Permit CITY OF TIGARD
BUILDING DIVISION PERMIT #: pl M20 )f 0( 5%6
13125 SW Hall Blvd., Tigard, OR 97223 D ATE ISSUED: 12114/20;)7
Phone: (503) 639 -4171 ' ,� j.
Inspection Requests (24 Hrs.): (503) 639 -4175 4±i' •
INSPECTION WORKSHEET FOR DATE: 1/29/2008 TIME: 7 : 02AM PAGE: 53
SITE ADDRESS: 09175 sw El`){ EWOO() ,-roT CLASS OF WORK:
SUBDIVISION: EDGE:WOOD LOT #: ()13 TYPE OF USE:
PROJECT NAME: S 3BE, •
DESCRIPTION: Installation of storm drain s {jstern for outbuilding, less than 100'.
OWNER: SABRE, PE1Viii PHONE #: 503 - 639.44113
CONTRACTOR: POWER PLUMBING CO PHONE #: 503244i- 1900
Inspection Request Scheduled For: Date: 1/29/2008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
359 Plumbing final 0640813 -01 503-6394443 Y
Corrections/Comments/Instructions:
CA rt. ci Lc ( 91.-• - )
V:t PASS ❑ PARTIAL APPROVAL fl CANCEL I I NO ACCESS
FAIL _ CALL FOR INSPECTION III ADDITIONAL FEES ASSESSED
Inspector: \11 1\--4 ii pci l o Phone #: (503) 718-
IN
r "r . ':CITY OF TIGARD PLUMBING PERMIT
„'= °.. , COMMUNITY DEVELOPMENT PERMIT #: PLM2007 -00556
'
TIG 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 12/14/2007
PARCEL: 2 S 102 DC - 00505
SITE ADDRESS: 09175 SW EDGEWOOD ST ZONING: R - 4.5
SUBDIVISION: EDGEWOOD LOT: 013 JURISDICTION: TIG
PROJECT: SABBE
Project Description: Installation of storm drain system for outbuilding, less than 100'.
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: 100 ft
Owner: FEES
REMI SABBE
9175 SW EDGEWOOD ST Description Date Amount
TIGARD, OR 97223 [PLUMB] Permit Fee 12/14/2007 $72.50
[TAX] 8% State Surcha 12/14/2007 $5.80
Phone : 503- 639 -4443 Total $78.30
Contractor:
POWER PLUMBING CO
PO BOX 19418
PORTLAND, OR 97280 REQUIRED ITEMS AND REPORTS
Contact # : PRI 503- 244 -1900
FAX 503- 244 -8825
Reg #: LIC 52378
PLM 34 -150PB
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 irect q :stions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued B I Permittee Signature: .s
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
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ly; '; City of Tigard
Date/By: l i '� 6 !, Permit No.: /IF ?iCO
IN
n 131 S W Ha ll Blvd., Tigard, OR 97223 D . y .�
0 ". Phone: 503.639.4171 Fax: 503.598.1960 Plan Review aA • �v
Date/By:
Permit No.: r o
= Inspection Line: 503.639.4175 Date Ready /By: ruri " See Page 2 for
4. I CAIZD; /�
Internet: www.tigard or.gov Notified/Method: ��f . Supplemental Information
. TYPE" OF WORK .FEE* SCHEDULE
[�] New construction ❑ Demolition For special informotiion use checklist
Description 1 Qty. 1 Ea. 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 ❑ 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: 9 (is 5� e. a (�c) b Catch basin or area drain 16.60
Drywell, leach line, or trench drain 16.60
City /State /ZIP: -
1161A ) C G [ 7. Z -
Suite/bldg. /apt. no.: Project name: j ct\ l .. Footing drain (no. linear ft.: _) Page 2
Manufactured home utilities 110.00
Cross street/directions to job site:
Manholes 16.60
Rain drain connector 1 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
0 L.A. O � � 1 . v16. ex/l._ (o-- L/• .e,(e C-2- � i � Backwater valve 16.60 .
22- x - L( - ( Cc vtti F V U c - - 140 l i, \ r t�- e Clothes washer 16.60
Dishwasher 16.60
2 PROPERTY' OWNER . . ( ❑ _ TENANT Drinking fountain 16.60
Ejectors /sump 16.60
Name: v/k e:;,_ CIl Expansion tank 16.60
Address: t--1 S Sup _ �� c- 04:)o.(p S t' Fixture /sewer cap 16.60
City /State /ZIP: ,--- 0... ip y o it__ q-.-Z----c Floor drain/floor sink/hub 16.60
Phone: (503) 6 - -c( , ({ c.(cF 3
Fax: ( ) Garbage disposal 16.60
Hose bib 16.60
F] APPLICANT ❑ CONTACT PERSON
Ice maker 16.60
Business name. -per l a( - SC,1 t f I/A C6 , Interceptor /grease trap 16.60
Contact name: F 7 Q� L7P � r Medical gas (value: $ ) Page 2
Address: a c - CA c2C, gk. (.3 n� Primer 16.60
City /State /ZIP: ./r Lc:4A c) Imo: 1-7 p 07 Roof drain (commercial) 16.60
1 Sink/basin/lavatory 16.
Phone: ( 9 2.4('--( j6 3 I Fax: (( 1 . 2... - 2- e - l 6,0 `T
Tub /shower /shower pan 16.60
E -mail: Urinal 16.60
CONTRACTOR . ' " -. ' Water closet 16.60
Business name: ' 91rC - 3 S _/ 1 .1 ? � B iQ. tto,.(�)1, Water heater 16.60
Address: Other:
City/State /ZIP: Subtotal
Minimum permit fee: $72.50 7�
Phone: ( ) Fax: ( ) Residential backflow minimum permit fee: $36.25 .
CCB Lic.: Plumbing Lic. no.: Plan review (25% of permit fee)
State surcharge (8% of permit fee) 5
Authorized signature: _. TOTAL PERMIT FEE 7g-30
•
Print name: of in e _ l ys I Date: 1117,0/0 "2 This permit application expires if a permit is not obtained within
L �1 180 days after it has been accepted as complete.
*Fee methodology set by Tri -County Building Industry Service Board.
I.\ Building \Permits\PLMF- PermitApp.doc 12/27/06 440- 4616T(I0 /02/COM/WEB)
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
• Site Utilities qtr.' Fee (ea) Teti Square Footage: P Fee:
Footing drain - 1s' 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 •
Storm &Rain Drain - 1st 100' 55.00 Valuation: Permlt Fee:.
$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
Fl%ture 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 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
Future 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