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Permit Support Document . . . Plumbing Permit Application RECEIVE a Building Fixtures FOR OFFICE USE () LA' City of Tigard li Received ..14.21 twi i permit No:: Apooei_4705_07 FEB 1 ZI32Z Ill 13125 SW Hall Blvd. Tigard OR 97223 , , A inn nuDPlan Review a Phone: 503.718.2439 Fax: 503.598.1960 CITY OF TIG/iatemy: ' Other Permit No: ..,e;t4,4ettit.6 Inspection Line: 503.639.4175 , Juris: 1 iiii See Kige 2 for . 11(5MM BUILDING DIVISIOW,i},t,r(ijairly,/11",y:: Internet: www.tigard-or.gov I. , Supplemental information, s, M 1 1 ForLyecial informatton use checAlmt. 0 New construction 0 Demolition Description I Qty. I Fa. I Total Addition/alteration/replacement El Other: New 1-2-family dwellings(includes 100 ft.for each utility connection) ' T410';-tk il 1•'':,Or ,. SI*R(1)bath fiit,:.,':.;::''''',4...%:,4:4',:N'',.'t',;71'''!-44'.'''''''',11,111$4,4 IrtirCIA ir,4,Itrq.LI"''.fiii:).COW:,'4,XiftiNniN':0:;•'''',''t-'' 312.70 - it‘X.1s:I.,:;,"stlilIiil';:,A::..:i-cAtiliii',,,.:siarris- tim.ike,, tra,.•ARId.i ....•, ,.•,,, . . si,R(2)bath 437.78 1,112 1-and 2-family dwelling 0 Commercial/industrial snt(3)bath 500.32 0 Accessory building 0 Multi-family Fach additional bath/kitchen 25.02 0 Master builder D Other: .,,, Fire sprinkler( __sq.ft.) Page 2 t A 11,141AtAir, . Site utilities: - Catch basin or area drain 18.76 Job site address: q -3L) si,,,), ,,„ ,9,-..„,u,,,,aa ..s\-... Drywell,leach line,or rench drain 18.76 City/State/ZIP: Tic-2:kjourek‘ k_lir:\ VIZ Footing drain(no.linear ft.: _) Page 2 .._. Suite/bldg./apt.no.: Project name: Manufactured home utilities 50.03 Cross street/directions to job site: Manholes I 8.76 _ Rain chain connector 18.76 - ... Sanitaty sewer c _ ..:r-=,z.___c _,e_.yt....,,Jtk-..y, Storm sewer(no.linear ft.:___) Page 2 1/9/;4', 1'0"J it Cre4"ir 5€.4'del- / , .--.01"rii, . A?:.... Water service(no.linear ft.:___) :, 7' Page 2 Subdivision: 1 Lot no.: mi.,.Fixture.or item: Backtlow preventer 3).27 Tax map/parcel no,: Backwater valve 12.51 ' l' I 11, Clothes washer 25.02 " •..... 'f.:. '^- 0.2.1i'A ,S)e,L.,ae r C re 9lik_kj Dishwasher 25.02 - ‘oc cAk c. - 1-N% 25.02 Ej CC tors/sump 25.02 - Expansion tank #41.14MiVtMtntranallfIrlirVitrialititizi:1:'4:64 -‘40 Fixture/sewer 12.51 :40,14iikt)tai-ViltiotoOviriilow7..$14', Wit.411: ,1:4.i,:itUAIt.iik$4. ..t 4 4 -pm ... - .- . cap 25.02 Name: Floor drain/floor sink/huh 25,02 Address: Garbage25.02 disposal .. City/State/ZIP: hose bib 25.02 Phone:( ) Fax ( ) Ice maker 12.51 25.02 *4 141m*L144"1",ki;v.0111S,,,i'fI'HA'it:',,44‘,4-41••':','";:41417,641.4fIrirrillitit.,:mX,1%.21,,wt,.,ti,......: 4-,75-174„,,,,ti.-sio, Interceptor/grease trap illY651224"411496:::Akin"t'''':44 4/-1,'"'"Itai"-'"'"''' Medical gas(value:$_1 Page 2 Business name:4ft,„,,,,,,,,, Dirc,„,r) , \e ,,,,,,,4....,......3 Primer 12.51 „ ‘t Contact name: ao,i pek,,. Roof drain(commercial) 12.51 Address: \:),„:-. 0°3. (,:,..:,..), ,, eiVaiik t.-_,, Sink/basin/lavatory 25.02 t... City/State/ZIP: ,2,.), c .A-Ackzpsi (0 . (2-- /'' q rt aa'.).-- Solar units(potable water) . 62.54 _ Tub/shower/shower pan 12.51 Phone:( -. .0, az,,, 5.,-- 9 59 5 I Fax::( ) Urinal E-mail: . if... ..*...411 ; _,,AD ill .. . ''' -:;- int( 6,. 4-1.113 Water closet 25.02, 25.02 Water heater 37.52 (---)C:Xt‘t Business name: Idyviitr",car- I f-C4:1° ir) . ,..„ ......" 1743 ... ... Water piping/DWV 56.29 .._..... ., ,,, Address: iv, A 0 Other: 25.02 Subtotal City/State/ZIP: -111 , - i ( ; i Ckt-t''' .