Permit t.
CI TY OF TIGARD PLUMBING PERMIT
111 PERMIT #: PLM2006 -00295
DEVELOPMENT SERVICES DATE ISSUED: 6/6/2006
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 PARCEL: 2S111 BD -02100
SITE ADDRESS: 09755 SW PEMBROOK ST ' ZONING: R - 3.5
SUBDIVISION: CLOUD CAP LOT: 003 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:
TUBISHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
•
Owner: FEES
SAARINEN, ANNETTE C +
EASTON, WILLIAM J Description Date Amount
9755 SW PEMBROOK ST • [PLUMB] Permit Fee 6/6/2006 $36.25
TIGARD, OR 97224 [TAX] 8% State Surcha 6/6/2006 $2.90 •
Phone : 503- 639 -3921 Total $39.15
Contractor:
TERRA -SOL LANDSCAPING
21685 SW HEDGES DR
TUALATIN, OR 97062 REQUIRED ITEMS AND REPORTS
Contact # : PRI 503- 691 -6105
Reg #: LIC 5019
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of �� Codes and all other
applicable laws. All work will be done in accordance with approved plans. This permit will - e if work is •t started within 180 days of
issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law r= 5 ires y• • o folio les adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 0001 -0010 through 0 - 952 - 0001 -0100 • u may obtain copies of
these rules or direct questions to OUNC by calling 503 - 246 -6699 or 1- 800 - 332 -2344.
Issued By: ' I _ �/ Permittee Signatu
���� V . . . —
Call 503 - 639 -4175 by 7:00 a.m. for an inspection that busines- day.
This permit card shall be kept in a conspicuous place on the job site until corn • •tie • of the project.
Approved plans are required on the job site at the time of each inspection.
Building Fixtures RECEIVED •
Plumbing Permit Application FoR OFFICE USE ONLY
City of Tigard JUN 0 IP 2006 e B &76/04, 41 �itNo.:RA 2 ` 495
t0
;� 13125 SW Hall Blvd., Tigard, OR 972 y pig Review
C Phone: 503.639.4171 Fax: 503.598? 60 OF TIGARD p� Other Pennit No.:
f I C. n It D Inspection Line: 503.639.4175 BUILDING DIVISION Date ReadyBy.j la See Page 2 for
Internet: www.tigard - or.gov Notified/Method 77 �� Supplemental Information
TYPE OF WORK FEE* SCHEDULE
❑ New construction ❑ Demolition For special information use checklist
Description • I Qty. I Ea. I Total
Rddition /alteration/replacement ❑ Other: New 1 - 2 - family dwellings (includes 100 It for each utility connection)
CATEGORY OF CONSTRUCTION SFR(1)bath 249.20
and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 350.00
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13 Accessory building ❑ Multi - family SFR (3) bath 399.00
El 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: 17 5 5 5 U Pew., b n e ° >c, 14.1. Catch basin or area drain 16.60
City /State/ZIP: 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
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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.: Abso ' • 16.60
DESCRIPTION OF WORK ackflow preventer Page 2
$44,&(y- ' X1,A ackwa 16.60
Clothes washer 16.60
Dishwasher 16.60
IA PROPERTY OWNER I ❑ TENANT Drinking fountain 16.60
Ejectors/sump J 16.60
Name: 4 ti 1►, T e 5 ,p As K..1.% wk.& Expansion tank 16.60
Address: Fixture /sewer cap 16.60
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City /State/ZIP: Floor drain/floor sink/hub 16.60
Phone5D1 ) CO 39. .. I . \ Fax: ( ) Garbage disposal _ 16.60
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: ( ) I Fax: : ( ) Sink/basin/lavatory 16.60
Tub /shower/shower pan 16.60
E-mail: Urinal 16.60
C
CONTRACTOR Water closet • 16.60
Business nanr� g rba4� - MVPs'14 g iNsczn k - y 3 ater heater 16.60
Address: Z` L 6, s , 1 oc s von, , // er:
Subtotal
City / State/ZIP: Z d�
V� et 10 kt Z 'J Minimum permit fee: $72.50 PE?
'_ ) ,7;_ t l� + _ Residential backflow minimum permit fee: $36.25
• I i; OX/ Plumbing Lic. no.: ( Plan review (25% of permit fee)
J'r l l � r V r ► / State surcharge (8% of permit fee) o� �d
Authorized signa ;�� TOTAL PERMIT FEE 3c _ I ti
Print name P ► �.. A Date:6 Q ®.., 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: VBuildingWennits \PLMF- Pem,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
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 Backfiow 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 $120 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.
❑, Any new commercial building. ,
Quantity by (Fixture) Work Performed >! .
Fi Type: Replace ❑ Any new exterior plumbing site utilitie .
Previous Capped Added Emoting ❑ 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 -D multipurpose'fire sprinkler system.' •
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 Y ,
- Service - • . . -, . ' , r , -, i , ., •. .
Swimming Pool Filter ,
Washer - Clothes
Water Extractor *Note: If the fixture work under this permit results in an
Water Closet - Toilet increase of sewer EDIJs,.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:\ Bui ldingtPennitAPLM- PerinitApp.doc 07/06/05 .
CITY OF TIGARD e'L
BUILDING DIVISION PERMIT #: — NJ, d2 c
13125 SW Hall Blvd., Tigard, OR 97223 • DATE ISSUED:
Phone: (503) 639 -4171 ' i
Inspection Requests (24 Hrs.): (503) 639 -4175 r 'I L.
INSPECTION WORKSHEET FOR DATE: TIME: PAGE:
SITE ADDRESS: q 7,53 P ...)1-t) CLASS OF WORK:
SUBDIVISION: L #: TYPE OF USE:
PROJECT NAME:
DESCRIPTION:
OWNER: PHONE #:
CONTRACTOR: PHONE #:
Inspection Request Scheduled For: Date: 6 —/-5-- O 4P Pour Time:
Code # Inspection Description Confirm # Contact # Message
3 9 9 "= ham- / -
BIOS
Corrections /Comments /Instructions:
/ , . 1 /
L..z-h lifrx
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/i , ,. ..„.. ' r� //_ JIB
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` V;' -ASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: IV 1 A v Date: 9v f.5 o-G Phone #: (503) 718- ,--1( ✓ �