Permit CITY OF TIGARD PLUMBING PERMIT
i ~ . > COMMUNITY DEVELOPMENT
I Permit #: PLM2009 -00249
a' Date Issued: 09/16/2009
Ti 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Parcel: 2S 110DA09400
Jurisdiction: Tigard
Site address: 10835 SW KABLE ST
Subdivision: Lot: 0
Project: Nelson
Project Description: Install 616 square feet of continuous loop fire sprinkler system and (1) bar sink.
Owner: FEES
NELSON, KIRK D & DEBORAH R Quantity Description Date Amount
10835 SW KABLE ST
TIGARD, OR 97224 616 sf Fire Sprinkler 09/16/2009 $115.00
1 ea Sink 09/16/2009 $16.60
PHONE: 1 12% State Surcharge - 09/16/2009 $15.79
Plumbing
Contractor:
RAYBORN'S PLUMBING INC
PO BOX 69
TUALATIN, OR 97062
PHONE: 503 - 692 -4139
FAX: 503 - 691 -2328
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp:
Stories:
Total $147.39
Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, .r if- work -is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utili lotification Center. Those rules are set forth in OAR 952 -001 -0010 through OAR 952 - 001 -0100. You may obtain a copy of the rules
• direct questions to OUN by calling .2 , ....99 or 1.800.332.2344. e------'
c
Issued By: 11 a ` Fermitt. - Signature: � /�
Call 503.639.4175 by 7:00 a.m. for an inspection that . . mess 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.
\, .3'391 2328 Rayborns Plumbing 09:49:07 a.m. 09 -09 -2009 1 /2
Plumbing Permit Application RECEIVED H47" � �'7 (,Q / 3 ,
Building Fixtures SEP 09 2009 FOR OFFICE USE ONLY
City of Tigard Received / / �,` Permit No.: Woo 7..QID ay?
III ti 13125 SW Hall Blvd., Tigard, OR 9722JCITY OF TIGARD - Date's :
g Ian Review
U Phone: 503.639.4171 Fax: 503.59: i tliLDING DIVISIO /By: Other Permit No.:
Inspection Line; 503.639.4175
I iGARD Date Ready /By: tuft : 9J See Page 2 for
, Internet: www.tigard Notified/Method: Supplemental Information
TYPE OF WORK FEE* SCHEDULE .
❑ New construction ❑ Demolition For special information use checklist.
Description I Qty. 1 Ea. I Total
.Addition/alteration /replacement ❑ Other: New 1- 2-family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION • SFR (I) bath 249.20
gl I - 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 (h/A sq. ft.) / Page 2 / /6,QO
JOB SITE INFORMATION AND LOCATION Site utilities _
Job site address: / 0 J 3r5 sal A-t/ St. Catch basin or area drain 16.60
City /State/ZIP: qQ �.. 0 t 97v Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: J Project name: LS D Footing drain (no. linear ft.: _) Page 2
Manufactured home utilities 110.00
Cross street/directions to job site:
Manholes 16.60
Rain drain connector 16.60
Sanitary sewer (no. linear ft.: ) Page 2
Storm sewer (no. linear ft.: Page 2
Subdivision: Lot no.: Water service (no. linear ft.: ) Page 2
Fixture or item
Tax map /parcel no.: `
. Absorption valve 16.60
R/� • is4 DESCRIPTION OF WORK ' L / Backflow preventer Page 2
/ ,/ (L L 7A6.2,4" .0 " , 7gf �Se'!/7 i er-s Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
CP ROPERTY OWNER l ❑ TENANT Drinking fountain 16.60
•nn'' ` ✓ DIG'7 C L n /� ` J� Ejectors /sump 16.60 .
Name: KI Yu� 4 �/L�
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: cam • 4" 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 C 16.60 r, 4
Tub/shower /shower pan 16.60
E -mail: Urinal 16.60
CONTRACTOR Water closet 16.60
Business name: D? J /O4 / Water heater 16.60
Address: �X 49 ( Other:
City /State /ZIP: / dC / �7d a-" Subtotal 0/, 4 d
/ " i - Minimum permit fee: $72.50
Phone: 5 6 91- Vf3 9 Fax: Leo 3) G v.. ,2.3,28 ✓� Residential backflow minimum permit fee: $36.25 _
i k CCB Lic.: g 7 g5 V Plumbing Lic. no.: 3� .,/G 6 PB I Plan review (25% of permit fee)
,1 State surcharge (12% of permit fee) /3 9
Authorized signature:
TOTAL PERMIT FEE 1 y73?
Print name_ S y C�i<L[,t, Date: 9��0 T his 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.
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X503 691 2328 Rayborns Plumbing 02:03:08 p.m. 09 -11 -2009 1 /1...
,W.,: v a r hi _ V D p� f "/
R k y I �.
RECEIVED
s SEP 11 2009 uponor
_' .
•
r CITY OF TIGARD FIRE PROTECTION SYSTEMS
VW. ' : i 4 , A BUILDING DIVISION
UPONOR RESIDENTIAL
� FIRE PROTECTION SYSTEM
. (FORMERLY AQUASAFE®)
t f' FLOW VERIFICATION TEST
Flow Verification Test t°
Alliance Color of test orifice used: a3 /a tz- k.
Member ID Manifold pressure reading
Number before test (static pressure):
Company Name:
�•�/�r-1&, 10163
�/ ( I Manifold pressure reading
Contact: K4 c)(- o1/q,h(ln�es- during test (residual pressure):
Phone: �S __) 6qQ - c. " efii.3 Test gauge pressure on test connector
� 3) 6 1 ` g-301.? before test (static pressure):
Fax O[ 1 I
Test gauge pressure on test connector
IL
Job Name: �. e sd✓ / during test (residual pressure):
Project Number: (� (9 C — 4/ -r , L— What time of day was the flow test taken?
Job Address: JO 3Z� r 5 ) J(4,J s- How many gallons of water ran into the
test bucket in 60 seconds?
City: / )' 5
How many gallons of water did Jq 6 p
State, ZIP: 7 the design predict as required? r f /
Did the test meet or exceed design flow ? Yes ❑ No
After completing this form, please fax it to
the Uponor Fire Protection Design department Which sprinkler did you flow? Number: !
at (952) 891 - 1115. Date left in service with all valves open: ` 47/Ir
Test Witnessed and Verified by:
Na �/ . A., - Occupation Date / Da
1 1-42G1 0 OA L).1- Sign / / . � �r..Ji Oro,- s oef
FP
s Additional Explanations and Notes
t
g
€ Uponor, Inc. Tel: (800) 321 -4739
. 5925 148th Street West Fax: (952) 891 - 1409
i Apple Valley, MN 55124 Web: www.uponor- usa.com