Permit , ,
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C ITY OF T I GA R D PLUMBING PERMIT
i DEVELOPMENT SERVICES PERMIT #: PLM2006 -00323
4 '' I. - 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 6/29/2006
PARCEL: 2S 104AC -00200
SITE ADDRESS: 13280 SW WALNUT ST ZONING: R -4.5
SUBDIVISION: LOT: JURISDICTION: TIG
Project Description: Backflow preventer for irrigation (water retention pond).
CLASS OF WORK: OTR GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS: 1
OCCUPANCY GRP: 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
J & S CONCRETE
2800 NE WAGNER Description Date Amount
MCMINNVILLE, OR 97128 [PLUMB] Permit Fee 6/29/2006 $72.50
[TAX] 8% State Surcha 6/29/2006 $5.80
Phone : 503 -538 -8615 Total $78.30
Contractor:
OTTYS LANDSCAPE CONSTRUCTION
PO BOX 68311
PORTLAND, OR 97268 REQUIRED ITEMS AND REPORTS
Contact # : PRI 503- 653 -7987
Reg #: LIC 7416
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
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 RFCb
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'PIU1[llbl City Permit Application I (� 2006 Received Olt. OFT ICE I1S1: ONLY
JU
Ilh `J Tigard , � V J �oo //� ��// PertnnNo� �^ �,�7�� a
Datemy C+/ /°" 4/� 9393... ` w'l ` 3.
to 13125 SW Hall Blvd. Tigard, O 4 97223 tl „ 4 ,
C Phone: 503.639.4171 `Ea SSt89146d � t Plan
atle/ Other Pemut No.
Inspection Line: 503:603 }35
I' fG Ii C p �' d � � ,�� ���I Date Ready/By. ® See Page 2 for
- Internet: www.tigard - or.g v L, 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 ft. for each utility connection)
` CATEGORY OF "CONSTRUCTION SFR (I) 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 ❑ Other:
Each additional bath/kitchen 45.00
Fire sprinkler ( sq. ft.) Page 2
_ JOB SITE INFORMATION AND LOCATION Site utilities
Job site address: ' .. ,it/ _ w ,_, A 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: (4 k. f' 4j_ 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 Page 2
ZZ Backwater valve 16.60
11111nA PII MBSI 11= Clothes washer I 16.60
Dishwasher 16.60
❑ PROPERTY OWNER I ❑ TENANT Drinking fountain 16.60
Ejectors/sump 16.60
Name: 3 _ u I.C� A _ / " • Expansion tank 16.60
Address: a tb r t o - , Fixture /sewer cap 16.60
City /State /ZIP() YDJ 4.4 t, i / . 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:
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
' , ' - CONTRACTOR . Water closet 16.60
Business name: (J�rS / 5 .� q � C�� Water heater 16.60
Address: f /5 0X / ,p 3 /7 , Other:
City / State/ZIP: , ®r t' b' - 9 7)4 e sobco50
Minimum permit fee: $72.50
Phone: (4 6s3 -7f2 Fax: ( ) Residential backflow minimum permit fee: $36.25 .5
Plan review (25% of permit fee)
State surcharge (8% of permit fee)
CCB Lie.: /a -.1/ 7q'( Plumbing Lic. no.:
�i / ' y Z2
Authorized signature: TOTAL PERMIT FEE 7f 7
Print name: `� r H _ C pr.- Date: a .9.6 , 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 \Bwiding\Pamits\PLMF- PemitApp doe 04/06/06 440.4616T(10/02/COM/WEB)
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information r e
•
Fee Schedule: Residential Fire Suppression Systems:
Site Utilities Qty Fee (ea) Total 'Square Footage: • Permit Fee:
Footing drain - 1 a 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 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
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 $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 vacutm, 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.
-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
- 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.
\ Building \Pennits\PLM- PennitApp.doc 07/06/05
CITY OFTIGARD „ .,
BUILDING DIVISION PERMIT #: PLM2006- 00323
13125 SW Hall Blvd., Tigard, OR 97223 • DATE ISSUED: 6/29/2006
Phone: (503) 639 -4171 /*do F } #
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 7/7/2006 TIME: 7:02AM PAGE: 61
SITE ADDRESS: 13280 SW WALNUT ST CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: HILLSIDE ESTATES SUBDIVISION
DESCRIPTION: Backflow preventer for irrigation (water retention pond).
OWNER: J & S CONCRETE, PHONE #: 503538.8615
CONTRACTOR: OTTYS LANDSCAPE CONSTRUCTION PHONE #: 503 -6 €'3 -79131
Inspection Request Scheduled For: Date: 7/7/2006 Pour Time:
Code # Inspection Description Confirm # Contact # Message •
395 Misc. inspection 032761 -01 503-260-2930 N
Corrections /Comments/ Instructions:
O
1, Jr ! A , .AL • /-- #% •
/
/
•
'ASS PARTIAL APPROVAL ❑ CANCEL 111 NO ACCESS
El FAIL CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: IVO b L( " Date: / l f)/ £ Phone #: (503) 718 - #(-3