Permit C ITY OF TIGARD PLUMBING PERMIT
DEVELOPMENT SERVICES PERMIT #: PLM2006 - 00510
It DATE ISSUED: 10/24/2006
---. 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171
PARCEL: 25111 DB -16500
SITE ADDRESS: 15065 SW 94TH AVE ZONING: R -4.5
SUBDIVISION: KESSLER ESTATES NO. 2 LOT: 022 JURISDICTION: TIG
Project Description: Installation of residential backflow preventor 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
BRIAN SUNADA Description Date Amount
15065 SW 94TH AVE
TIGARD, OR 97224 [PLUMB] Permit Fee 10/24/200E $36.25
[TAX] 8% State Surcha 10/24/200E $2.90
Phone : 503- 752 -2417 Total $39.15
Contractor:
JEFFERY STEVENSON INC
PO BOX 1372 1`
TUALATIN, OR 97062 -1372 REQUIRED ITEMS AND REPORTS
Contact # : PRI 503 -534 -1080
FAX 503 -534- 1080�'���)'� -'' 1
CIF
Reg #: LIC 6224 L(/I '.4 l o C 0
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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 it work is suspended for more than 180 days. ATTENTION: Oregon law requires you to f flow rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 0001 -0010 through OAR 952 - 0001 -01Q0. You may obtain copies of
these rules or direct questions to OUNC by calling 503 - 246 -6699 or 1- 800 - 332 - 2344.
-
Issu d By: (` J�' 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.
•
CITY TIGARD PLUMBING PERMIT
Akk DEVELOPMENT SERVICES PERMIT #: PLM2006 -00510
- 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 10/24/2006
PARCEL: 2S111DB-16500
SITE ADDRESS: 15065 SW 94TH AVE ZONING: R -4.5
SUBDIVISION: KESSLER ESTATES NO. 2 LOT: 022 JURISDICTION: TIG
Project Description: Installation of residential backflow preventor 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
BRIAN SUNADA
15065 SW 94TH AVE Description Date Amount
TIGARD, OR 97224 [PLUMB] Permit Fee 10/24/200E $36.25
[TAX] 8% State Surcha 10/24/200E $2.90
Phone : 503- 752 -2417 Total $39.15
Contractor:
JEFFERY STEVENSON INC
PO BOX 1372
TUALATIN, OR 97062 -1372 REQUIRED ITEMS AND REPORTS
Contact # : PRI 503 -534 -1080
FAX 503 -534 -1080
Reg #: LIC 6224
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 How rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 0001 -0010 through OAR 952 -000 -01 0. You may obtain copies of
these rules or direct questions to OUNC by calling 503 - 246 -6699 or 1- 800 - 332 -2344.
1 ..
Issu d By: A _daL L'yij 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.
1
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Plumbing Permit Application - _I t)
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Ill City of Tigard /l, ;41/ �� (4.71)-----6 Permit No.: / L.yae:e -DOS�d
a 13125 SW Hall Blvd:, Tigard, OR 97223
Ill Phone: 503.639.4171 Fax: 503.598.1960 Plan Review
Date/By: • Other permit No.:
Inspection Line:: 503.639.4175 Date Ready/By:
® See Pa e 2 for
I PG'i� Et n Internet: www.tigard- or.gov Notifie/ethd: l Su lemental lotormation
TYPE OF WORK • FEE* SCHEDULE
❑ New construction ❑ Demolition _ For special information use checklist
Description 1 Qty. 1 Ea. 1 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
® 1- and 2- family dwelling ' ❑ Cornmercial/industrial ,SFR (2) bath 350.00
❑ Accessory building .. ❑ Multi- family . 'SFR (3) bath 399.00
❑Master builder Each additional bath/kitchen 45.00
❑� Fire sprinkler ( sq. ft.) Page 2
• JOB SITE INFORMATION AND LOCATION • Site utilities
Job site address: 15065 SW 94th Catch basin or area drain 16.60
City/State/ZIP: Tigard, OR 97224 • Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no .: l Project name: - Footing drain (no. linear ft.: ) Page 2
Manufactured home utilities • 110.00
Cross street/directions to job site: SW Sattler St.
Manholes - 16.60
Turn west on Sattler off SW Hall Blvd. Turn north on SW 94". Third house on the 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 1 Page 2 36.25
Install backflow preventer for new outside irrigation system. Backw valve 16.60
LIBDI #6224 Clothes washer 16.60
Dishwasher . . 16.60
® PROPERTY OWNER . Drinking fountain 16.60
• El
Ejectors/sump 16.60
Name: Brian Sunada
Expansion tank 16.60
Address: 15065 SW 94th Fixture/sewer cap 16.60
City/State/ZIP: Tigard, OR 97224 Floor drain/floor sink/hub 16.60
Phone: (503)752 -2417 Fax: ( ) Garbage disposal 16.60
® APPLICANT . . ® .CONTACT PERSON Hose bib 16.60
' - Ice maker 16.60
Business name: JSI Landscapes Inc.
Interceptor /grease trap 16.60
Contact name: Paul Welty Medical gas (value: $ ) Page 2
Address: P.O. Box 1372 Primer - .16.60
City/ State/ZIP: Tualatin, OR 97062 Roof drain (commercial) 16.60
Phone: (503) 534 -1080 Fax: : (503) 534 -1080 Sink/basin / lavatory 16.60
Tub /shower /shower pan . 16.60
E -mail: paul @jsilandscapes.com Urinal 16.60
CONTRACTOR : Water closet 16.60
Business name: JSI Landscapes Inc. Water heater 16.60
Address: P.O. Box 1372 Other:
City/State /ZIP: Tualatin, OR 97062 Subtotal
Minimum permit fee: $72.50 36.25
Phone: (503 -) 534 -1080 Fax: (503) 534 -1080 Residential backflow minimum permit fee: $36.25
CCB Lic.: 6224 4/b6k7 Plumbing Lic. no.: 6224 Plan review (25% of permit fee) .
