Permit
~t CITY OF TIGARD PLUMBING PERMIT
r COMMUNITY DEVELOPMENT Permit#: PLM2009-00314
13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 10/30/2009
Parcel: 2S111AB07500
Jurisdiction: Tigard
Site address: 9390 SW INEZ ST
Subdivision: Lot: 0
Project:
Project Description: Replace water line.
Owner: FEES
ANGER, KATHLEEN Quantity Description Date Amount
9390 SW INEZ ST
TIGARD, OR 97224 100 If Water Service 10/30/2009 $62.54
1 12% State Surcharge - 10/30/2009 $8.70
PHONE: Plumbing
10 ea Minimum Fee Adjustment - 10/30/2009 $9.96
Plumbing
Contractor:
PIPELINE PLUMBING
333 S STATE ST, STE. V-108
LAKE OSWEGO, OR 97034
PHONE: 503-624-1906
FAX: 503-624-1926
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp:
Stories:
Total $81.20
Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. 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 the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0100. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By: Permittee Signature: j \
Call 503.639.4175 by 7:00 a.m. for an inspection that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each Inspection.
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,,. RECEIVED Nt
Plumbing Permit Application
ilding Fixtures OCT 2 9 2009 c012 01 USE ONLY
City of Tigard fr OF TIGARD
Received
f /0 i 0 . . emit NoAi1 '0. i ■ /
13125 SW Hall Blvd., Tigard, OR Plan Revi Otherpermir No.:
Phone: 503.639.4171 Fax: 503 ING DIVISION DateyBy
Inspection Line: 503.639.4175 Date Rcady ! ' el Si See Page 2 for
T I G 2 p Notified/Method: J► suppkmeotal Information
.A170�.:A❑� AF.113A011LAC13E; E:7,0 0 DO0ono .{FEE' SCHEDULE : .
TYPE OF WORK
For special il»fornrafion use checklist
❑ New construction ❑Demolition Desc iOon ` Qty. 1 Ea. I Total
. Addition/alteratiou/replacement ❑ Other. New 1- 2- family dwellings (includes 100 fl. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (1) bath 312.70
1:51- and 2- family dwelling ❑ Commercial/industrial SFR (2) bath al SFR (3) bath 500.32
❑ Accessory building ❑ Multi- family Each additional bath/kitchen 25.02
❑ Master builder ❑ Other fire sprinkler (___ _. sq. ft.) Page 2
JOB: SITE INFORMATION AND: LOCATION Site utilities:
Catch basin or area drain 18.76
Job site address: q'_9 l7 a u f _a Drywall, leach line, or trench drain l I 8.76
City/State/ZIP: ; - , L 47 a Footing drain (no. linear ft.: Page 2
Suite/bldg./apt. no.: Project name: Manufactured home utilities 50.03
Manholes 18.76
Cross street/directions to job site - l8 76
•
Rain drain connector
1Gi(irt�� I1IL t�lf jiM1 u%a -fIJ/ Q.+VI� Sanitary sewer (no. linear R: 1 Page 2 l
rail flu ti ?iil L'X. TY1E,.tS ' -F- - Storm sewer (no. linear R.: _) Page 2
Water service (no. linear IL: ) f Page 2
Subdivision: I Lot no.: Fixture or item:
Backflow prevcnter 31.27
Tax map /parcel no.: Backwater valve 12.51 l
DESCRIPTION OF WORK • Clothes washer 25.02
Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
`ROPERTY OWNER I Expansion tank 12.51
❑ TENANT 25.02
Fixture/sewer cap
drain Name: Floor e/sew floor sink/hub 25.02
Address: s Garbage disposal 25.02
City /State/ZIP: Hose bib 25.02
Phone: ( )
Fax: ( ) Ice maker 1231 CONTACT PERSON Interceptor /grease trap
25.02
.2r APPLICANT ❑ Medical gas (value: S ) Page 2
Business name +M24211 i it r ,rr1h a Cl f Primer 12.51
Contact name: 10(t'> T Y i2 rq Roof drain (commercial) 12.51
'�- S
Address: 2 S S. S4z2J' te . Stk te. k/ Oa Sink/basin/lavatory 25.02
Ci / Sate/ZIP: lr
+ (� .t l( � 0 .Ji 1 ) L:[ L i � 4 Solar units (potable water) 62.54 -
Phone: (9j3 ) ( 14 a I Fax: : () day - iC a Li. Tub/showerlshower pan 1251
l
Urinal 25.02
E -mail: �2J •pn Qy2I Minthe!! e I/-Q'J ?t 1 .III Water closer 25.02
CO[v'TRACTOR Water heater 37.52
Business name: �
rf�-� t � e (�mbi % i Water piping/DWV 56.29
Address: � 25.02
S(1! i'h� ��- C.�.X111'!;-� Other: Subtotal
City /State/ZIP: .
