Permit '1c� - CITY OF TIGARD
PLUMBING PERMIT
14 a COMMUNITY DEVELOPMENT Permit #: PLM2010 00126
Date Issued: 04/20/2010
4EGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Parcel: 2S102CA00232
Jurisdiction: Tigard
Site address: 9560 SW FREWING CT
Subdivision: Lot: 0
Project: Swanson
Project Description: Replace 59' water service
Owner: F EES
SWANSON, PRISCILLA Quantity Description Date Amount
9560 SW FREWING CT
TIGARD, OR 97223 59 If Water Service 04/20/2010 $62.54
1 12% State Surcharge - 04/20/2010 $8.70
PHONE: 503 - 620 -0987 Plumbing
10 ea Minimum Fee Adjustment - 04/20/2010 $9.96
Contractor: Plumbing
APOLLO DRAIN & ROOTER SERVICE
2208 NW BIRDSDALE #8
GRESHAM, OR 97030
PHONE: 503 - 239 -8801
FAX: 503 - 669 -8028
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.
r
Issued By: W ���� PermitteeSignature: e ), A / " 9 / 0 / 0 4 �� ,9 7O _ /V /
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.
A pr, 19. 2010 9: 58AM No. 1681 P. 1i 3
Plumbing Permit Application
Building Fixtures RECEIVED
Ci ty g of Tigard Receives !
_ /
13125 SW Hall Blvd„ Tigard, OR 97 R 1 9 2010 D Z /M 4L -- PermitN °. po 't/t L:zeQ
t
III Phone: 503,639.'l171 Fax: 503.598.1960 Plan Review
- Other Permit No.:
Da teBy:
Inspection Line: 503.639.4175
1 I GARu CITY OF TIGA Date Ready/By: pier El See Page 2 to
Internet: www Ilgerd- or.gov Nonfied0vleihod: ,gyp Supplemental Information
i _JILDING DIVISION 1 1 • . : TYPE OF W ORK - _ FE
❑ New construction ❑ Demolition - For special information rise checklfsR
Description 1 Qty. 1 Ea, 1 Total
dditi on/al teration/rcplacemenl 1=1 Other: New 1- 2-family dwellings (includes 100 ft, for each utility connection)
CATEGORY OF CONS SFR (1) bath 312.70
and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 437.78
❑ Accessory building 17 Multi-family SFR (3) bath 500.32
Each additional bath/kitchen 25.02
❑ Master builder i ❑ Other: Fire sprinkler ( sq. ft.) Page 2
: ..
JO SITE INFORMATIQN AND LOCATION Site utilitiest
Job site address: 1() a i F/1(2.4Arldet Catch basin or area drain 18.76
Drywall, leach line. or trench drain 18.76
City /State /ZIP: P 314n ° -
C%� Fooling drain (no. linear ft,: `) Page 2
Suite/bldg. /apt. no.: Project name: Manufactured home utilities 50.03
Cross strcct/dircctions to job site: Manholes 18.76
Rain drain connector 18.76
Sanitary sewer (no. linear ft.: ) Page 2
Storm sewer (no. linear ft.: ) Page 2
Water service (no. linear fl.:6q ) 1 Page 2
Subdivision: 1 Lot no.: Fixture or item:
Tax map /parcel no.: Elackflow preventer 31.27
OESCRFPTION; OF;WORrC ac atcrvahe 12.51
/t. " C" • l ... 4
/
AL
i . . . _ Clothes washer 25.02
. - l - 41L - - Dishwasher 25.02
Drinking fountain 25.02
Ejectors /sump 25.02
mt PROPERTY OWNER Ex
❑ T ENANT N
Name: q P
anSiOn tank 12.)1
r� Fixture/sewer cap 25.02
K
FIoor drain/floor sink/hub 25.02
Address:
Garbage disposal 25.02
City /State /ZIP: Hose bib 25.02
Phone wJ )02_0 t' o9 $1 Fax ( ) Ice maker 12,51
PPLICANT
CONTACT PERSON Interceptor /grease trap 25.02
Business name: / / ( 0 ,+ati Medical gas (value: S _) Page 2
HO Primer 12.51
Contact name:
Roof drain (commercial) 12.51
Address; Sink/basin/lavatory 25.02
City /State /ZIP: Solar units (potable watcr) 62.54
Phone: &j) 2� - 88'ol Fax: : ( ) Tub /shower /shower pan 4 12.51
E -mail' Urinal 25.02
. CONTRACTOII_ Water closet
25 02
Water heater 37.52
BusineSs name: A f v _, �� N Water piping/DAN 56.29
Address: Z ; 0.611.6 (1 � or 1 lilaMiL_ v . • Other:
25.02
City/State/ZIP: 0 I d Q -71() Subtotal
Phone: • ' '. 1 • q ° gkp i Fax: ( fit ( pC43 Mini mum permit fee: 572,50 , S8
l &' 7 4 >‘,7 Plan review (25% of permit fee) • CCB I ic.: �� i ./ Plumbing I ic. no' ' State surcharge (12% of permit fee) '- g ', -
Authorized signat c: TOTAL PERMIT FEE k/ , AO r
Print name: mI /,,,/ e. sE ,c/, Date: O 9/0 This permit application expires it a permit is not obtained within 100 days
eller it has been accepted as complete.
