Permit C ITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT PERMIT #: PLM2008 - 00328
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 8/5/2008
PARCEL: 25111 BC -05000
SITE ADDRESS: 14730 SW 103RD AVE ZONING: R -3.5
SUBDIVISION: MITCHELL - GALICH PARTITION LOT: 002 JURISDICTION: TIG
PROJECT: YOX
Project Description: Installing backflow preventer.
CLASS OF WORK: ALT 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
ROUNDSTONE CONSTRUCTION CO. Description Date Amount
9550 SW BEAVERTON- HILLSDALE
HIGHWAY
BEAVERTON, OR 97005 [PLUMB] Permit Fee 8/5/2008 $36.25
[TAX] 12% State Surch 8/5/2008 $4.35
Phone : 503- 619 -4668 Total $40.60
Contractor:
MARK BROWN LANDSCAPING
PO BOX 744
VANCOUVER, WA 98666 -0744 REQUIRED ITEMS AND REPORTS
Contact # : PRI 503- 234 -2667
FAX 360 - 993 -5993
Reg #: LIC 5192
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 g.oJa-_
Utility Notification Center. Those rules are set forth in OAR 952 - 0001 -0010 through OAR 952 - 0001 -0100. You ma.,obta co pies of
these rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued B , 11111111Fr 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.
•
Plumbing Permit Application
• Building Fixtures FOR OFFICE USE ONLY
1 3 1 `y g an 25 of Ti d q Date/By: y: Received p Air r' ennit No.: /4.12 I a e 13125 SW Hall Blvd., Tigard, OR 7223 5 Vt%
``11 Plan Review
: P hone: 503.639.4171 Fax: 5O3.598.196(� . p Date/By: Permit No.:
y: „CZ 8 - �/�,b��
Inspection Line: 503.639.4175 �± ®® Ready/By: Page 2 for
T IGARD ���i71r` Date ReaY B Y Ju ris: ® See Pa B
Internet: www.tigard- or.gov VY� DV 1S,® + otified/Method: -- /T6, Supplemental Information
TYPE OF WO . 31 1 03 �� i FEE* SCHEDULE
El New construction Demolition For special information use checklist
Description I Qty. I 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
❑ I- and 2- family dwelling El Commercial /industrial SFR (2) bath 350.00
El Accessory building ❑ Multi - family SFR (3) bath 399.00
Each additional bath/kitchen 45.00
El Master builder ❑ Other:
Fire sprinkler ( sq. ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities
Job site address: /'( sit/ /03.46#47-1°- Catch basin or area drain 16.60
City /State /ZIP: Tt '� yor)c
Drywell, leach line, or trench drain 16.60 Suite/bldg. /apt. no.: / I Project name: Footing drain (no. linear ft.: ) Page 2
Cross street/directions to job site:
Manufactured home utilities 110.00
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.: Absorption valve 16.60
DESCRIPTION OF WORK Backflow preventer / Page 2 S5
�) Backwater valve 16.60 . • • Clothes washer 16.60
Dishwasher 16.60
PROPERTY OWNER l ❑, TENANT Drinking fountain 16.60
Ejectors /sump 16.60
Name: 4741001 re- ' / s ' // Expansion tank 16.60 _.
Address: f C b� / 1 �c. U Fixture /sewer cap 16.60
City /State /ZIP: C.V g70 Floor drain/floor sink/hub 16.60
Phone: ( 3 731 6, (9 - 7 ( J- Fax: ( 33) � 3SY J Garbage disposal 16.60
❑ APPLICANT CONTACT PERSON Hose bib 16.60
Ice maker 16.60
Business name: Interceptor /grease trap 16.60
Contact name: (A 51" Medical gas (value: $ ) Page 2
Address: 7 53 5 6T ! J-r-c�-k Gt/ Wl� Primer 16.60
City /State /ZIP: 07.-- 0 q �� Roof dram (commercial) 16.60
L Sink/basin/lavatory
lavatory 16.60
Phone:()) 6 II' 96.65 F a x :
Tub /shower /shower pan 16.60
E -mail: Urinal 16.60
CONTRACTOR Water closet 16.60
r
Business name: w &at f (� s o „„ Water heater 16.60
L./ " �`�"
Address: P, 0 , a ')' Other:
` Subtotal
City /State /ZIP: /i� � Cud( 94944
& Minimum permit fee: $72.50
Phone: (,) „,2 3y a to G 7 Fax: ( ) _ Residential backflow minimum permit fee: $36.25 360,
CCB Lic.: 5 j 9 Plumbing Lic. no.: Plan review (25% of permit fee)
/ % /�� / State surcharge (12% of permit fee) L(, 3`S
Authorized signature: ; , � /`. TOTAL PERMIT FEE liaGo
Print name: W4 l/ / /L 4 .3 j - di p1 Date: 8-S p- O 8 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 \Building\Permits\PLMF- PermitApp.doc 12/27/06 440- 4616T(] 0 /02 /COM /WEB)
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 - 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: 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
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
and including $50,000.00.
specially requested inspections - per hour 72.50
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 *. E) Any 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. El 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.
• - 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
CITY OF TIGARD
BUILDING DIVISION PERMIT #: Pl M2008 0030
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 815/2008
Phone: (503) 639 -4171 ittnin ii
Inspection Requests (24 Hrs.): (503) 639 -4175 � ..'1 __..
INSPECTION WORKSHEET FOR DATE: 8/517008 TIME: 7. AM PAGE: 14
SITE ADDRESS: 14730 SW 103RD AVE CLASS OF WORK:
SUBDIVISION: MITCHELL GALICH PARTITION LOT #: 002 TYPE OF USE:
PROJECT NAME: YOX
DESCRIPTION: Insielling bacisflow preventer.
OWNER: ROUNDSTONE CONSTRUCTION CO., PHONE #: 503
CONTRACTOR: MARK BROWN LANDSCAPING PHONE #: 503 234
•
Inspection Request Scheduled For: Date: 8/6/2008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
399 Plumbing final 073810 -01 503-320-2703 Y
•
Corrections /Comments /Instructions:
D ,) 1 c_., Te , - mot.
ca rte f a r., 4A.--.TA jilA
XPASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
I 1 FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Q x\ viw,. Date: ?AC 1 071 Phone #: (503) 718-