Permit CITY OF TIGARD PLUMBING PERMIT
E{ I: - COMMUNITY DEVELOPMENT Permit #: PLM2009-00335
IiOARD. 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 11/20/2009
Parcel: 2S103BA00200
Jurisdiction: Tigard
Site address: 11525 SW WALNUT ST
Subdivision: Lot: 0
Project: Scroggin
Project Description: Replace water service.
Owner: FEES
SCROGGIN, MARY LYNN Quantity Description Date Amount
11525 SW WALNUT ST
TIGARD, OR 97223 100 If Water Service 11/20/2009 $62.54
PHONE: 1 12% State Surcharge - 11/20/2009 $8.70
Plumbing
10 ea Minimum Fee Adjustment - 11/20/2009 $9.96
Contractor: Plumbing
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: 9-n7 zi 69_ A l
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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Plumbing Permit Application n ) r EivE,,,
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Building �,. �,
F , C I of Tigard r OR 9722 NO 19 , 2009 %0;749/0 y .0 ` . permit No.:AI /A 0 . It/ 1.; s
131 A. SW Hall Blvd, Tigard, Other Permit No.:
, j C . ' Ph. , . 503.639A171 Fax: 503.59x_196�1 F TIGARD ® sex z for
T - p Line: 503.639.4175 M Ban RsedY7BY• ! g Information
in�;n,t www.tigard -a.ga BUILDI G DIVISIO Norifi l: + �
TYPE OF WORK FEE' SCHEDULE
•
For spedtd iajomradon roe cheecu
El New construction 0 Demolition Description 1 Qty. 1 Ea. 1 Total
` 'Addition/alteradtonh m
eplaceeat ❑ Other. New 1- 2-family dwellings (includes 100 ft for each utility connection)
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CATEGORY OF CONSTRUCTION SFR (I) bath 312.70 .
SFR (2) bath 437.78
IA 1- and 2- family I welling ❑ Cammer+ciaYindustrial SFR (3) bath 50032 •
❑ Accessory buil ' [] Multi-famfly Each additional bath/kitchen • 25.02
❑ Master builder P Other: Fire sprinkler (_., - s4. R) Page 2
IJOB SITE INFORMATION IAND LOCATION Site utilities:
{� 5-k.
Catch basin or area drain 18.76
Job site address ` Z S sL/.7 W Drywcll, leach Imc, or trench drain 18.76
City/State/ZIP: l ) c `12- C 11 - 2-- -- 2- 3 Footing drain (no. linter ft.: 1 2
I n Suite/bldg./apt. rho. : 1' roJ � °�e� I � Manufactured home utilities 50.03
1
II Cross /directions to job site: i I Manholes 18.76 18.76
I Rain drain connector
Sanitary sewer (no. linear 11: ___) Page 2
I
Sturm sewer (no. linear 8: ) Palle 2
Water service (no. linear ft.: 1 ) i Page 2 G Sj
Subdivision: I 1 Lot 40.: Fixture or item:
Bacidlow pnwenter 31.27
Tax map/parcel no.: ; � Backwater value 1231
DESCRIPTION OF WORD Clothes washer 25
I 1 Dishwasher 25-02
I I Dunking fountain 25.02
Ejectors/sump 25.02
Expansion tank 1251
❑ PROPERTY OWNER ❑ TENANT
Fix umJscwer cap 25.02
1 - Floor drain/ loon sink/hub 02
25.
