Permit A PLUMBING PERMIT
i z,4!:i , z. CITY OF TIGARD
.1 COMMUNITY DEVELOPMENT Permit #: PLM2010 -00122
'T,iUAR 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 04/16/2010
Parcel: 2S114BB15400
Jurisdiction: Tigard
Site address: 10353 SW RIVERWOOD LN
Subdivision: SWANSONS GLEN NO. 2 Lot: 95
Project: Smythe
Project Description: Replace gas water heater
Owner: FEES
SMYTHE, SETH L & Quantity Description Date Amount
10353 SW RIVERWOOD LN
TIGARD, OR 97224 1 ea Water Heater 04/16/2010 $37.52
PHONE: 503-867-2018 1 12% State Surcharge - 04/16/2010 $8.70
Plumbing
35 ea Minimum Fee Adjustment - 04/16/2010 $34.98
Contractor: Plumbing
OWNER
PHONE:
FAX:
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
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 opy of the rules
or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344. /
J
Issued By: \ 4 Permittee Signatur
CaII 503.639.4175 by 7:00 a.m. for an inspection tha ' ii�ness da
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.
Plumbing Permit Application Bui ldin Fixtures R
I
Building FOR OFFICE USE ONLY
City of Tigard APR 16 2010 Received
Date /By: ��p�U /O� e atilp ° 22O2204g,.... n Permit No �/n
q 13125 g
III SW Hall Blvd., Tigard. OR 97223
= CITY OF TIGARD Da n Review
Phon 503.639.4171 Fax: 503.598.1960 Other Permit No.:
Date /By:
T I G ARD Inspection Line: 503.639.4175 BUILDING DIVISIOI`il Date Ready /By: Juris ® See Page 2 for
Internet: www.tigard Notified /Method: 76SupplementalInformation
TYPE OF WORK FEE* SCHEDULE
❑ New construction ❑ Demolition For special information use checklist.
Description Qty. Ea. Total
® Addition /alteration /replacement ❑ Other: New 1 - 2 - family dwellings (includes 100 0. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (1) bath 3 12.70
® 1- and 2- family dwelling El Commercial /industrial SFR (2) bath 437.78
SFR (3) bath 500.32
❑ Accessory building ❑ Multi - family
Each additional bath /kitchen 25.02
❑ Master builder ❑ Other: Fire sprinkler ( sq. 0.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: 10353 SW Riverwood Lane Catch basin or area drain 1 8.76
Drywell, leach line. or trench drain 18.76
City /State /ZIP: Tigard, OR 97224
Footing drain (no. linear ft.: ) Page
Suite /bldg. /apt. no.: Project name: Manufactured home utilities 50.03
Cross street/directions to job site: Corner of SW 103' Ave and Riverwood Ln Manholes 18.76
East on Durham Rd. from Hwy 99. south on 103 to T- intersection, west on Rain drain connector 18.76
Rivenvood Ln to address Sanitary sewer (no. linear ft.: _ ) Page 2
Storm sewer (no. linear ft.: _ ) Page 2
Water service (no. linear 11.: _ ) Page 2
Subdivision: I Lot no.: Fixture or item:
Tax map /parcel no.: 2S114BB15400 Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 25.02
Replace water heater
Dishwasher 25.02
Drinking fountain 25.02
Ejectors /sump 25.02
® PROPERTY OWNER I ❑ TENANT Expansion tank 12,51
Name: Seth Smythe Fixture /sewer cap 25.02
Floor drain /floor sink/hub 25.02
Address: 10353 SW Riverwood Ln
Garbage disposal 25.02
City /State /ZIP: Tigard, OR 97224 Hose bib 25.02
Phone: (503)867 - 2018 Fax: ( ) Ice maker 12.51
® APPLICANT ❑ CONTACT PERSON Interceptor /grease trap 25.02
Business name: Medical gas (value: 5 1 Page 2
Primer 12.51
Contact name: Seth Smythe
Roof drain (commercial) 12.51
Address: 10353 SW Riverwood Ln Sink /basin /lavatory 25.02
City /State /"ZIP: Tigard, OR 97224 Solar units (potable water) 62.54
Phone: (503) 867 - 2018 Fax: : ( ) Tub /shower /shower pan 12.51
E - mail: seth.smythe @gmail.com Urinal 25.02
Water closet 25.02
CONTRACTOR
Water heater I 37.52 37.52
Business name: Water piping/DWV 56.29
Address: Other: 25.02
City /State /ZIP: Subtotal 37.52
Phone: ( ) Fax: ( )
Minimum permit fee: 572.50 72.50
Plan review (25% of permit fee) . 18.13
CCB Lic.: Plumbing Lic. no.:
State surcharge (12% of permit fee) 8.7
Authorized signature: TOTAL PERMIT FEE
Print name: Seth Smythe Date: 04/16/10 This permit application expires if a permit is not obtained within 180 days
after it has been accepted as complete.
*Fee methodology set by Tri- County 13uilding Industry Service 13oard.
1 A Building V Permits VPLMU- PermitApp. dos 10/01/09 440 - 4616[(10 /02 /COM/WEB) 1/ A 0
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
Valuation: Permit Fee:
Storm & Rain Dram - 1st 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 S5.000.00 and $1.52 for
Other Inspections or Fees Qt Fee (e Tota each additional $100.00 or fraction thereof, to
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 $100.00 or fraction thereof.
Subtotal:
Commercial Fixture Work:
Are you capping, adding or replacing fixtures? If "yes ", Plan Review for Plumbing Installations
please indicate work performed by fixture. Failure to Plan review is required for any of the following.
accurately report fixtures could result in increased sewer fees Please check all that apply.
Quantity by (Fixture) Work Performed ❑ Any new commercial building with water service 2" and
Fixture Type: Replace greater, except systems designed and stamped by licensed
Previous Capped Added Existing engineer.
Baptistry/Font
Bath - Tub /Shower 111 New exterior plumbing site utilities for any complex structure
as defined in OAR918- 780 -0040.
- Jacuzzi /Whirlpool
Car Wash -Each Stall 111 Medical gas and vacuum systems for health care facilities.
Drive Thru 1=1 Any multipurpose fire sprinkler system.
Cuspidor /Water Aspirator ❑ Any complex structure as defined in OAR918- 780 -0040.
Dishwasher - Commercial
Domestic Submit 2 sets of plans with any of the above.
Drinking Fountain
Eye Wash Isometric; or Riser Diagram
Floor Drain /sink - 2" ❑ Isometric or riser diagram is required for new buildings
that meet the qualifications above.
-4"
Car Wash Drain
Garbage - Domestic
Disposal - Commercial
- Industrial Comments regarding fixture work:
Ice Mach. /Refrig. Drains
Oil Separator (Gas Station)
Rec. Vehicle Dump Station
Shower -Gang
-Stall
Sink - Bar /Lavatory
- Bradley
- Commercial *Note: If the fixture work under this permit results in an
- Service increase of sewer EDUs, a sewer permit will be issued and
Swimming Pool Filter fees assessed for the sewer increase must be paid before the
Washer - Clothes
water Extractor plumbing permit can be issued.
Water Closet - Toilet
Urinal
Other Fixtures:
C: \Documents and Settings \slsmythe \My Documents \personal \PLMF- Perr$itApp.doc