Permit N� CCTV ®F TOGAR® PLUMBING PERMIT
ti COMMUNITY DEVELOPMENT Permit #: PLM2010 -00144
rT [ GARD. 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Date Issued: 04/30/2010
Parcel: 1S135CD01201
Jurisdiction: Tigard
Site address: 11665 SW 98TH AVE
Subdivision: Lot: 0
Project: Scott
Project Description: Connect existing house to sewer service. Septic tank must be pumped and filled.
Owner: FEES
SCOTT, STEVEN A & JANET K Quantity Description Date Amount
11665 SW 98TH AVE
TIGARD, OR 97223 30 If Sewer Service 04/30/2010 $62.54
PHONE: 503 407 -3731 1 12% State Surcharge - 04/30/2010 $8.70
Plumbing
10 ea Minimum Fee Adjustment - 04/30/2010 $9.96
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 of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted b, the Oregon
Utility Notifi • G- ter. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain a .•py • the rules
or direc uestions to O b' C by • ling 503.246.6699 or 1.800.332.2344.
Issue By: 1 / Permittee Signature:
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.
Plumbing Permit Application .
g � I OIZ OI 1 I(1 k l1til OiAI 1
Building Fixtures 1 -; EcFIVED . ,�: ,, _.. Q : ;� , f , u >
Received [/ ' (�
City of Tigard Date/By: /(� Permit No.: 1 A _�l ��
,' , u ' 1 3125 SW Hall Blvd., Tigard, OR ' 2
I C Phone: 503.639.4171 Fax: 5(�^'� .1 668 2010 Plan Review ` � f/Q p -
^ �O 0�
Date/By: vvv -ttrvrvry Other Permit No.: ,� )6 ,
lns ection Line: 503.639.4175
.:1 A R 1;�. P Date Ready/By: Juris: ® See Page 2 for
. Internet: www.tigard - or.gov C OF TIGARD Notified/Method: Supplemental Information
TYPE BUIEYING DIVISION FEE* SCHEDULE
❑ New construction 0 Demolition For special information use checklist
Description 1 Qty. 1 Ea. 1 Total
❑ Addition/alteration/replacement Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (1) bath 312.70
❑ I- and 2- family dwelling ❑ 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. ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: 1 t b, ( s G ci 6 . f l J ' c- f -t fee+ Catch basin or area drain 18.76
1 )2 , q Drywell, leach line, or trench drain 18.76
City /State /ZIP: T q a � ( � t I Z Z.
_ ` Footing drain (no. linear ft.: ) Page 2
Suite/bldg. /apt. no.: f Project name: i 3i f - Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
Rain drain connector 22 18.76
Sanitary sewer (no. linear ft& ) Page 2
Storm sewer (no. linear ft.: ) Page 2
Water service (no. linear ft.: ) Page 2
Subdivision: 1 Lot no.: Fixture or item:
Tax map /parcel no.: Backflow preventer 31.27
• DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 25.02
COI/WIC? (.5f 4) s.c loPV' Dishwasher 25.02
Drinkin fountain 25.02
Ejectors /sump 25.02
❑. PROPERTY OWNER I . ❑ TENANT Expansion tank 12.51
Name: She .0 -t--E Fixture /sewer cap 25.02
(,} Floor drain/floor sink/hub 25.02
Address: 1 t 06 5 d �`j Garbage disposal 25.02
City /State /ZIP: - n & �. o o(e cf 42 Z Hose bib 25.02
Phone: (') 40i 7 3 / Fax: ( ) Ice maker 12.51
O. APPLICANT , ' ❑ CONTACT PERSON Interceptor /grease trap 25.02
Business name: Medical gas (value: $ ) Page 2
Primer 12.51
Contact name:
Roof drain (commercial) 12.51
Address: Sink/basin/lavatory 25.02
City /State /ZIP: Solar units (potable water) 62.54
Phone: ( ) Fax: : ( ) Tub /shower /shower pan 12.51
E -mail: Urinal 25.02
Water closet 25.02
CONTRACTOR
Water heater 37.52
Business name: Water t to WV 56.29
Address: A , Other: 25.02
City /State /ZIP: Subtotal
Phone: ( ) Fax: ( ) Minimum permit fee: $72.50 72,2
CCB Lic.: Plumbing Lic. no.: Plan review (25% of permit fee)
/ State surcharge (12% of permit fee) g . ?v
Authorized signature: , iJ TOTAL PERMIT FEE J
/ �// This permit application expires if a permit is not obtained within I80 days
Print name: /‘�ti �� /' Date: //Q after it has been accepted as complete.
t *Fee methodology set by Tri-Count uilding Industry Service Board.
I:\Building\Permits\PLMU- PermitApp.doc 10/01/09 440- 4616T(10 /02/COM/WEB) te a._ C.A 'j v 51
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site' Utilities • `Qty, Fee (ea) . Total Square:Fobtage: 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 Drain - 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 $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 ", 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 ❑ New exterior plumbing site utilities for any complex structure
-Tub/Shower as defined in OAR918- 780 -0040.
Car Wash Each Stall ❑ Medical gas and vacuum systems for health care facilities.
Drive tall ❑ Any multipurpose fire sprinkler system.
Cuspidor/Water Aspirator El 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:
I:\Building\Permits\PLMF- PermitApp.doc 2