- State surcharge (8% of permit fee) • 2.90
Authorized signature: : / A f i , TOTAL PERMIT FEE 39.15
Print name: Paul G. Welty I Date: 10/23/06 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.
•
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 , $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 1 27.55 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
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 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 *. ❑ My 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 ❑ Any new exterior plumbing site utilities.
Baptistry/Font ❑ Medical gas and vacuum systems for health care facilities.
Bath - Tub /Shower ❑ Any multipurpose fire sprinkler system. .
- Jacuzzi/Whirlpool ❑ Any complex structure as defined in OAR918- 780 -0040.
Car Wash -Each Stall
-Drive Tiro Submit 2 sets of plans with any of the above.
Cuspidor/Water Aspirator -
Dishwasher - Commercial
Domestic Isometric•or Riser Diagram
Drinking Fountain ❑ Isometric or riser diagram is required for new buildings
Eye Wash that meet the qualifications above.
. Floor Drain/sink - 2"
•
4 ., Comments regarding fixture work:
Car Wash Drain •
Garbage - Domestic
Disposal -Commercial
-Industrial
Ice Mach./Refrig. Drains
Oil Separator (Gas Station)
Rec. Vehicle Dump Station
Shower - Gang • *Note: u the fixture work under this permit results in an
- Stall increase of sewer EDUs, a sewer permit will be issued and
Sink - Bar/Lavatory , • fees assessed for the sewer increase must be paid before the
- Commercial plumbing permit can be issued.
-Service _
Swimming Pool Filter
Washer - Clothes -.
Water Extractor
Water Closet - Toilet
Urinal •
Other Fixtures: •
•
INSPECTOR'S SIGNATURES ARE NOT
Inspections Required for: i ;006.. 00516 REQUIRED ON GREEN INSPECTION CARD.
L✓ Code Inspection Description PASS Date By ✓ Code Inspection Description PASS Date I By
BUP - Building Permit ELC - Electrical Permit
405 Excavation 105 Underground/slab cover
410 Fill 110 Temporary electrical service _
415 Grading 115 Electrical service
205 Footing 120 Electrical rough -in
805 MFG - Structure grading/footing 125 Wall cover _
210 Foundation walls 130 Ceiling cover
215 Footing drain 135 Low voltage
220 Slab 140 Sign installation
310 Crawl drain 145 A/C or heating unit circuit
225 Post/beam structural 150 Hot tub /spa /pool
230 Underfloor insulation 195 Misc. inspection:
235 Shear walls /anchors 199 Electrical final
240 Exterior sheathing
245 Firewall
250 Roof nailing ELR - Restricted Energy Permit
255 Wtr proofing basement walls 135 Low voltage
260 Tilt -up panel 195 Misc. inspection:
265 Masonry 199 Electrical final
270 Reinforcing steel (rebar)
275 Framing _
810 MFG- Structure set-up MEC - Mechanical Permit
280 Insulation 605 Post/beam mechanical
285 Drywall nailing 610 Gas line
287 Suspended ceiling 615 Mechanical rough -in
295 Misc. inspection: 620 Hydronic piping
899 MFG- Structure final 625 Duct work
498 Grading final 630 Fire damper
299 Final inspection 635 Smoke detector shutdown
640 Exhaust hood
695 Misc. inspection:
699 Mechanical final
BUP - Fire Protection System Permit
905 Sprinkler underfloor /slab PLM - Plumbing Permit
910 Sprinkler rough -in 305 Plumbing underslab
915 Fire alarm rough -in _ 310 Crawl drain
920 Suppression trip test 315 Post/beam plumbing
995 Misc. inspection: 320 Plumbing rough -in
998 Alarm final 322 Shower pan
999 Sprinkler final 330 Water service
335 Rain drain
340 Storm drain
SIT __ Site Work Permit 505 Sanitary sewer
405 Excavation I _ 345 Culvert /catch basin __ I
410 Fill l 350 Septic tank
415 Grading 1\-.99 395 Misc. inspection: __
205 Footing Plumbing final
210 Foundation walls
215 Footing drain
r 420 Sprinkler supply lines SWR - Sewer Permit
495 Misc. inspection: 505 Sanitary sewer _
_ 498 Grading final I 595 Misc. inspection:
499 Final inspection J L- 599 Final inspection
I.\Bu ilding\Inspection Cards \Forms\AOP- InspCard- Blank.doc 12/09/2005
CITY OF TIGARD (A% l'e-sk ri:t •
BUILDING DIVISION PERMIT #:
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED:
Phone: (503) 639 -4171 A oar l i
Inspection Requests (24 Hrs.): (503) 639 -4175 ..:' ''i I 1
INSPECTION WORKSHEET FOR DATE: TIME: PAGE:
L , ' t 1 -(*. SITE ADDRESS: S e.32 cce 5, CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME:
DESCRIPTION:
_OWNER �} PHONE #:
(�NTRACTOR - , i t ( Q / Se ,, PHONE #:
Inspection Request Scheduled For: Date: Pour Time:
Code # Inspection Description Confirm # Contact # Message
3q C et- - ci OW - d nz..c L -41L A
Corrections /Comments /Instructions:
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I I PASS PARTIAL APPROVAL ❑CANCEL TA:S NO ACCESS
I I FAIL n CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Zi
Date: Phone #: (503) 718-