Permit CITY TIGARD PLUMBING PERMIT
AK l � DEVELOPMENT SERVICES PERMIT #: PLM2005 -00535
1 3125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 10/11/2005
PARCEL: 1S134CA-08300
SITE ADDRESS: 11168 SW 117TH TERR ZONING: R -4.5
SUBDIVISION: FEHRENBACHER LOT: 004 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
PAYS CUSTOM HOMES INC Description Date Amount
17481 SW HOODOO CT
BEAVERTON, OR 97007 [PLUMB] Permit Fee 10/11/200; $36.25
[TAX] 8% State Surchaq 10/11/200E. $2.90
Phone : 503 475 - 5041 Total $39.15
Contractor:
BLAZER LANDSCAPE
13995 SW FERN ST. REQUIRED ITEMS AND REPORTS
TIGARD, OR 97223
Phone : 503- 998 -1507
Reg #: PLM 6872
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 . re set forth in OAR
952 - 0001 -0010 through OAR 952 - 0001 -0100. You may obtain copies of these rules or dirt t qua to OUNC by
calling 503 - 246 -669 or 1- 00- 332 -2344.
Issued By: 4) 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 am required on the job site at the time of each inspection.
• ' Building Fixtures c `,
Plumbing Perms,, e_ggi tllg® f. FOR OFFICE USE ONLY • .
City of Tigard 2005 Date/By. � 1'0 I 1 I O, bh Permit No. 7T �4
13125 SW Hall Blvd., Tigard, OR 913T A n1 Plan Review Phone: 503.639.4171 . Fax: 503.59 6 TIDA RD r.//xr Other Permit No.:
24- Hour Inspection Line: 503.639 -m/ OF aJ� DateBy.
Internet: www.ci.tigard.or.us v4 5J1 ONISIO Notified/Method: r, Date Ready/By: t°9S . V lb ® See Page 2 for
BUII DING Supplemental Information
TYPE OF WORK FEE* SCHEDULE ,
❑ New construction ❑ Demolition For special information use checklist.
Description I Qty. I Ea. I Total
❑ Addition /alteration/replacement ❑ Other: New 1 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
❑ Master builder Each additional bath/kitchen 45.00
❑ Other: Fire sprinkler ( sq. ft.) Page 2
JOB SITE INFORMATION AND LOCATION .
111.1 6 cg . C4 (17'L t 'tilt : C a t utilities
n
Job site address: .
C basin or area drain 16.60
City /State/ZIP: 1 ( • ef ct OK Drywell, leach line, or trench drain 16.60
Suite/bldg./apt. no.: I Project name: Footing drain (no. linear ft.: ) Page 2 kok Manufactured home utilities 110.00
Cross street /directions to job site: �( J�
/ ` ' v (� ( . 44/ 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 WO K Back flow preventer Page 2
rJ GZC ' Lc.) Cy' Srf -`11 K ef = Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
❑ PROPERTY OWNER ❑ TENANT Drinking fountain 16.60
Ejectors/sump 16.60
Name: pry S (C45 X 2 Expansion tank 16.60
Address: � Fixture /sewer cap 16.60
City /State /ZIP: Floor drain/floor sink/hub 16.60
Phone: ( ) Fax: ( ) 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: ( ) Fax:: ( )
Sink/basin/lavatory 16.60
Tub /shower /shower pan 16.60
E -mail:
Urinal 16.60
CONT CTO Water closet 16.60
Business name: 6 l,,- � Sr 4 Water heater 16.60
Address: T3_15.,____ i� 514/ Feril 1' Other:
City /State /ZIP:
� �J 22■
M inimum permit fee: $72.50 .
Phone: (. (rj J,) fqx- /s-0-7 Fa x: ( ) Residential backflow minimum permit fee: $36.25
CCB Lic.: / 6 k Z P Lic. no.: Plan review (25% of permit fee)
Authorized signature:
ii State surcharge (8% of permit fee)
TOTAL PERMIT FEE
Print name: W AV :4 v/ S C -ercf 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.
is 1Building \Permits\PLMF- PennitApp.doc 06/05 440-4616T(10/07JCOM/WEB)
Plumbing Permit Application - City of Tigard ,
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site Utilities, - . Qtr• Fee.(ea) , Total Square Footage: _Permit Fee:, _ •
Footing drain - l' 100' 55.00 0 to 2,000 $1 15.00
Footing drain - each additional 100' 46.40 2,001 to 3,600 $160.00
3,601 to 7,200 $220.00
Sewer - I st 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
additional $100.00 or fraction thereof to and
Fixture Or Item • Qty. F (e a) Total 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 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.
• Qu (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 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
CI 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 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:\ Building \Permits\PLM- PennitApp.doc 07/06/05
CITY OF TIGARD
BUILDING DIVISION PERMIT #: PLM2005-00536
13125 SW Hall Blvd., Tigard, OR 97223 -� — DATE ISSUED: 10/11/2006
Phone: (503) 639 -4171 ve fi�� 1p , 1\
Inspection Requests (24 Hrs.): (503) 639 -4175 I.E. qS.S
• INSPECTION WORKSHEET FOR DATE: 10/14/2005 TIME: 7:02AM PAGE: 125
SITE ADDRESS: 11168 SW 117TH TERR CLASS OF WORK:
SUBDIVISION: FEHRENBACHER LOT #: 004 TYPE OF USE:
PROJECT NAME: FEHRENBACHER
DESCRIPTION: Backfiovw preventer for irrigation.
OWNER: PAYS CUSTOM HOMES INC, PHONE #: 503- 475 -5041
CONTRACTOR: BLAZER LANDSCAPE PHONE #: 503 -998 -1507
Inspection Request Scheduled For: Date: 10/14/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Me �e i 3 3 99 g final 018261 -01 503-475-5041 0
Corrections/Comments/Instructions:
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PASS f PARTIAL APPROVAL ❑ CANCEL NO ACCESS
. F4 ' IL 1 I CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
\/('-( Date: 1, 6/ �VO
Phone #: (503) 718-