- Minimum permit fee.: 572.50 7A , .S0
t _ / Phone: ( ) Fax: ( ) - Plan review (25% of permit fee)
^� Plumbing Lic. no.: 3 i Q - P& -T-
CCB Lic.: I `;2) • C p State surcharge (12 /o of permit fee) �"� 7� •
Authorized signature: j -.7 i o I t5 TOTAL PERMIT FEE I O I a0
Thb permit applianioa expires if a permit is not obtained within 180 days
� after it has been accepted as complete.
Print name: Loy 'Rot J Date: i - 2� � � �'"' "Fee methodology set by Tri -County Building Industry Service Board.
1. 111uildiegPerniinTLIIU- PcrrailAPP4oc 10/01109 44046 16T(IOrovcoMNJEB)
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•
.
king Perm A licatio - City of Tigard
2 - Supplemental Information
ee
Residential Fire Su . I ression S stems:
Site Sch Utilities .t S' uare Foota Le: . permit Fee:
Qty. $ t2 1. 90
•
•
Sit Utilities . 50.03 0 to 2,000 • , ,
�� 2.001 1 to 3,600 S233Z0
Footing drain - 1" t 00' 3,601 to 7,200
Sewr Footing drain each additional t 00' �� 7,201 and - ter
Sewer -1st 100'
Water Service - tat 100' 37.52 OM Valuation: • Permit Fee
Water Service - rain additional 100' 11.1111112011111111111 $1.00 to $5,000.00 Minimum fee $72.50 $1 for
Storm & Rain Drain - 1st 100' _
�� $5.001.0 to 510.000.00 $72.50 for the first $.5.000.00 and
Storm & Rain Drain -each additional 100' and additional 5100.00 fraction , to
fraction thereof,
each i addit i n $10,000.00.
Other II1 i ' = OnS ng Fees $10,001.00 to $25,000.00 $148.50 for the first $10,000.00 and $1.54 for
plumbing or for each additional $100.00 or fraction thereof, to
which h on fee is specifically p 90.00/hr ■ each additi o $$10 $100.00 no fee - :. — ho ur indicated •
In (minimum Inspections c d e 1/2 hour 90.00/hr 525,001.0 to 550,000.00 $37 additional fthe first 000 0 0.0frad+o�rdhe $1.45 for
h ours ( outside of normal business and $50,000.00.
hours ec (minimum Fees e — 2 hours) 111111 90.00lhr and incl for the 0,0 S50,000.00 and $1.20 for
Aunspecti0n Fees $50.007.0 and up each additional $100.00 or fraction thereof.
Additional plan review for revisions
90.00/hr
minimum c —112 hour � 11111111111•111
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P lan Review for Pln>Gnb Installations
i
Commercial Fixture W ork:
Are you capping, adding or replacing fixtures? If "yes", Nan review is required for arty of the fnlowing•
please indicate work performed by fixture. Failure to
Ple ase check all that apply.
accurately Any new commercial building with water by i t ensed
re ort fixtures could result in increased sewer fees *. greater, except systems designed end stamp Y
I oaati -R r ° � o
and
� ® engineer. complex structure ❑ New exterior plumbing site utilities for any
B:.•tisuY/Font r — as defined in OAR918- 780 -00
-- systems for h care facilities.
Bath -Rib/Shower ��- El Medical gas and vacuum health e
]acuurlv St . , ,1 � �r— ❑ Any multipurpose fire sprinlder
Wash -Each Stan �= ❑ Any complex structure as defined in OAR918- 780 -0
-Drive nun =��
C • idorJWetcr • •'razor —� Submit 2 sets of plans with any of the above.
Dishwasher -Commercial �r��
_Domestic - -r
Erin :. Fountain r �' 1 Isometric or Riser Dia am
E . � -� I isometric or riser diagram is required for new buildings
Drainlsink _ 2"
" = = � - that meet the , ualiflcations above.
-4 ,. -r •
Car Wash Drain
Garbage - Domestic r = =� C regarding fixture work:
Disposal - Commercial
• - industrial -�
ice MachJRefri: Drains NONINNIIIIINONIIINMEN
r ec. Vehicle Dorn. R Station sommilmisolm _
Shower -Sta l g MEN MM. MEM
Sink - BarlL,avatory MOM—
remit results in an
- Bradley
- rr� *Note: If the fixture work under this p will be issued and
- Commercial -�' increase of sewer EDUs, a sewer pe must it be i before d
- Service 1111111101111111111111110111011011111
fees assessed for the sewer increas
Swivtmin: Pool Filter ��S plumbing permit can be issued.
Washer -Clothes - -r�
Water Extractor ��
Urinal inset- Toilet �r��
Urinal —��—
Other Fixtures:
slip: //www.tigard- or.gov /city hall! departments lid /docslPl-MF- PermitApecloc