Permit ti
(t CITY OF TIGARD
PLUMBING PERMIT
DEVELOPMENT SERVICES PERMIT #: PLM2006 - 00022
DATE ISSUED: 1/17/2006
=-° 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171
PARCEL: 2S 109BA -07500
SITE ADDRESS: 13766 SW LEAH TERR ZONING: R -
SUBDIVISION: DAFFODIL HILL LOT: 001 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
MARSHALL, GEORGE
PO BOX 91249 Description Date Amount
PORTLAND, OR 97291 [PLUMB] Permit Fee 1/12/2006 $36.25
[TAX] 8% State Surcha 1/12/2006 $2.90
Phone : 503- 705 -7933 Total $39.15
Contractor:
GREENCO LANDSCAPE
20625 SW 65TH AVE
TUALATIN, OR 97062 REQUIRED ITEMS AND REPORTS
Contact # : PRI 503- 638 -6212
FAX 503- 638 -7088
Reg #: PLM 7442
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 �` S /� Permittee Signature: � A ii � — -- . i
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
Ni
'I- ' - r*Ci , ED
Plumbing Permit ii ""
FOR OFFICE USE ONLY
Cl of Ti and Received �f �) J / `1
`J g t� (� Date/By /-- / / (/ p - Per mit N l 7 //6 C `. D
13125 SW Hall Blvd., Tigard, OR 97223 ((�� 1 O NOS Plan Review t �cx -v v
Phone: 503.639.4171 Fax: 503.598.1966M i�iv. "g ` � Other Permit No.:
24- Hour Inspection Line: 503.639.4175 ( � Mlf � ' I Date/By. Jung
®F 'YIG !�J ~' I I Date Ready/By: ®See Page 2 for •
Internet: www.ci.tigard.or.us
���� ITI`�I®�� Notified/Method 1 )& Supplemental Information • I ' d? f FEE* 'SCHEDULE '
'��ew construction ❑ Demolition For special information use checklist
Description . 1 Qty. 1 Ea. 1 Total
❑ Addition /alteration/replacement ❑ Other: New 1 dwellings (includes 100 ft. for each utility connection)
' CATE OF CONSTRUCTION - SFR (I) 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 Site utilities
Job site address: / 376 G 6. t0 L ( - ' ' ' .Catch basin or area drain 16.60
City /State /ZIP: 77� /�je 97 49 Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: (( Project name: 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: 11 0 4..- � 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
Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
Drinking fountain 16.60
.
❑ PROPERTY OWNER 0 TENANT
' Ejectors/sump 16.60
Name: 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: ,.e ' /� 4 .� Q, Afecv
.�� Interceptor /grease trap 16.60
Contact name: ��
f, �C.£w/� Medical gas (value: $ ) Page 2
Address: ' �� G ���` 4, Primer 16.60
City /State /ZIP: �D1LT�.laa�� e.Z. "3z Roof drain (commercial) 16.60 •
Sink/basin/lavatory 16.60
Phone: (5 ) adorl7 rr Fax: : ( ,si 3 ) ,2 4 , ¢ / v",,./
Tub /shower /shower pan 16.60
E -mail:
Urinal 16.60
' CONTRACTOR Water closet 16.60
Business name: Water heater 16.60
Address: Other:
City /State /ZIP:
Subtotal
Minimum permit fee: $72.5
Phone: ( ) Fax: ( ) Residential backflow minimum permit fee: 6.
- -
CCB-Lic.: - Plumbing -L- is -no.: -
Plan review _ (25 %_of permit_fee)_
Authorized signature: State surcharge (8% of permit fee)
� TOTAL PERMIT FEE ? / ��
C'
Print name: �AP / Date: /.•77..../.•77.../.•77....--a This permit application expires if a permit is not obtained within
A ' ` 180 days after it has been accepted as complete.
*Fee methodology set by Tri- County Building Industry Service Board.
i:\ Building\Permits\PLMF- PermitApp.doc 06/05 440- 4616T(10 /02/COM/WEB)
Plumbing Permit Application - City of Tigard • ' •$
Page 2 - Supplemental Information •
A
Fee Schedule: Residential Fire Suppression Systems:
Site• Utilities - . . ' Qty. , Fee (ea) Total .Square Footage: Permit Fee:• ' . . LL
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
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) t 27.55 �
. Z - and including $25,000.00.
Rain Drain, single family dwelling 65.25 325100P0016 $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: $50,001.00 and up $742.00 for the first $50,000.00 and $1.20 for .
each additional $100.00 or fraction thereof.
Fixture Work: Plan ReviewSor.Complex:Stru
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'P,erformed ❑ 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
Eye Wash ❑ Any NFPA 13 - multipurpose fire sprinkler system.
Floor Drain /sink 2" . Submit 2 sets of plans with any of the above.
Car Wash Drain Isometric or RiserDiag , • t
Garbage - Domestic ❑ Isometric or riser. diagram is required for new'buildings
Disposal - Commercial three (3).or more in height.. -
- Industrial •
Ice Mach. /Refrig. Drains y T '' •:a
Oil Separator (Gas Station) • Comments regarding fixture` wor ` "'
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 ermit results in an
Water Extractor p
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