Permit •
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-1"100' 50.03 0 to 2,000 $121.90
Footing drain-each additional 100' 37.52 2,001 to 3,600 $169.69
3,601 to 7,200 $233.20
Sewer-1st 100' 62.54 7,201 and greater $327.54
Sewer-each additional 100' 37.52
Water Service-1st 100' 62.54 Medical Gas Systems:
Water Service-each additional 100' 37.52
Storm&Rain Drain-1st 100' 62.54 Valuation: Permit Fee:
$1.00 to$5,000.00 Minimum fee$72.50
Stonn&Rain Drain-each additional 100' 37.52 $5,001.00 to$10,000.00 $72.50 for the first$5,000.00 and$1.52 for
Other Inspections or Fees Qty. Fee(ea) Total each additional$100.00 or fraction thereof,to
P and including$10,000.00.
Inspection of existing plumbing or for $10,001.00 to$25,000.00 $148.50 for the first$10,000.00 and$1.54 for
which no fee is specifically indicated 90.00/hr each additional$100.00 or fraction thereof,to
(minimum charge-1/2 hour) and including$25,000.00.
Inspections outside of normal business 90.00/hr $25,001.00 to$50,000.00 $379.50 for the first$25,000.00 and$1.45 for
hours(minimum charge-2 hours) 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$1.20 for
(minimum charge-1/2 hour) each 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*. Plan Review for Plumbing Installations
Quantity by Fixture Type Plan review is required for any of the following.
Fixture Type for Replace/ Please check all that apply.
Work Performed: Capped Added Relocate
❑ Any new commercial building with water service 2"and
Baptistry/Font greater,except systems designed and stamped by licensed
Bath: -Tub/Shower
engineer.
-Jacuzzi/Whirlpool
Car Wash: -Each Stall ❑ New exterior plumbing site utilities for any complex structure
Drive 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"
-3" Isometric or Riser Diagram
4.. ❑ Isometric or riser diagram is required for new buildings
-Car Wash Drain that meet the qualifications above.
Garbage -Domestic non-food
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: -Iav/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 increase of sewer EDUs,a sewer permit will be issued and
Washer-Clothes fees assessed for the sewer increase must be paid before the
Water Extractor
Water Closet-Toilet plumbing permit can be issued.
Urinal
Other Fixtures:
T:\Building\Permits\PLMF_PermitApp.doc 08/04/2011 2
r .
Plumbing Permit Application ,
Building Fixtures FOR OFFICE USE ONII\Il
City of Tigard Received Permit No.: f t in.�tJ�)_00 e/+I
• 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Rev ea n
■ ' Phone: 503.718.2439 Fax: 503.598.1960 Date/By: Q I-a t/-.ZO23,1ri'n
Other Permit No.'
Ti G A R D Inspection Line: 503.639.4175 Date Ready/By: runs ® See Page 2 for
Internet. www.tigard-or.gov Notified/Method Suppkmental Information
TYPE OF WORK P V 1rJ *"SC tIULE
AlFor special information use checklist
New construction El Demolition Description I Qty. I Ea. 1 Total
❑Addition/alteration/replacement ❑Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
_ t SFR(1)bath 312.70
Commercial/industrial SFR(2)bath 437.78
❑1-and 2-familydwellmg El
SFR(3)bath
500.32
❑Accessory building %Multrfamlly Each additional bath/kitchen 25.02
❑Master builder 0 Other: Fire sprinkler(_sq.ft.) Page 2
-
-....--.5.._:.?"--.,-,':-.'aif 1.SITE.INFORMATION AND LOCATION Site utilities:
Catch basin or area drain 18.76
Job site address: goori 5 0 {tZwl t O i 1 tY c�t Drywell,leach line,or trench drain ;Z 18.76 311 5a
City/State/ZIP: (, qr 0Y23.e,r. qriot J d Footing drain(no.linear ft.:_) Page 2
Suite/bldg./apt.no.: Project name: Hfti,,,p{tptek S{tee'. Opts• Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
Rain drain connector h 18.76 (1a,5 6
Sanitary sewer(no linear ft.:_) Page 2
Storm sewer(no.linear ft.:_) Page 2
Water service(no.linear ft.: ) Page 2
Subdivision: I Lot no.: Fixture or item:
Tax map/parcel no.: Backflow preventer 1 31.27 3 j,21
- _ 12.51
..
I 1 Y;:f f ) Y"c i .,pl 25.02
LL clothes washer 5 6 III61,IZ
1vt'teY;Otr exw, I)1 J Dishwasher 5E, 25.02 4gc1.I2
fl Drinking fountain 25.02
S ,) Ejectors/sump t 25.02 2S,Q
c:PROPERTY OWNER _ Expansion tank A 12.51 ea S,ca
�, - -.. Fixture/sewer cap 25.02
Name:
Flow drain/floor sink/hub (E 25.02 400 r3a,
Address: _ Garbage disposal 25.02
City/State/ZIP: Hose bib if 25.02 106,68
Phone:( ) Fax:( ) Ice maker 12.51
0 APPLICANT i .SP'..:i Gr r ai'',:-cl Interceptor/grease trap 25.02
2
Medical gas(value:$ ) Page
Business name: 2. N,Primer 12.51 , c,
Contact name: Roof drain(commercial) 12.51
Address: - Sink/basin/lavatory (.19 25.02 317>?,5q
City/State/ZIP: Solar units(potable water) 62.54
Phone:( ) Fax::( ) Tub/shower/shower pan 90 12.51 S 9.5.96
Urinal 25.02
E-mail: Water closet If 25.02 19176.4/2
` CONTRACTOR Water heater / 37.52 '317,5,1
Business name: Water piping/DWV 56.29
Address: Other: B 25.02 a(Io.I(s
City/State/ZIP: Subtotal CO,A6,39
Minimum permit fee: $72.50
Phone'( ) Fax:( ) Plan review (25%of permit fee) ALA%,5q
CCB Lic.: Plumbing Lic.no.: State surcharge(12Vo of permit fee) 1155 r 1¢...