-e;) "' Minimum permit fee: $72.50 4.,,. : ?Fp Phone ,60-2 d(pi- ..,.. if ° Fax:( ) Plan review (25%of permit fee) CCB Lic.: , Ai --) Plumbing Lic.no.: if 6 Plan 350 Authorized signatu ri:el 4 ,,,, 3,' 9,11 TOTAL PERMIT FEE 81.,;X: Print name: c t,,,, This perinii applic tion expires if a permit is not obtained'nithin 180 days D , INIF i....1„ after it has been accepted as complete. ) : \ " ' I - . ,r, , ., • ate: .-1.ee methodology set by Trt-County Building Industry Service Board. .440-4610(10/02/COM/WE13) ElBuilding\PermiisTLMILI.PermitApp.doc 10101/09 _ -- . _ Plumbing Permit Application - City of Tigard Page 2 - Supplemental Information Fee Schedule: Residential Fire Su i4 ression S stems: ii i t � i a ..'� ii. � r. � -7.. Footing drain-1" alivimpai $1,.2 1.90 100' 50.03 0 to 2,000 � 1 � Footing drain-each additional 100' 37.52 2,001 to 3,600 $169.69 Sewer- 1st 100' 62.54 if 3,601 to 7,200 $233.20 4 ° 7,201 and greater $327.54 Sewer-each additional 100' 37.52 Water Service-1st 100' 62.54 Water Service-each additional 100' Medical Gas S sterns: 37.52 .IRT 17i Storm&Rain Drain- 1st 100' 62.54 ° s a ''ii, °, i ems " aF . ° �illit 3 Storm&Rain Drain each additional 100' b 1.00 to$5,000.00 Minimum fee$7�50 37 52 $5,001.00 to$10,000,00 $72.50 for the first$5,000,00 and$1.52 for u 'r a t," a x"\a il"< rorth,4 i ila each additional$100.00 or fraction thereof,to Inspection of existing plumbing or for and including$I0,000.00, which no fee is specifically lingindicated t $10,001.00 to$25,000.00 $148.50 for the first$10,000.00 and$1.54 for )0.00/hr (minimum charge—i!2 hour) each additional$100.00 or fraction thereof,to Inspections outside of normal business 90.00/hr and including$25,000.00. hours(minimum charge—2 hours) $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 Reinspection Fees 90.00/hr and including$50,000.00. Additional plan review for revisions 90.00/hr $50,001.00 and up $742.00 for the first$50,000.00 and S1.20 for (minimum charge—1/2 hour) cash additional$100.00 or fraction thereof. Subtotal: -- Commercial Fixture Work: Are you capping, adding or replacing fixtures? If"yes", please indicate work performed by fixture. Failure to accurately report fixtures could result in increased sewer fees*. 4 7 W � quantlt} by Fixture Type v '. Plan review is required for any of the following. °.! �$ ` tteptacel g� z �t �aI Please check all that apply. v(,' �. ' 0410r� letu40 4i.A'),Rrn , dried Rel''cxttr Baptistry/Font ElAny new commercial building with water service 2"and Bath: -Tub/Shower greater,except systems designed and stamped by licensed Jacuui/Whirlpool _ engineer. Car Wash: Each Stall El New exterior plumbing site utilities for any complex structure -Drive Thni as defined in OAR918-780-0040. Cuspidor/Water Aspirator ❑ Medical gas and vacuum systems for health care facilities. Dishwasher: Commercial ❑ Any multipurpose fire sprinkler system. Domestic ❑ Any complex structure as defined in OAR918-780-0040. Drinking Fountain Eye Wash Submit 2 sets of plans with any of the above. Floor Drain/sink: -2" sit t ,h_ i -Car Wash Drain Ell Isometric or riser diagram is required for new buildings Garbage -Domestic non-food — that meet the qualifications above. Disposal: -Domestic food related -Commercial food related -Industrial food related ice Mach./Refrig.Drains Comments regarding fixture work: Oil Separator(Gas Station) Rec.Vehicle Dump Station Shower: -Gang -Stall Sink: -Lay/Bar non-food related -Bradley -Com/Serv/Util food related -Service *Note: if the fixture work under this permit results in an Swimming Pool Filter Washer-Clothes increase of sewer EDUs, a sewer permit will be issued and Water Extractor fees assessed for the sewer increase must be paid before the Water Closet-Toiler plumbing permit can be issued. Urinal Other Fixtures: i:\I3uilding\Permits\PL.MF_pennitApp.doc 08/04/2011 2