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Permit CITY TIGARD PLUMBING PERMIT 4 DEVELOPMENT SERVICES PERMIT #: PLM2006 - 00394 - I 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 8/23/2006 PARCEL: 2S112BC -01200 SITE ADDRESS: 14533 SW 81ST AVE ZONING: R -4.5 SUBDIVISION: DURHAM ACRES LOT: 070 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 JENNINGS, DONALD J AND MARY J Description Date Amount 14533 SW 81ST AVE TIGARD, OR 97224 [PLUMB] Permit Fee 8/23/2006 $36.25 [TAX] 8% State Surcha 8/23/2006 $2.90 Phone : 503- 684 -3943 Total $39.15 Contractor: OWNER REQUIRED ITEMS AND REPORTS Contact # : Reg #: 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 folio les adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 0001 -0010 through OAR 952 - 0001 - 0100. .. • obtain copies of these rules or direct questions to OUNC by calling 503 - 246 -6699 or 1- 800 - 332 -2344. Issued By: " �` ' Permittee Signature. • . * frit 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 pro eft. Approved plans are required on the job site at the time of each inspection. ' Bdifdir g Fixtures Plumbing Permit App V F f) Foit,OFFICE ` USE ONLY. ",. City of Tigard Received O ; (6 Permit No: Li - b '6 yL li u 13125 SW Hall Blvd., Tigard, OR 97 {� O :? Plan Review C Phone: 503.639.4171 Fax: 503.598104 C+ '•• LUU6 Other Permit No.: Date /By: Inspection Line: 503.639.4175 Iu :11 C.AR D e , Date Rea ® See Page 2 for + Internet: www.tigard- or.gov Cif y gj 1 jIj Notified/Method: Supplemental Information - TYPE ;l1" 'OR?' T '% tr I T. FEE* SCHEDULE . ❑ New construction ❑ Demolition For special information use checklist. Description I Qty . j Ea. I Total 1l ■ 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 El 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: / 445-33 6 13 I s A) 1 ,, e Catch basin or area drain 16.60 City /State /ZIP: r r . 8 CD ( 1 7 Z21( 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: co rt a ri:t4 Manholes 16.60 c4 ) V 4lite.. • 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 ; � Back flow preventer Z Page 2 . ..1- 7 h5 #11X. 4 ca-AP J trz+J Z : P rev eu n.�, l J 2.V i C.e _ _ Backwater valve 16.60 Clothes washer 16.60 Dishwasher 16.60 Drinking fountain 16.60 al PROPERTY.. OWNER I ❑ TENANT Ejectors /sump 16.60 Name: bo�4,...\A i Kosmi h , S Expansion tank 16.60 Address: ) cis 33 S L.,13 1 , q 1 s G . 4 ✓e _ Fixture /sewer cap 16.60 City /State /ZIP: (L ed d t © 1 7 Z Floor drain/floor sink/hub 16.60 Phone: ( sj3) (A gi - 3 9 q 3 Fax: ( ) N o N t-- 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 Phone: ( ) I F es:: ( ) Sink/basin/lavatory 16.60 Tub /shower /shower pan 16.60 E -mail: Urinal 16.60 CONTRACTOR Water closet 16.60 Business name: v /�� -1 Water heater 16.60 Address: ` � Other: City /State /ZIP: Subtotal Minimum permit fee: $72.50 Phone: ( ) Fax: ( ) Residential backflow minimum permit fee: $36.25 3p, a5 CCB Lic.: + ��� bing Lic. no.: (25% Plan review (25 of permit fee) �� -�� State surcharge (8% of permit fee) A.7( Authorized signatur• ;t► _I �.4 , .� a o ' e i .. l TOTAL PERMIT FEE . . is Print name: i � l Date: / � This permit application expires if a permit is not obtained within 111111111-. a� ''�' �` 180 days after it has been accepted as complete. *Fee methodology set by Tri - County Building Industry Service Board. 1:\ Building \Permits\PLMF- PertnitApp.dce 04/06/06 \. 440 -0616T(lo /02/COM /WEB) Plumbing Permit Application - City of Tigard 4 - Page 2 - Supplemental Information - Fee Schedule: - Residential Fire Suppression Systems: :'Site Utilities - - Qty. 'Fee (ea) . Total Square-Footage: Permit Fee: . Footing drain - l' 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 :: Permit 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 Qty.. F (ea) To tal additional $100.00 or fraction thereof, to and Fixture or Hein: 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. a I 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 . • Fixt T ype: ,R eplace ❑ ' Aninew e 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 Thru 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 IO ' Any NFPA 13 -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./Refrig. 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 ermit results in an Water Extractor p 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:\ Building \Permits\PLM- PermitApp.doc 07/06/05 CITY OF TIGARD BUILDING DIVISION - PERMIT #: PLM2004 0039 . 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 8123/2006 Phone: (503) 639 -4171 u �✓f!ugpi l ill Inspection Requests (24 Hrs.): (503) 639-4175 INSPECTION WORKSHEET FOR DATE: 9/8/2006 TIME: 7 : 00AM PAGE: 28 for r4 SITE ADDRESS: 14533 SW 81ST AVE CLASS OF WORK: SUBDIVISION: DURHAM ACRES LOT #: 070 TYPE OF USE: PROJECT NAME: JENNINGS DESCRIPTION: Backfiow preventer for irrigation. OWNER: JENNINGS, DONALD J AND MARY J, PHONE #: 503434.3943 CONTRACTOR: OWNER PHONE #: Inspection Request Scheduled For: Date: 91812005 Pour Time: Code # Inspection Description Confirm # Contact # Message 399 Plumbing final 036248 -01 503-437-1173 N Corrections /Comments /Instructions: cf. ----.. ! ,11 . 1) . ASS ❑ PARTIAL APPROVAL ❑ CANCEL _ NO ACCESS FAIL n CALL FOR INSPECTION I I ADDITIONAL FEES ASSESSED Inspector: eine Date: 9 €• 0 C Phone #: (503) 718- 7.4gy