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
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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