Permit CITY TIGARD PLUMBING PERMIT
t i DEVELOPMENT SERVICES
. . PERMIT #: PLM2006 -00239
� II DATE ISSUED: 5/30/2006
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171
PARCEL: 2S104DC-08800
SITE ADDRESS: 13293 SW WOODSHIRE LN ZONING: R -4.5
SUBDIVISION: MORNINGSTAR LOT: 025 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
KHAVARI
13293 SW WOODSHIRE LN Description Date Amount
TIGARD, OR 97223 [PLUMB] Permit Fee 5/30/2006 $36.25
[TAX] 8% State Surcha 5/30/2006 $2.90
Phone : 503 - 579 -2819 Total $39.15
Contractor:
ESEQUIEL ROBLES LANDSCAPING
7076 RIDGEMONT DR N
KEIZER, OR 97303 REQUIRED ITEMS AND REPORTS
Contact # : PRI 503- 997 -9874
Reg #: PLM 7784
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: ` Permittee Signature: ./ D 4.1X,LY
r `
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.
Buildin Fixtures
R EC rt.-. ii v r_l_ .;
Plu Permit Application Tt)It :offi 'us ONLY ; r
City of Tigard MAY 30 21)06 .. Receive.' 3o D6 ' � Permit j�6 /� "���
a 1 3125 SW Hall Blvd., Tigard, OR 97223 Plan Re w
':: ' C r Phone. 503 639.4171 Fax 503 9f:I�6f1P i 1 � f-' ' j y Other Permit No.
Date/B
Inspection Line: 503.639.41 Juns
TIC K l7 1 TT ,DI.TC , t� 3 31TSI �� D ate Ready/By RI See Page 2 for
Internet: www tigard- or.g i t N r Notified/Method Supplemental Information
TYPE OF WORK FEE* S EDULE
❑ 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 (I) bath 249 20
❑ I- and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 350 00
❑ Accessory building ❑ Multi- family SFR (3) bath 399 00
Each additional bath/kitchen 45.00
❑ Master builder ❑ Other:
Fire sprinkler ( sq. ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities
Job site address: Catch basin or area drain 16 60
City /State /ZIP: A .... g. a (4) cod $1,„0 ( Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: I 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.:
21ksorplio 1 valve 16 60
DESCRIPTION OF WORK (Back flow preventer . Page 2
(ilA C f e f S Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
❑ PROPERTY OWNER ❑ TENANT Drinking fountain 16.60
9 Ejectors/sump 16 60
Name: l ' k ),, 0 Y j - Expansion tank 16 60
Address vsa0.2 Sts I r,,,7Ch e1 S X r r p. t Fixture /sewer cap 16.60
City/State/ZIP-j-'5 Q r 0 ?h F7 3 Floor drain/floor sink/hub 16.60
Phone ) s7 q. , ski ?, Fax: ( ) Garbage disposal 16.60
❑ APPLICANT ❑ CONTACT PERSON Hose bib 16.60
Ice maker 16.60
r
Business name C S eQ t Q S tell a cc/ r. `n9 Interceptor /grease trap 16.60
Contact name: e" . e ? u d t R le h � i '' e c Medical gas (value $ ) Page 2
Address 7 6 i. aS e rK d i o k Primer 16.60
City/State /ZIP''n Ke7: z(1 - O jZ Q 7 3(n Roof drain (commercial) 16.60
Phone ( c'p�) 419 7 ? fe) Fax. : ( ) Sink/basin/lavatory 16.60 _
Tub /shower /shower pan 16 60
E-mail:
Urinal 16.60
CONTRACTOR Water closet 16.60
Business name Water heater 16.60
Address: 7 0?( R, k3e »zeni D ''L/ Other
City /State /ZIP: IQ; 2_ ( ® R 9 . 1 O./ Su btotal
Minimum permit fee: $72.50
Phone: ( +1) ?9 '7 ?lc 7 ,L, Fax: ( ) Residential backflow minimum permit fee. $36.25
"�/ Plan review (25% of permit fee)
CCB Lie.: 7 �/ 1, Plumbing Lice. no.: y 54 F State surcharge (8% of permit fee)
Authorized signature:
TOTAL PERMIT FEE
Print name: 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
I \Bwldmg\Permiis\PLMF- PenmtApp doc 04 /06/06 440 -4616T(I0 /02JCOM/WFB)
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 a 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 Back flow 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
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 Complex Structures
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.
Quantity by (Fixture) Work Performed ❑ Any new commercial building.
Fixture Type: Replace ❑ Any new exterior plumbing site utilities.
Previous Capped Added Existing ❑ 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 The, 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"
-4"
Car Wash Drain Isometric or Riser Diagram
Garbage - Domestic ❑ Isometric or riser diagram is required for new buildings
Disposal -Commercial three (3) or more stories in height.
- Industrial
Ice Mach./Ref ig. 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
Water Closet - Toilet increase of sewer EDUs, a sewer permit will be issued and
Urinal fees assessed for the sewer increase must be paid before the
Other Fixtures: plumbing permit can be issued.
i \Buiidmg\Pertmis\PLM- PennnApp doc 07/06/05
CITY OF TIGARD
BUILDING DIVISION - PERMIT #: PLM200G -00239
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 5/30/2005
Phone: (503) 639-4171 i�
Inspection Requests (24 Hrs.): (503) 639 -4175 °�I:L.
INSPECTION WORKSHEET FOR DATE: 10/6/2006 TIME: 7 :03AM PAGE: 26
SITE ADDRESS: 13 293 SW WOODSHIRE CLASS OF WORK:
SUBDIVISION: MORNINGSTAR LOT #: 025 TYPE OF USE:
PROJECT NAME: KHAVARI
DESCRIPTION: Backflow pre enter for irrigation.
OWNER: KHAVARI PHONE #: 5035752619
CONTRACTOR: ESEQUIEL ROBLES LANDSCAPING PHONE #: 503 - 997 -9874
Inspection Request Scheduled For: Date: •I0 /6 /2006 Pour Time: •
Code # Inspection Description Confirm # Contact # Message
399 Plumbing final 037805 -01 ,.503- 997.9874 Y
Corrections /Comments /Instructions:
A
ff
JJPASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
n FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Q /6/4 , J l
Inspector:(/ Date Phone #: (503) 718-
m
CITY OF TIGARD
. BUILDING DIVISION - PERMIT #: PLM2006 -00239
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 5/3012006
Phone: (503) 639- 4171��� it � +k
Inspection Requests (24 Hrs.): (503) 639 -4175 ' I I..
INSPECTION WORKSHEET FOR DATE: 10/2/2006 TIME: 7:03AM PAGE: 68
SITE ADDRESS: 13293 SW WOODSHIRE LN CLASS OF WORK:
SUBDIVISION: MORNINGSTAR LOT #: 025 TYPE OF USE:
PROJECT NAME: KHAVARI
DESCRIPTION: RacF low preventer for irrigation.
OWNER: KHAVARI, PHONE #: 503 - 579.2819
CONTRACTOR: E SEQUIEL ROIf3LES LANDSCAPING PHONE #: 503,997-9674
Inspection Request Scheduled For: Date: 10/2/2006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
399 Plumbing final 037447 -01 503-997-9874 N
Corrections /Comments/ Instructions:
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n PASS ❑ PARTIAL APPROVAL ❑ CANCEL NO ACCESS
X FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: /47171,r ti p Date: b .2 Phone #: (503) 718- , ""G/ 3 1