Permit CITY TI CARD PLUMBING PERMIT
AI X DEVELOPMENT SERVICES PERMIT #: PLM2005 -00117
tj 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 3/22/2005
PARCEL: 2S109DD -00300
SITE ADDRESS: 12685 SW BEEF BEND RD ZONING: R -7
SUBDIVISION: LOT: JURISDICTION: TIG
Project Description: Installation of backflow prevention device for irrigation.
CLASS OF WORK: NEW 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
RIVERSIDE HOMES Description Date Amount
1925 SW AMBERGLEN PKWY STE 250
BEAVERTON, OR 97006 [PLUMB] Permit Fee 3/22/2005 $36.25
[TAX] 8% State Surcharl 3/22/2005 $2.90
Phone : 503 645 - 0988 Total $39.15
Contractor:
ALL METRO LANDSCAPE
PO BOX 1812 REQUIRED ITEMS AND REPORTS
BEAVERTON, OR 97075
Phone : 503- 642 -1350
Reg #: LIC 7908
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 18P days. ATTENTION: Oregon law
requires o follow rules adopted by the Oregon Utility Notification Center. T •se rules are set forth in OAR
952- 1 -0010 thro gh • R 952 - 0001 -0100. You may obtain copies of these r les or direct questions to OUNC by
calli g 503 - 246 -6699. 1 -80 � - 332 -2344.
Issu d By: _ F / /� Permittee Signature 4 4
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.
I- I. .
Plumbing Permit Application , •' ''• / FOR OFFICE'USE` '" '
City of Tigard Received Al 7 at Permit No.: PLl'/J�J� 17
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review ��
Phone: 503.639.4171 Fax: 503.598.1960 tj fl'' I Date/By: Other Pernut No.:
24- Hour Inspection Line: 503.639.4175 „!: °� II ' Ready/By: Read /B Page El See Pa e 2 for
Internet: www.ci.ti ard.or.us ��
g Notified/Metho 1 Supplemental Information
TYPE OF WORK FEE* SCHEDULE
-New construction ❑ Demolition For special information use checklist.
Description Qty. Ea. I 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: (2( S to 11l• P (2.y� Catch basin or area drain 16.60
City/State /ZIP: Drywell, leach line, or trench drain 16.60
u ` 1 � A Footing drain (no. linear ft.: ) Page 2
e
Suite/bldg. /apt. no.: I Project name: V
Manufactured home utilities 110.00
Cross street/directions to job site:
+ Manholes 16.60
f e t/�Q - [` 1 2 c S�Q 1'� ZV" t, Rain drain connector 16.60
YY Sanitary sewer (no. linear ft.: ) Page 2
Storm sewer (no. linear ft.: ) Page 2
Subdivision: < e \'& \t hj I Lot no: Water service (no. linear ft.: ) Page 2
Tax map /parcel no.: d S / D 77:10 - 7(50 ;Dv Fixture or item
Absorption valve 16.60
DESCRIPTION OF WORK Backflow preventer Page 2
7 i CA F(.Ol,,) Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
❑ PROPERTY OWNER 1 TENANT Drinking fountain 16.60
Ejectors /sump 16.60
Name: Ct,-41 - t4 S S Expansion tank 16.60
Address: N A-oA \ ..A P col • Fixture /sewer cap 16.60
City/State /ZIP: QY 9700 (e 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: 9
1 tw �Cf`� D$CA Interceptor /grease trap 16.60
Contact name: (art/ t t f . 0 (� S Medical gas (value: $ ) Page 2
Address: 4p0 6 p t. V% Primer 16.60
City/State /ZIP: \e)e.a v . O y q1015- Roof drain (commercial) 16.60
Phone: ( (5 t. y 2 t3 So ( ) Sink /basin/lavatory 16.60
Fax:
Tub /shower /shower pan 16.60
E -mail:
Urinal 16.60
CONTRACTOR Water closet 16.60
Business name: j4-u_Me j L ,56.. C_ Water heater 16.60
Address: k) S.vt^�
1 Other:
Subtotal ,�
City/State /ZIP:
Minimum permit fee: $72.50 „
Phone: ( ) Fax: ( ) Residential backflow minimum permit fee: $36.25 ✓ 3
CCB Lic.: 1.4pj 11 / v Plumbing Lic. no.: Plan review (25% of permit fee)
� � State surcharge (8% of permit fee) 5_7/4.1/7'.."'
1 / J /
�o/
Authorized signature: PERMIT FEE
Print name: lT SBV\f� Date: 1 0) This permit application expires if a permit is not obtained within
1. ■ 180 days after it has been accepted as complete.
*Fee methodology set b -County Building Industry Service Board.
is\ Building \Permits\PLM- PennitApp.doe 12/03 440 -4616T 10 /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 - 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 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 theiTirst $25,000.00 and $1.45 for
each additional $100.00 or fraction thereof, to
Inspection of existing plumbing or
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:
•
Are you capping, moving or replacing existing fixtures? If •
"yes ", please indicate work performed by fixture. Failure to
accurately report fixtures could result in increased sewer fees * .
Quantity by (Fixture) Work Performed
Fixture Type: Replace
New Moved Existing Capped Comments regarding fixture work:
Baptistry/Font '
Bath - Tub /Shower
- Jacuzzi /Whirlpool
Car Wash -Each Stall
-Drive Thru
Cuspidor /Water Aspirator
Dishwasher - Commercial
- Domestic •
Drinking Fountain
Eye Wash
Floor Drain/sink - 2"
-4"
Car Wash Drain
Garbage - Domestic
Disposal - Commercial *Note: If the fixture work under this permit results in an
Industrial increase of sewer EDUs, a sewer permit will be issued and
Ice Mach./Refrig. Drains
Oil Separator (Gas Station) fees assessed for the sewer increase must be paid before the
Rec. Vehicle Dump Station plumbing permit can be issued.
Shower -Gang
-Stall
Sink -Bar /Lavatory
Quantity Total
- Bradley
Commercial Isometric or riser diagram is required if fixture quantity
- Service
total is >9.
•Swimming Pool Filter
Washer - Clothes
• Water Extractor Plan Review
Water Closet - Toilet Plan review is required if fixture quantity total is >9.
Urinal
Other Fixtures: •
i:\ BuitdinglPennits \PLM- PermitApp.doc 3/03
CITY OF TIGARD -
BUILDING DIVISION PERMIT #: OQS_60 / I
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED:
Phone: (503) 639 -4171 / MI A\
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: TIME: PAGE:
SITE ADDRESS: / �� 63 ' (/ g ' 1 ""C CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME:
DESCRIPTION:
OWNER: PHONE #:
CONTRACTOR: PHONE #:
Inspection Request Scheduled For: Date: 3-F — 9 Pour Time:
Code # Inspection Description Confirm # Contact # Message
; 73" 8- 5
Corrections /Comments /Instructions: W Li a 3
r e Pb AL t/E..tz-k 1 r0 .i�w " rw /4 C /42z,■• X. \ 04 irk/ -'
C ap � c ---* t t U P ; r A�� �. � te.
•
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
n FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: t: Date: 3 / r/ o 4 Phone #: (503) 718-