Permit C ITY OF TIGARD PLUMBING PERMIT
i DEVELOPMENT SERVICES PERMIT #: PLM2006 -00442
,.� I 13125 SW Hall Blvd., Tigard, OR 97223 503 -639 -4171 DATE ISSUED: 9/27/2006
PARCEL: 1S133CA-03600
SITE ADDRESS: 13838 SW ANNA CT ZONING: R -25
SUBDIVISION: GABRIEL WOODS LOT: 015 JURISDICTION: TIG
Project Description: Backflow preventer for irrigation.
CLASS OF WORK: OTR GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: SFA 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
JOE BAUSCHELT
4325 SW PRIMROSE ST Description Date Amount
PORTLAND, OR 97219 [PLUMB] Permit Fee 9/27/2006 $36.25
[TAX] 8% State Surcha 9/27/2006 $2.90
Phone : 503- 860 -6001 Total $39.15
Contractor:
REDWOOD LANE NURSERY
8222 BROADACRES RD
WOODBURN, OR 97071 REQUIRED ITEMS AND REPORTS
Contact # : PRI 503- 678 -3242
Reg #: LIC 7009
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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: A i_ a Permittee Signatur =.
Call 503 -639 -4175 by 7:00 a.m. for an inspection that busine- day.
This permit card shall be kept In a conspicuous place on the job site until c pletion of the project.
Approved plans are required on the Job site at the time of eac spection.
Pluntbjug rcrmit Application
'Building Fixtures i ii OI• l'IC :: i si.. oNt.V
City of Tigard Received � Nall/ b "� $419
Date/By. L. I/ !. i `, Permit `I`. �(
4 13125 SW Hall Blvd., Tigard, OR 97223
• M Phone: 503.639.4171 Fax: 503.598.1960 Plan By.
B
Datey. Other Permit No.:
TI I C. n it r� Inspection Line: 503.639 Date Ready/By: '° I 63 See Page 2 for
Internet: www.tigard - or.gov Notified/Method V Supplemental Information
TYPE OF WORK FEE* SCHEDULE
R I 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(1)bath 249.20
Ell- 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
0 Other Fire sprinkler ( sq. ft.) Page 2
• JOB SITE INFORMATION AND LOCATION Site utilities Job site address: 1 33 ii 3 € 5w A- Abvii- t // .-T . Catch basin or area drain 16.60
City /State/ZIP: TIC. OR 9 721 Drywell, leach line, or trench drain 16.60
r Footing drain (no. linear ft.: Page 2
Suite/bldg. /apt. no.: I Project name: 4 /t (Li V V Do 6 S
Manufactured home utilities 110.00
Cross street/directions to job site: S 11.) Bq -12/2D Lv S g-0 11-10 Mt )4 p- 70 Manholes 16.60
1./Sit i zort/ U(,t -( l.rd /A. y Rain drain connector 16.60
Sanitary sewer (no. linear ft.: Page 2
Storm sewer (no. linear ft.: Page 2
Subdivision: G /{.g 1.l £L WOO Q S. I Lot no.: ' S- Water service (no. linear fl.: Page 2
Fixture or item
Tax map/parcel no.: Absorption valve 16.60
DESCRIPTION OF WORK Back flow preventer -1 Page 2
840 <I =GUW VALVE Poi? COMM ARS:4 7-44-0- 44 O Backwater valve 16.60
F' -oA/r v/-1s r OK Lors / /',s. fr v A-,vd vrn v E Clothes washer 16.60
Lo cm -/"i4 5 /4/111-66 X GGGL. Dunking fountain 16.60
I PROP RTY OWNER 1 1 ❑ TENANT Drinking fountain 16.60
Q Ejectors/sump 16.60
Name: Jb L U4 Lt,SCM s LT. Expansion tank 16.60
Address: 325' s I Po S Fixture/sewer cap 16.60
City /State/ZIP: P6L.7./4ll//) / 0i- 9 72..f 9 Floor drain/floor sink/hub 16.60
Phone: (503) e( &OD) Fax: (503) I5 2 - L l3 2-.5 Garbage disposal 16.60 •
a APPLICANT I CONTACT PERSON Hose bib 16.60
Ice maker 16.60
Business name: T ax C i.,,Sr HoM Interceptor /grease trap 16.60
Contact name: t RCv kt( tiZ Medical gas (value: $ ) Page 2
Address: 7245" Slv 5 6A) l 4. Primer 16.60
City/State/ZIP: 7% 4 /K Z, OA_ 9 7 z z y Roof drain (commercial) 16.60
Sink/basin/lavatory 16.60
Phone: (503 ) 800-75 I Fax: ( So3)(o Lt ( o- 3 705
Y Tub /shower/shower pan 16.60
E r07 / �lle Qt t_Tt h orit25•CO Y - Urinal 16.60
I CONTRACTOR Water closet 16.60
• Business name � � DUD L/} /v Water heater 16.60
Address: p " � Ot�C n Other:
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City /State/ZIP: IN D , cf 7o '7/ Subtot
•` / Minimum permit fee: $72.50 /
Phone: () C, 7S - 3 t 2 Fax: ( ) Residential backflow minimum permit fee: $36.25 '� Op4( 5
CCB Lic.: 7 - Plumbing Lic. no.:( //Q Plan review (25% of permit fee)
• State surcharge (8% of permit fee) 9..t'f0
Authorized signature: TOTAL PERMIT FEE 3 I g , 1 IA
Print name: 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.
