Permit CITY OF TIGARD
!� PLUMBING PERMIT
" ° COMMUNITY DEVELOPMENT PERMIT #: PLM2008 - 00240
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 5/29/2008
PARCEL: 2S 110BD -00600
SITE ADDRESS: 11830 SW WILDWOOD ST ZONING: R -2
SUBDIVISION: SHADOW HILLS LOT: 004 JURISDICTION: TIG
PROJECT: BJORKMAN
Project Description: Install residential 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
BRETT BJORKMAN
11830 SW WILDWOOD Description Date Amount
TIGARD, OR 97224 [PLUMB] Permit Fee 5/29/2008 $36.25
[TAX] 12% State Surch 5/29/2008 $4.35
Phone : 503 -579 -8179 Total $40.60
Contractor:
OWNER
REQUIRED ITEMS AND REPORTS
Contact # : PRI
Reg #:
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 I • rted , • • • • • • -ys of
issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law requires you to = o . le r •opted by t - • regon
Utility Notifi Center. Those rules are set forth in OAR 952 - 0001 -0010 through OAR 952 -0f! -010 i. You may • stain •spies of
these es or direct aestio OUNC by calling 503.246.6699 or 1.800.332.2344.
s II �
Iss ed By: ,f) Y Permittee Signature. 7
Call 503.639.4175 by 7:00 a.m. for an inspection j f business day.
This permit card shall be kept in a conspicuous place on the job site until completion o he p - • ject.
Approved plans are required on the job site atthe time of each inspectio , . _
Plumbing Permit Application
Building Fixtures RECEIVED FOR OFFICE USE ONLY
City of Tigard Received 5 n7 B Permit No ■ M $�602G��
2 9
q 13125 SW Hall Blvd , Tigard, OR 9722MAY
Date/By A
C Phone 503.639 4171 Fax 503 598 1960 2�0$ Plan Review
Date/By Other Permit No
Inspection Line 503 639 4175 CITY OF TIGARD Date Ready /By.
> 0 see P 2
T I G A R D Internet• www tigard Notified/Method.
• fied/Method. / /� Supplemental e Info rm ation
g BUILDING DIVISION
TYPE OF WORK FEE* SCHEDULE
❑ New construction ❑ Demolition For specie! lnjormation 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
❑ 1- 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: // y3 0 S IA) j4)17 d )ooh ST. Catch basin or area drain 16 60
City /State /ZIP: T ,C,d i d/Z, 9722 9 Drywell, leach line, or trench drain 16 60
Project name: Bq{ IL Flo 14) Footing drain (no linear ft.. ) Page 2
Suite/bldg. /apt. no.:
/il-ssr k, 6/ta
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
/' OW Backflow preventer / Page 2
R /1}•[.0 6-x55 r7...46,— /�6oV6 you inef / Alt ot ti 15..<0.414{ Backwater valve 16.60
L. I a 6e /O � ✓'4 �i iss a we 1 /, O Clothes washer 16.60
" V� Dishwasher 16 60
[PROPERTY OWNER I ❑ TENANT Drinking fountain 16 60
Ejectors /sump 16 60
Name: 13 R 6. ir 7Ef., R 14144 /t ")
Expansion tank 16.60
Address: / if-3 0 3 tN W Tz. D &op Q 5% Fixture /sewer cap 16 60
City/State /ZIP: - rr..4— t4e(8 f 01 9 7 2 2 l Floor drain/floor sink/hub 16 60
Phone: (9)3 ) 57e 81 7,6 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
Sink/basin/lavatory 16 60
Phone: ( ) I Fax:: ( )
Tub /shower /shower pan 16.60
E -mail: Urinal 16 60
CONTRACTOR Water closet 16.60
Business name: Water heater 16.60
Address: 06) Y /C Other:
City/State /ZIP: Subtotal
Minimum permit fee $72 50
Phone: ( ) Pax: ( - -• Residential backflow minimum permit fee $36 25 �p
CCB Lic.: PI g Lic. no.: Plan review (25% of permit fee) J
--
■
ye... State surcharge (12% of permit fee) (. ?7 5
Authorized signature: �, ,l
/,∎ TOTAL PERMIT FEE !1 V
Print name: /� Date: c/2..1 G y /6 p This permit application expires if a permit is not obtain&
OrOr" 180 days after it has been accepted as complete.
*Fee methodology set by Tri -County Building Industry Service Board
I\ Budding \Permits\PLMF- PermrtAppdoe 1 t: 440- 4616T(10 /02/COMM'EB)
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 - 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 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
Subtotal: $50 00 and up $742 00 for the e first rst $50,000 00 and $1.20 for
each additional $100.00 or fraction thereof
Commercial Fixture Work: `Plan 'Review for•Plumbing Installation
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'
i \Building\Permns\PLM- PermiApp doc 12/27/06
CITY OF TIGARD
BUILDING DIVISION PERMIT #: PLM2008 -00240
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 5/29/2008
Phone: (503) 639 - 4171 al
Inspection Requests (24 Hrs.): (503) 639 -4175 ..! J!J i L
INSPECTION WORKSHEET FOR DATE: 6/6/2009 TIME: 7:01AM • PAGE: 51
SITE ADDRESS: 11830 SW WILDWOOD ST CLASS OF WORK:
r SUBDIVISION: SHADOW HILLS LOT #: 004 TYPE OF USE:
, `'PROJECT NAME: WORKMAN
DESCRIPTION: Install residential backflow preventer for irrigation.
OWNER: WORKMAN, BRETT PHONE #: 503. 579 -8179
CONTRACTOR: OWNER PHONE #:
Inspection Request Scheduled For: Date: 6/6/2008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
399 Plumbing final 070828.01 503579-8176 N
Corrections /Comments /Instructions:
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fia,camA. Sp c ee rf •
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PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: \eyl.,�,J' \ \1 Date: (01 t. V o Phone #: (503) 718-