Authorized signature: TOTAL PERMIT FEE 1311 i fa,!4
Thla permit application expires if a permit is oat obtained within 180 days
Print name: Date: after it has been accepted as complete.
"Fee methodology set byrTri-County Building Industry Service Board.
1:lliwIrl,glPermilsPPLMU•PermitAppdoc 10/01/09 440-4616T(10/02/COM/WBB) .- 10.v`5 i t/
\>t5i'y,k 5 c 56
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Plumbing Permit Application - City of Tigard '
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression S stems:
Site Utilities Qty. Fee(ea) Total 'lSI are Foota_e: r=;,alLtr -'. , -,,k,
Footing drain-1"100' 50.03 0 to 2,000 $121.90
Footing dram-each additional 100' 37.52 2,001 to 3,600 $169.69
. 3,601 to 7,200 $233.20
Sewer-1st 100' 62.54 7,201 and greater $327.54
Sewer-each additional 100' 37.52
Water Service-1st 100' 62.54 Medical Gas stems:
Water Service-each additional 100' 37.52
Storm&Rain Drain-1st 100' 62.54 $100 to$5,000.00 Minimum fee$72.50
Storm&Rain Drain-each additional 100' 37.52 $5,001.00 to$10,000.00 $72.50 for the first$5,000.00 and$1.52 for
Other lnspectiOt�Sor +Ee5 Qly, Fee(ea1 Total each additional$100.00orfractionthereof,to
, v..a uaht3s : and including$10,000.00.
Inspection of existing plumbing or for $10,001.00 to$25,000.00 $148.50 for the first$10,000.00 and$1.54 for
which no fee is specifically indicated 90.00/hr each additional$100.00 or fraction thereof,to
(minimum charge-1/2 hour) and including$25,000.00.
Inspections outside of normal business 90.00/hr $25,001.00 to$50,000.00 $379.50 for the first$25,000.00 and$1.45 for
hours(minimum charge-2 hours) 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$1.20 for
(minimum charge-1/2 hour) each additional$100.00 or fraction thereof.
Subtotal:
Commercial Fixture Work:
Are you capping,adding or replacing fixtures? If"yes",
please indicate work performed by fixture. Failure to
accurately report fixtures could result in increased sewer fees*. Plan Review.for Plumbing Installations
Quantity by Fixture Type Plan review is required for any of the following.
Fixture Type for Replace/ Please check all that apply.
'Work Performed: '„, t;. Capped Added Relocate
❑ Any new commercial building with water service 2"and
Baptistry/Font greater,except systems designed and stamped by licensed
Bath: -Tub/Shower 5 b engineer.
-Jacuzzi/Whirlpool 0 New exterior plumbing site utilities for any complex structure
Car Wash: -Each Stall as defined in OAR918-780-0040.
-Drive Thru
Wirator ❑ Medical gas and vacuum systems for health care facilities.
Cuspidor/Water Aspirator
al ❑ Any multipurpose fire sprinkler system.
Dishwasher:
-Domestic 6 0 Any complex structure as defined in OAR918-780-0040.
Drinking Fountain
Eye Wash Submit 2 sets of plans with any of the above.
Floor Drain/sink: -2"
1 L Isometric or Riser Diagram
❑ Isometric or riser diagram is required for new buildings
-Car Wash Drain that meet the qualifications above.
Garbage -Domestic non-food
Disposal: -Domestic food related
-Commercial food related
-Industrial food related
Ice Mach./Refrig.Drains Comments regarding fixture work:
Oil Separator(Gas Station) 1;4-:ve.fu 0-Ste- . Z .3`.F5-i F1oor5ini,$
Rec.Vehicle Dump Station ( hay Teov.)4 p rZtiS ct v i Keller vul uu)
Shower: -Gang one 3'‘FS-/ .ftvr ST-I aka 5T-2 Stovalx Ya,1(c
-Stall %4
Sink: -LavBar non-food related /l ri
-Bradley ONe3'cFS-I ✓ Ileaf&chanfer jdnaSo-I Sw+a' ,,,k
-Com/Serv/Util food related JJ
-Service *Note: If the fixture work under this permit results in an
Swimming Pool Filter increase of sewer EDUs,a sewer permit will be issued and
Washer-Clothes S b fees assessed for the sewer increase must be paid before the
Water Extractor
Water Closet-Toilet 11 I plumbing permit can be issued.
Urinal
Other Fixtures:
I:\Building Termits\PLMF_PermitApp.doc 08/04/2011 2