.-____'.. , Fee merhodologv set by Tri- County Building Industry Service Board.
1: 1BUilding2Peamits \PLDN- PeaniiApp.dot 10/01/09 440- 1616T(10 /021COMIWEB)
Apr. 19. 2010 9: 58AV No. 1681 P. 213
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site Utilities: •.. Qty Fee (ea) Total :7 Footage : Permit Fee,
Footing drain - 1" 100' 50.03 0 to 2,000 _ $121.90
Footing drain - each additional 100' 37,52 2001 l0 3,600 $169.69
3,601 to 7,200 3233.20
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 _ ' . . .
Sloan &Rain Drain - 1st 100' 62.54
Valuati0II Permit
$1.00 to $5,000.00 Minimum fee 372.50
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
each additional 3100.00 or fraction thereof, to
Other Inspections:or:.Fees :,Qty .: .
Fcc (c;.0.:: : .... Tof a l. ... 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 fcc is specifically indicated 90.00/hr each additional $100.00 or fraction thereof, to
minimum char a -1/2 hour and including $25,000.00.
Inspections outside of normal business 90.00/ltr 325,001.00 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 90.00/11r and including $50,000.00.
Additional plan review for revisions 90.00/hr 350,001.00 and up $742.00 for the first $50,000.00 and 5 1.20 for
(minimum charge - I!2 hour) each additional $100.00 or fraction thereof.
Y Subtotal:
.
Commercial Fixture Work:
Are you capping, adding or replacing fixtures? 11' "yes ", '
'.Plan Re'yiew tit. 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
Previous Capped Added Exi3fiag engineer.
Baptistry/Font ❑ New exterior plumbing site utilities for any complex structure
Bath Tub /shower as defined in OAR918- 780.0040.
- Jacuzzi/Whirlpool
Car Wash -Each Stall ❑ Medical gas and vacuum systems for health care facilities.
Each Stall
11 Any multipurpose lire sprinkler system.
Cuspidor/Water Aspirator - ❑ Any complex structure as defined in 0AR918- 780 -0040.
—
Dishwasher - Commercial
Domestic Submit 2 sets of plans with any of the above.
Drinkin Fountain
Isometric . or-Riser.-Diagram
Floor Drain/sink - r ❑ Isometric or riser diagram is required for new buildings
that meet the qualifications above.
—
Car Wash .,,
Garbage -Domestic
Disposal -Commercial
Comments regarding fixture work:
Ice Mach./Rcfrig. Drains -
Oil Separator (Gas Station)
Rec. Vehicle Dump Station
Shower -Gang
-Stall
Sink •13ar/Lavatory
-Bradley _
- Commercial *Note: 11' the fixture work under this permit results in an
- Service increase of sewer EDTUs, a sewer permit will be issued and
Swimming Pool Filter - fees assessed for the sewer increase must be paid before the
Washer - Clothes
Water Extractor plumbing permit can be issued.
Water Closet • Toilet _
Urinal _
Other Fixtures;
http: / /www.tigard or.gov /city halUdepartments /cd/docs/PLMF- PermitApp2doe