1 :\BuildingTermitAPLMF -Perini p.doc 04/06/06 4404616T(10/02/COM/WFB)
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information •
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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
Storm & Rain Drain - 1st 100' 55.00 Valuation: Permit Fee:
$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
Inspection of existing plumbing or each additional $100.00 or fraction thereof to
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 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
Fu=ture Type: Replace engineer.
Previous Capped Added Existing ❑ Any new exterior plumbing site utilities.
. Baptistry/Font ❑ Medical gas and vacuum systems for health care facilities.
Bath - Tub /Shower ❑ Any multipurpose fire sprinkler system.
- Jacuzzi/Whirlpool ❑ Any complex structure as defined in OAR918 780 - 0040.
Car Wash - Each Stall
- Drive Thru Submit 2 sets of plans with any of the above.
Cuspidor/Water Aspirator
Dishwasher -Commercial
- Domestic Isometric or Riser Diagram
Drinking Fountain ❑ Isometric or riser diagram is required for new buildings
Eye Wash that meet the qualifications above.
Floor Drain/sink - 2"
-3"
Car Wash Drain Comments regarding fixture work:
Garbage - Domestic
Disposal -Commercial
- Industrial
Ice Mach./Refiig. Drains
Oil Separator (Gas Station)
Rec. Vehicle Dump Station
Shower -Gang
-Stall
Sink - Bar/Lavatory *Note: If the fixture work under this permit results in an
- Bradley increase,of sewer EDUs, a sewer permit will be issued and
-Commercial fees assessed for the sewer increase must be paid before the
- Service plumbing permit can be issued.
Swimming Pool Filter
Washer - Clothes
Water Extractor
Water Closet - Toilet
Urinal
Other Fixtures:
iABuildingtPennits PLM- PamitApp.doc 09/22/06
CITY TIGARD
BUILDING DIVISION
Alo- #: PLM2006.00442
13125 SW Hall Blvd., Tigard, OR 97223 D ATE ISSUED: 9/27/2006
Phone: (503) 639 -4171
Inspection Requests (24 Hrs.): (503) 639 -4175 s' °: _..
INSPECTION WORKSHEET FOR DATE: 10/2/2006 TIME: 7:03AM PAGE: 69
SITE ADDRESS: 13838 SW ANNA CT CLASS OF WORK:
SUBDIVISION: GABRIEL WOODS LOT #: 015 TYPE OF USE:
PROJECT NAME: GABRIEL WOODS
DESCRIPTION: Bacidlow preventer for irrigation.
OWNER: JOE BAUSCHELT. PHONE #: 503 -860 -6001
CONTRACTOR: REDWOOD LANE NURSERY PHONE #: 5Q3- 678 -3242
Inspection Request Scheduled For: Date: 10/2/2006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
399 Plumbing final 037444 -01 503-799.4883. Y
Corrections /Comments /Instructions: •
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PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
I
Inspector: Y
Date: ` 3 2 Phone #: (503) 718-