Permit f' n CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT PERMIT #: PLM2007 -00429
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 9/20/2007
PARCEL: 1S133AD
SITE ADDRESS: 12750 SW SPRINGWOOD DR ZONING: R -7
SUBDIVISION: AMART SUMMERLAKE LOT: 012 JURISDICTION: TIG
PROJECT: MITCHELL
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
MITCHELL, JOHN EDWARD AND
KAREN KAY Description Date Amount
12750 SW SPRINGWOOD DR [PLUMB] Permit Fee 9/20/2007 $36.25
TIGARD, OR 97223 [TAX] 8% State Surcha 9/20/2007 $2.90
Phone : 503 -524 -4068 Total $39.15
Contractor:
DENNIS' 7 DEES LANDSCAPING
7355 SW JOHNSON CREEK BLVD
PORTLAND, OR 97206 REQUIRED ITEMS AND REPORTS
Contact # : PRI 503- 777 -7777
FAX 503- 777 -2399
Reg #: LIC 5009
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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: / Permittee Signature: fhk 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.
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Plumbing Pe I j ; t h 1 71 FOR OFFICE USE ONLY
City of Tigard I Date/By: / j.� 6 Permit Nz )may.,/- ev D e
13125 SW Hall Blvd., Tigard, OR3 r 2007 Plan Review / `� _
Phone: 503.639.4171 Fax: 503. its. x51 i 960 1, f Date/B Other Permit No.:
24- Hour Inspection Line(39 A I Q A _ , . ■ ' y Jul,- - Hour
www.ci.tigard. 5sL .. 1 o! ju i � la See Page 2 for
BUIL- i�!]Y-LYVH QF 1 JSIO Z N Notified/Method: I ' Supplemental Information
K�JICi FEE* SCHEDULE
❑ New construction ❑ Demolition For special information use check list.
Description I Qty. I Ea. I Total
❑ Addition/alteration/replacement ® Other: LANDSCAPE New 1 dwellings (includes 100 ft. for each utility connection)
• CATEGORY OF CONSTRUCTION • SFR (1) bath 249.20
I- 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: / -7 $ s�, /J/ DQ� , /0rL( r Catch basin or area drain 16.60
City /State /ZIP: ( 77< C 0-92c, Drywell, leach line, or trench drain 16.60 -
Suite/bldg. /apt. no.: Project name: MATCH-S... 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
Backflow preventer 1 Page 2 3(P .75
INSTALL BACKFLOW DEVICE Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
❑ PROPERTY OWNER I ❑ TENANT Drinking fountain 16.60
� v tilt ML Ex tan 16.60
Name: IITT� l Expansion tank 16.60
Address: *JAW- AI ver__ Fixture /sewer cap 16.60
City /State /ZIP: Floor drain/floor sink/hub 16.60
Phone: (' a �-(('_ /O Col 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: ( ) Fax :: ( ) Sink/basin/lavatory 16.60
Tub /shower /shower pan 16.60
E -mail:
Urinal 16.60
CONTRACTOR Water closet 16.60
Business name: DENNIS' SEVEN DEES LANDSCAPING, INC Water heater 16.60
Address: 7355 SE JOHNSON CREEK BOULEVARD Other:
Subtotal
City /State /ZIP: PORTLAND, OR 97206
Minimum permit fee: $72.50 3
Phone: ( 503 ) 777 - 7777 Fax: (503 ) 777 - 2399 Residential backflow minimum permit fee: $36.25
CCB Lie.: 5009 Plumbing Lic. no.: 05LIBDI Plan review (25% of permit fee)
State surcharge (8% of permit fee) ; . qQ
Authorized signature:
-1 / TOTAL PERMIT FEE 3'. / 5
Print name: DEAN SNODGRASS Date: `' 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.
is \BuiIdingdPermits\PLM- PermitApp doc 12/03 440- 4616T(t0/02/COM/WEB)
Plumbing Permit Application - City of Tigard
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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
Q ty. Fee (ea) Total additional $100.00 or fraction thereof, to and
Fixture or Item 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 $50,001.00 and up $742.00 for the first $50,000.00 and $1.20 for
Subtotal: each additional $100.00 or fraction thereof.
Fixture Work:
Are you capping, moving or replacing existing fixtures? If
"yes ", please indicate work performed by fixture. Failure to
accurately report fixtures could result in increased sewer fees * .
Quantity by (Fixture) Work Performed
Fixture Type: Replace
New Moved Existing Capped Comments regarding fixture work:
Baptistry/Font
Bath - Tub /Shower
- Jacuzzi/Whirlpool
Car Wash -Each Stall
-Drive Thru
Cuspidor/Water Aspirator
Dishwasher - Commercial
- Domestic
Drinking Fountain
Eye Wash
Floor Drain/sink - 2"
-3"
-4"
Car Wash Drain
Garbage - Domestic
Disposal - Commercial *Note: If the fixture work under this permit results in an
- Industrial increase of sewer EDUs, a sewer permit will be issued and
Ice Mach./Refrig. Drains
Oil Separator (Gas Station) fees assessed for the sewer increase must be paid before the
Rec. Vehicle Dump Station plumbing permit can be issued.
Shower -Gang
-Stall
Sink - Bar/Lavatory Quantity Total
- Bradley Isometric or riser diagram is required if fixture quantity
- Commercial
Service total is >9.
Swimming Pool Filter
Washer - Clothes
Water Extractor Plan Review
Water Closet - Toilet Plan review is required if fixture quantity total is >9.
Urinal
Other Fixtures:
CITY OF TIGARD
BUILDING DIVISION ;,` PERMIT #: PL.M2007 -00429
13125 SW Hall Blvd., Tigard, OR 97223 D ATE ISSUED: 9/20/2007
Phone: (503) 639 -4171 �j111 qi--._-..._
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 10/23/2007 TIME: 7:00AM PAGE: Q3
SITE ADDRESS: 12750 SW SPRINGWOOD DR CLASS OF WORK:
SUBDIVISION: AMART SUMMERLAKE LOT #: 012 TYPE OF USE:
PROJECT NAME: MITCHELL
DESCRIPTION: Backflew preventer for irrigation
OWNER: MITCHELL, JOHN EDWARD AND, PHONE #: 503•.524 -4058
CONTRACTOR: DENNIS' 7 DEES LANDSCAPING PHONE #: 503. 777.777
Inspection Request Scheduled For: Date: Pour Time:
P q 10/23/2007 t fr i (/
Code # Inspection Description Confirm # Contact # Message O
395 Misc. inspection 058132-01 503-777-7777 Y VI/ 4.
Corrections /Comments /Instructions:
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PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
1 6 61
Inspector: t/ ��� Date: 161'0 a ' Phone #: (503) 718- ��