Permit CITY TIGARD PLUMBING PERMIT
° COMMUNITY DEVELOPMENT PERMIT #: PLM2008 - 00336
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 8/12/2008
PARCEL: 2S104CA -11800
SITE ADDRESS: 13674 SW WESTRIDGE TER ZONING: R -7
SUBDIVISION: HILLSHIRE LOT: 118 JURISDICTION: TIG
PROJECT: KUBES
Project Description: Installing backflow preventer.
CLASS OF WORK: ALT 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
LARRY & MI KUBES Description Date Amount
13674 SW WESTRIDGE TERRACE
TIGARD, OR 97223 [PLUMB] Permit Fee 8/12/2008 $36.25
[TAX] 12% State Surch 8/12/2008 $4.35
Phone : Total $40.60
Contractor:
SIGNATURE LANDSCAPE
PO BOX 304
TUALATIN, OR 97062 REQUIRED ITEMS AND REPORTS
Contact # : PRI 503- 673 -0142
FAX 503- 673 -0189
Reg #: PLM 6195LCB
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: /l //
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.
' Plumbing Permit kpplitation
B eilding Fixtures � � FOR OFFICE USE ONLY
r 4 v Received L
Er il
City of Tigard Date/By ��j 0� „ Pennn No � ,
13125 SW W Hall Blvd., Tigard, OR 97223 C; P lan Review
Phone 503 639.4171 Fax' 503.598 1901 � % 2� $ Other Permit N
U DateBy.
T I G AR D Inspection Line. 503 639 4175 Date Ready /By ® See Page 2 for
Internet' www.tigard - gov ` o vitGN _ Nohfied/Method Supplemental Information
TYPE OF WOR �1 1 " rt iliN tSIA -Y 'j FEE* SCHEDULE
❑ New construction LT emolition For special information use checklist
Description I Qty I Ea I Total
❑ Addition /alteration/replacement ® Other: Backflow Ins 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
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: 13674 SW Westridge Terr Catch basin or area drain 16.60
City /State /ZIP: Tigard, Or 97223 Drywell, leach line, or trench drain 16 60
Suite/bldg. /apt. no.: Project name: �5 Footing drain (no. linear ft.: ) Page 2
Manufactured home utilities 110.00
Cross street/directions to job site: Hillshire Dr
Manholes 16 60
Walnut to 135 turns into westridge Terr 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
Backflow Installation Backwater valve 16 60
Clothes washer 16.60
Dishwasher 16 60
® PROPERTY OWNER I ❑ TENANT Drinking fountain 16.60
Electors /sump 16.60
Name: Larry Kubes Expansion tank 16 60
Address: 13674 SW Westridge Terr Fixture /sewer cap 16 60
City /State /ZIP: Tigard, OR 97223 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: Signature Landscape Care
Interceptor /grease trap 16 60
Contact name. Bob Smith Medical gas (value' $ ) Page 2
Address: PO Box 304 Primer 16.60
City /State /ZIP: Tualatin, OR 97062 Roof drain (commercial) 16.60
Phone: (503) 673 -0142 Fax: : (503) 673 -0189 Sink /basin/ lavatory 16 60
Tub /shower /shower pan 16 60
E -mail: Urinal 16.60
CONTRACTOR Water closet 16.60
Business name: Signature Landscape Care Water heater 16.60
Address: PO Box 304 Other
City /State /ZIP: Tualatin OR 97062 Subtotal
Minimum permit fee. $72.50 36 25
Phone: (503) 673 -0142 Fax: (503) 673 -0189 Residential backflow minimum permit fee. $36.25
CCB Lic.: 6195 Plumbing Lic. no.: Plan review (25% of permit fee)
Authorized signature State surcharge (12% of permit fee) 4 35
► TOTAL PERMIT FEE 40 60
Print name: 'Biqa vtt- , T ,,,,_ Date:g - /Q, 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
L \Buddmg\Permits\PLMF- PermdApp doc 12/27/06 440- 46t6T(10 /02 /COMRVEB)
Plumbing Permit A iblilation - City of Tigard
,.. Pie 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site Utilities Qty. Fee (ea) Total Square Footage: Permit Fee:
Footing drain - I' 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 Backtow Prevention Device I 27 55 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.
Commercial Fixture Work: — Plan Review for Plumbing Installations
Are you capping, adding or replacing fixtures? If "yes ", Plan review is required for any of the following.
please indicate work performed by fixture. Failure to Please check all that apply.
accurately report fixtures could result in increased sewer fees * . ❑ Any new commercial building with water service 2" and
Quantity by (Fixture) Work Performed greater, except systems designed and stamped by licensed
Fixture Type: Replace engineer.
Previous Capped Added Existing ❑ New exterior plumbing site utilities for any complex structure
Baptistry/Font as defined in OAR918- 780 -0040.
Bath - Tub /Shower ❑ Medical gas and vacuum systems for health care facilities.
- Jacuzzi /Whirlpool ❑ Any multipurpose fire sprinkler system.
Car Wash -Each Stall ❑ Any complex structure as defined in OAR918- 780 -0040.
-Drive Thru
Cuspidor /Water Aspirator Submit 2 sets of plans with any of the above.
Dishwasher - Commercial
- Domestic
Drinking Fountain Isometric or Riser Diagram
Eye Wash ❑ Isometric or riser diagram is required for new buildings
Floor Drain /sink - 2" that meet the qualifications above.
-3
-4"
Car Wash Drain
Garbage - Domestic Comments regarding fixture work:
Disposal - Commercial
- Industrial
Ice Mach. /Refrig. Drains
Oil Separator (Gas Station)
Rec Vehicle Dump Station
Shower -Gang
-Stall
Sink - Bar /Lavatory
- Bradley *Note: If the fixture work under this permit results in an
- Commercial increase of sewer EDUs, a sewer permit will be issued and
- Service fees assessed for the sewer increase must be paid before the
Swimming Pool Filter plumbing permit can be issued.
Washer - Clothes
Water Extractor
Water Closet - Toilet
Urinal
Other Fixtures.
\Bwlding\Permus\PLM- PermiApp doc 12/27/06
CITY OF TIOARD
BUILDING DIVISION PERMIT #:
PLM2008-00336
.13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED:
Phone: (503) 639-4171
8112/2008
Inspection Requests (24 Hrs.): (503) 639-4175
INSPECTION WORKSHEET FOR DATE: TIME: 7 :00AM PAGE:
8/15/2008 20
SITE ADDRESS: CLASS OF WORK:
13674 SW WESTRIDGE TER
1 7 - SUBDIVISION: LOT #: TYPE OF USE:
HILLSHIRF 1 18
PROJECT NAME: KUBES
DESCRIPTION:
• Installing backflovv preventer.
• -
OWNER: PHONE #:
KUBES, LARRY & MICHELLE
. - CONTRACTOR: SIGNATURE LANDSCAPE PHONE #:
503-673-0142
-- Request Scheduled For: Date: Pour Time:
E3/15/2008
•Code # Inspection Description Confirm # Contact # Message
395 Misc. inspection 074211-01 503-310-6612
f: Corrections/Comme ts/InsdUctions:
f t ) e I c e , C04,41.7.c.a rai,_ et, t fz-- 2e, poicl
Co.ft
•
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•
Sgt PASS El PARTIAL APPROVAL LII CANCEL El NO ACCESS
Li FAIL El CALL FOR INSPECTION El ADDITIONAL FEES ASSESSED
Inspector: c(31431.4-7 Date: 71 IS1 Phone #: (503) 718-