Name: L1 1 Ev1 �}('QU
Address: F ` _L «-M E 1 Garbage disposal 25.02
City/StateJZIP: 1 Hose bib 25.02
Phone: ( ) 1 l Fax: ( Ice maker 12.51
❑ AP1'UcAr4T Q CONTACT PERSON b t /t' sc trap 25.02
1 Medical gas (value: $ _) I Page 2 J
Business name: `_ O l Primer 12.51
Contact name: 1 -1 Roof drain (commercial) 1251
Address' 1 1
Sink/basin/lavatory 25.02
City/State/LIP: 1 Solar units (potable water) 62.54
1 TublshowedshOwer pan 1251
Phone: ( ) Farc : ( ) 25.02
Urinal
E-mail: 1 Watts closet 25.02
CONTRACTOR 1 Water heater 3752
Business name: ; Pe\ vt 11t ,INA.b -om, Water piping/DWV 56.29
C' 25.02
Address: ` i `:J � � t• �
City/State/City/State/DP: • l(J? �`' ,� e l 1 'e)� CO c _ 3 Subtotal
Minimum peotrit fee: 572.50 7pZ , _C O
Phtme: CD? `p -2...u, - lc-A ( Fax. ( E j) L.f22k -1 - igZR..p Plan review (25% of permit fee)
CCB Lic.: 1 5 ()ZL00 '✓ I Plumbing Il.ic. no.: 5\ D - P`e) State surcharge (129'0 of permit fee) k, Ip
TOTAL PERMIT FEE • /. A O I 2.-- l Print name:
Authorized signature: C_ 1 n(� AA fro diva
1 l C \O CA 1 This permit application expires if a penult is not obtained within
\(� C t 0.r v.;, ��� C1 Date: l " after it has been accepted as complete
` .5...er6.vi..t..rru wort t... T.iJ'n....1.. A 7A:w. l...t...w., C... -4.. Rm..r
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- City of Tigard e /rr 7
Plumbing Permit Appllcahon ty �
Page 2 - Supplemental Information
Fee Schedule; Residential Fire Suppression Systems:
Site Utilities Qty. I Fee (ca) Total Square Footage: Permit Fee:
Footing drain - ]g 190' 50.03 0 to 2,000 $12190 2,001 to 3,600 $169.69
Footing drain - eachadditional 100' 37.52 3,601 to 7,200 $233.20
Sewer - 1st 100' I 62.54 7,201 and greater $327.54
Sewer - each additiMtal 100' 37.52
Water Service - 1st 100' i 62.54 Medical Gas Systems:
Water Service -each additional 100' 37.52. Valuation: Permit Fee:
Storm & Rain Drain - lst 100' 62.54 $1.00 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
Q ty. Fee (ea) Total each additional $100.00 or fraction thereof, to
Other Inspections or Fees _ and including 510,000.00.
Inspection of existing plumbing or for $10.001.00 to $25,000.00 $14850 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 -11/2 hour) and including $25,000.00.
Inspections outside of normal business 90.00/hr $25,001.00 to $50,000.00 $379.50 for tltc first 525,000.00 and $1.45 for
hours (minimum charge - 2 hours) - each additional S100.00 or fraction thereof, to
Reinspection Fees I 90.00/hr and including $50,000.00.
90.00/hr $50,001.00 and up $742.00 for the first $50,000.00 and 51.20 for
Additional plan review for revisions each additional $100.00 or fraction thereof.
(minimum charge i 1/2 hour) —
Subtotal:
Commercial Fixture Work:
Are you capping, adding or replacing fixtures? If "yes", Plan Review for Plumbing Installations
please indicate work performed by fixture. Failure to Plan review is required for any of the following.
accurately report fixtures could result in increased sewer fees * . Please check all that apply.
Quantity by (Fixture) Work Performed ❑ Any new commercial building with water service 2" and
Fixture Type: Replace greater, except systems designed and stamped by licensed
YPe Prrviaus Capped , Added ' Existing engineer.
Baptistry /Font I ❑ New exterior plumbing site utilities for any complex structure
Bath - Tub/ShOwer as defined in OAR918 -780 -0040.
- JacazzilWhirlpool ❑ Medical gas and vacuum systems for health care facilities.
Car Wash - Each Stall 0 Any multipurpose fire sprinkler system
- Drive Thru ❑ Any complex structure as defined in OAR918-750-0040.
Cuspidor /Water .Aspirator
Dishwasher -Commercial , Submit 2 sets of plans with any of the above.
- Domestic
Drinking Fountain , Isometric or Riser Diagram
Wash .
Floor Drain/sink - 2" 0 Isometric or riser diagram is required for new buildings
that meet the qualifications above.
- 4 "
Carl Wash Dram
Garbage - D9tmestic ,
Disposal -Commercial Comments regarding fixture work:
- Industrial
Ice Mach. /RefrigJ Drains
Oil Separator (Gas Station) - _
Rcc. Vehicle Damp Station
Shower -Gang
-Stitt)
Sink - Bar/Lavatory
- Bradley
- Commercial *Note: If the fixture work under this permit results in an
-Slice increase of sewer EDUs, a sewer permit will be issued and
Swimming Pool Filter - - fees assessed for the sewer increase must be paid before the
Washer - Clothas r plumbing permit can be issued.
Water Extractor 1
Water Closet - Toilet
Urinal I
Other Fixtures: 1 ,