/replacement 0 Other: New 1 2 dwellings (includes 100 ft for each utility connection)
l•-r -_;i„
y f ' '; C :1 7: ;'' ' . CATEGORY OF CONSTRUCTION .,-...;. ''.....„!, , .... SFR (1) bath
-g 1- and 2-family dwelling 0 Commercial/industrial SFR (2) bath 350 00
SFR (3) bath 399.00
ID Accessory building 0 Multi-family
Each additional bath/kitchen 45 00
El Master builder 0 Other:
.
Fire spnnkler ( sq ft ) Page 2
.. i,
.,„ _ .,;--, - •;•.. ,: Vi.iii;Jpg SITE INFORMATION AND LOCATION .,, . ,.... ' - -
Site utilities
Job site address: 1 (Q (0 5--- ,.1.j . V - Ter ir, Catch basin or area drain 16 60
City/State/ZIP: - DO I at.A4 Ok or, cr-iag_. Drywell, leach line, or trench drain 16.60
Footing drain (no linear ft. ) Page 2
Suite/bldg./apt. no.: V I Project name:
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
Water service (no linear ft. ) Page 2
Subdivision: Lot no.:
Fixture or item
Tax map/parcel no.:
. Absorption valve 16 60
' , ; '.;. --,11:- ', ,,' ' .•' '', scitEFTIoN QF woRx..• : ,_ ..i, _%,,; , ,
' '' ' '1.: ^: ''., Backflow preventer i Page 2
Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16 60
,
%.: ' . Drinking fountain 16.60
'0 PRO ' :- ''
PERfi' .' -.' ' ;' I -, i'' -- ,:'. -'.." E. TENANi, `J,%.:
Ejectors/sump 16 60
Name: ) tk, (LAtr P e sq...
....
Expansion tank 16 60
Address: 10 9,. SS-4 V i.e.s.t) Tv Y . Fixture/sewer cap 16.60
..
City/State/ZIP: TA, a 0 Lt q / g.- 1._e2 Floor drain/floor sinlc/hub 16.60
Phone: (50i) b _ e 5 7 Fax: ( ) Garbage disposal 16.60
Hose bib 16 60
— -
=1 APPLICANT - ' ' ' " o- CONTACT PERSON , '
- , - ' '- Ice maker 16 60
Business name: L t ,,,,,, 1,( ‘,_ 9 , i , Lcv ,
Interceptor/grease trap 16 60
Contact name: t` tit 1 4 a - 4-,,t k Medical gas (value: $ ) Page 2
Address: 1S5-- 0 aG- - i3novt.e._, F-e-v- -Rd, Pnmer 16.60
City/State/ZIP: S cd &4 i ii, 0 r_., 'I 740:: Roof drain (commercial) 16 60
Sink/basin/lavatory 16 60
Phone: (5b 2) ( Fax: : ( )
Tub/shower/shower pan l6.60
E-mail:
Urinal 16 60
cc't9 CONTRACTOR -- - ." , .. :-
R ::- .-- Water closet 16.60
Business name: t c tAdi Qct v_ ( ee.. z ... Water heater 16 60
Address:CA() t (,,, sr ( 0 6 --- . itt, 4 (1 -e_ - Other:
Subtotal
City/State/ZIP: 1?0-v--4-1 0 a f - eg 00
Minimum permit fee. $72 50
Phone: (5t,S ) L /co 7' T Fax: (5-03) L g I 0 7 Is- i Residential backflow minimum permit fee. $36 25 . .../,0 •" 1-4)
CCB Lie.: : 5 -- j g ci Plumbing Lie. no.: 1, y 7g. Plan review (25% of permit fee)
State surcharge (8% of permit fee) 0
Authorized signature: ‘ ' ° , . I 1
. , , ... -,,, b. k • 2-• 9
TOTAL PERMIT FEE c 3f 1 . /5
Print name: 1 i Date: CeLios This permit application expires if a permit is not obtained within
180 days after it has been accepted as complete.
*Fee methodology set by Tn-County Building Industry Service Board.
1 \ Buildmg \Pcnruts \PLMF-PennitApp doc 12/03 440-4616T(i 0/02/COM/WEB)
Plumbing Permit Application - City of Tigard
r
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 $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.
$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 Performed • •
Fixture Type: Replace
} New Moved Existing 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
Ice Mach./Refrig. 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
Commercial Isometric or riser diagram is required if fixture quantity
- 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.
i.\Buiiding\Pemuts\PLM- PemtiV+pp doc 3/03
•
CITY OF TIGARD y •
BUILDING DIVISION PERMIT #: PLM2005 -00134
.13125 SW Hall Blvd., Tigard, OR ,97223 DATE ISSUED: 4/6!2005
• A
Phone: (503) 639- 4171f1l?l
Inspection Requests (24 Hrs.): (503) 639 -4175 ^__..
INSPECTION WORKSHEET FOR DATE: %7/6/2005 TIME: 7:12AM PAGE: 4
SITE ADDRESS: 10265 SW VIEW TERR CLASS OF WORK:
SUBDIVISION: GREENBRIER LOT #: 001 TYPE OF USE:
PROJECT NAME: STACK
DESCRIPTION: Installation of residential backflow prevention device for irrigation.
OWNER: STACK, RICHARD W JUDITH C, PHONE #: 503 -639 -4537
CONTRACTOR: RODRIGUEZ, ESAU PHONE #: 503.260.4927
Inspection Request Scheduled For: Date: 7/6/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
325 RP /backflow preventer 010036 -01 503-639.4537 N
Corrections /Comments /Instructions:
•
s,
(PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Date: Phone #: (503) 718-