Permit CITY OF TIGARD PLUMBING PERMIT
DEVELOPMENT SERVICES PERMIT #: PLM2006 -00230
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 5/23/2006
PARCEL: 2S112CD -06800
SITE ADDRESS: 07993 SW CHURCHILL WAY ZONING: R -12
SUBDIVISION: BOND PARK NO. 2 LOT: 048 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
KIRK & AMY MARKOVITZ
7993 SW CHURCHILL WAY Description Date Amount
TIGARD, OR 97224 [PLUMB] Permit Fee 5/23/2006 $36.25
[TAX] 8% State Surcha 5/23/2006 $2.90
Phone : 503- 684 -5164 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 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 or direct questions to OUNC by calling 503 - 246 -6699 or 1- 800 - 332 -2344.
Issued By: / � �j Permittee Signature: Oka u S. A' , ;-►
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.
Building Fixtures, _. .. �, - . .
P ➢umbing Permit Applicat><o EvF F OR OFFICE USE ONLY .
City of Tigard p�/ Permit No /y) " �`
11 13125 SW Hall Blvd., Tigard, OR 972P 23 2006 C , • ` 1
C Phone: 503.639.4171 Fax: 503.598.1960 a Other Permit No.:
Inspection Line: 503.639.4175 (. f (. + Date Re ; hurls: ® See Page 2 for
T I G A`Ft D g g Internet: www.ti and -or. o v-8 �� d . -
' .-- `� . Supplemental Information
wWd R 1 T 1 ' ' / �
TYPE OF WO
K "' 4: . FEE* SCHEDULE
❑ New construction ❑ Demolition For special information use checklist.
Description I Qty. I Ea. I Total
❑ Addition /alteration/replacement , Other: 1 e.e( G i\Tto /i New 1- 2- family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (I) bath 249.20
Al. and dwelling ■ Commercial/industrial SFR (2) bath 350.00
■ ■ SFR (3) bath 399.00
Accessory building Each additional bath/kitchen 45.00
0 Master builder 0 Other:
Fire sprinkler ( sq. ft.) • Page 2 SITE ' 1 Site utilities
/ ' b Catch basin or area drain 16.60
City /State /ZIP: l (2 i,c Q a. ( 1 - 12 , -- --l-'?-L( Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: --- I Project name: /N) -G � O 1) OD l e t 6INTP. Footing drain (no. linear ft.: ) Page 2
Manufactured home utilities 110.00
Cross street /directions to job site: -79 \I'll. r- (, LI o2t t LC SPY
Manholes 16.60
Rain drain connector 16. 1
Subdivision: Sanitary sewer (no. linear ft.: ) Page 2
Stonn sewer (no. linear ft.: ) Page 2
& ()fie_
Fixture or item
Tax map/parcel no.:
Absorption valve 16.60
1 I I ' Backflow preventer 6 Page 2
a \ " LGA U Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
Drinking fountain 16.60
'
'x_, Drinking OWNER ❑ TENANT
Ejectors /sump 16.60
Name: Kt ./AMY M AQXV 11 Z Expansion tank
..1
Address: 9 93 S to co u424_14) L" L L&3'.( Fixture /sewer cap 16.60
City /State /ZIP: fl,, {NQ C) D °LI '.. \I Floor drain /floor sink /hub 16.60
Phone: Fax: Garbage disposal 16.60
L^F 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 • 1
Tub /shower /shower pan 16.60
E -mail:
Urinal 16.60
CONTRACTOR Water closet • 1
Business name: -r T r O(I3 k) G r Water heater 16.60
Address: Other:
•
Subtotal
City /State /ZIP: Minimum permit fee:_ $ /
Phone: ( ) Fax: ( ) Residential backflow minimum permit - , $36.25
CCB Lic.: Plumbin Lic. no.: Plan review pe�mit=ffe)
State surcharg 8% of perrtti.tee)
Authorized signature: j1 S. TOTAL PERMIT FEE
Print name: A (V`.1 S S . M A 2 KO') (7-Z, Date: J -a,3-- 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.
1. \BuiIdingWerm its\ PLMF -Perm itApp.doc 04/06/06 440- 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 - 1' 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
F i x ture 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
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: Plan Review for Co S tructures
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.
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 ❑ 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- PermitApp.doc 07/06/05
CITY OF TIGARD Qu - co Z3 0
BUILDING DIVISION PERMIT #:
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED:
Phone: (503) 639 -4171
Inspection Requests (24 Hrs.): (503) 639-4175
WORKSHEET FOR DATE: I /9/07 TIME: PAGE:
SITE ADDRESS: L 4 '` CD/14A-IdA W 0 CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME:
DESCRIPTION:
OWNER: PHONE #:
CONTRACTOR: PHONE #:
Inspection Request Scheduled For: Date: Pour Time:
Code # Inspection Description Confirm # Contact # Message
-2 766 P (,
Corrections/Comments/Instructions:
•
(9)e9-C •
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
n FAIL ❑ CALL FOR INSPECTION ADDITIONAL FEES ASSESSED
Inspector: ` V Date: ) / 9 / 6 Phone #: (503) 718 - ��L