Permit 5 9, C ITY OR TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT
PERMIT #: PLM2007 -00288
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 7/5/2007
PARCEL: 2S 105DA -17100
SITE ADDRESS: 13255 SW NAHCOTTA DR ZONING: R -7
SUBDIVISION: PACIFIC CREST LOT: 059 JURISDICTION: TIG
PROJECT: BLODGETT
Project Description: Install residential backflow prevention device 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
NEIL BLODGETT
13255 SW NAHCOTTA DR Description Date Amount
TIGARD, OR 97223 [PLUMB] Permit Fee 7/5/2007 $36.25
[TAX] 8% State Surcha 7/5/2007 $2.90
Phone : Total $39.15
Contractor:
ESEQUIEL ROBLES LANDSCAPING
7076 RIDGEMONT DR N
KEIZER, OR 97303 REQUIRED ITEMS AND REPORTS
Contact # : PRI 503- 997 -9874
Reg #: PLM 7784
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 d' -ct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issue By: •,d_4frL4 Permittee Signature: 1; Aga
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
1 R•
Plumbine Permit Applicdtion FOR OFFICI liSE ONLY
City of Tigard Received ' j' Q� Permit No.: • LN/A 7 X
III to 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
C Phone: 503.639.4171 Fax: 503.598.1960 DatiBy. Other Pemtit No.:
TI C A K D Inspection Line: 503.639.4175 Date ReadyBy ^ - ® See Page 2 for
Internet: www.tigard or.gov Notified/Method / ((„. 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- 2- family dwellings (includes 100.I for each utility connection)
CATEGORY OF CONSTRUCTION • SFR(1)bath 249.20
❑ 1- and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 350.00
•
El 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: I za > -5 Sim 4Q , k cc ,I. a 13 Catch basin or area drain 16.60
City /State/ZIP: L 5a,V C 9 - 7 a 3 Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: I 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: I Lot no.: Water service (no. linear ft.: ) Page 2
Fixture or item •
Tax map /parcel no.: -
Absorption valve 16.60
DESCRIPTION OF WORK -fa preventer Page 2
-
'C4 , ?(5Cgt.) 0C ti-? ? Bad water va ve 16.60
Clothes washer 16.60
Dishwasher 16.60
❑ PROPERTY OWNER I ❑ TENANT Drinking fountain 16.60
Ejectors/sump 16.60
Name: ,&'® L. fc j (. 3 Expansion tank 16.60
Address: 1. -- 6a 55 S (. , "4 ItCak V15 -- Fixture/sewer cap 16.60 •
City / State/ZIP T ,a yd O 7 2a 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: Es e ( gs44 5 Interceptor /grease trap 16.60 •
Contact name: f S PRY Zg C gdote S Medical gas (value: $ ) Page 2
Address: ZO't( (t;A S L 'pitc,n, 1) �,�/ - Primer 16.60
City/State/ZIP: l` e
Y i � p '1 Roof drain (commercial) 16.60
/ O /� 9 7 a
Phone: (�) 7 ?g'? Y I Fax: : ( )
Sink/basin/lavatory 16.60
Tub /shower /shower pan 16.60
E -mail: Urinal 16.60
CONTRACTOR Water closet 16.60
Business name: Cs e v eet II44, b( ( e ,. ik9 Water heater • 16.60
Address: 70 K . e pus- X• r .z/ Other:
Subtotal
City /State/ZIP: �C e s ?II/ a
6 ? 73
Minimum permit fee: $72.50 ermit fee) (D ;0" / ,��
Phone: (56 -�) Q5' � permit Fax: ( ) Residential backflow minimum pmit fee: $36.25
CCB Lic.: - 77 8 � 1 , � /0 Plumbing Lic. no.: Plan review (25% of permit nn p
State surcharge (8% of permit fee) o� ' /C)
Authorized signature: f �;��t� TOTAL PERMIT FEE 4_95
�
I Print name: {4, I Date: I 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.
I:U Building \Permits\PLMF- PermitApp.doc 04 /06/06 410.4616T(I0/02/COM/WEB)
■
r 1
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 • .
Sewer - 1st 100' 55.00 3,601 to 7,200 $220.00 .
•
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
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 Back flow 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: $50,001.00 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 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.
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.
l Eye Wash
Floor Drain /sink - 2" Submit 2 sets of plans with any of the above. •
-
-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 \PennitAPLM- PennitApp.doc 07/06/05
CITY OF TIGARD -
BUILDING DIVISION PERMIT #: P11+12007-00288
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 71r�1-d007
Phone: (503) 639 -4171 y
Inspection Requests (24 Hrs.): (503) 639 -4175 F 'I �..
INSPECTION WORKSHEET FOR DATE: 9/28/2007 TIME: 7:00AM PAGE: 72
SITE ADDRESS: 13255 SW NAHCOTTA DR CLASS OF WORK:
SUBDIVISION: PACIFIC CREST LOT #: 059 TYPE OF USE:
PROJECT NAME: BL
DESCRIPTION: Install residential bacldlow prevention device for irrigation.
OWNER: EBLODGEiT, NEIL PHONE #:
CONTRACTOR: ESEGUIEI. ROBLES LANDSCAPING PHONE #: 503-997-9874
Inspection Request Scheduled For: Date: 9/28/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
399 Plumbing final 056523 -01 503 -997 -9874 N
Corrections/Comments/Instructions:
OR i. T- e" Set_ e v po"T,
C a-re- t-.,■_,,,t p,
it PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: 1 \) \_-- Date: 9 `2,71 cl ) Phone #: (503) 718-