Permit CITY OF TIGARD - PLUMBING PERMIT
11111 s COMMUNITY DEVELOPMENT Permit #: PLM2009 -00298
T t G AR D 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 10/21/2009
Parcel: 2S102DD00808
Jurisdiction: Tigard
Site address: 13960 SW 87TH CT
Subdivision: FILBERT PARK Lot: 1
Project: Curtis
Project Description: Replace up to 100 feet water service, repipe water piping to (11) fixtures.
Owner: FEES
CURTIS FAMILY TRUST Quantity Description Date Amount
15285 SW ALDERBROOK CT
TIGARD, OR 97224 100 If Water Service 10/21/2009 $62.54
PHONE: 56 da Misc Other Fee 10/21/2009 $56.29
1 12% State Surcharge - 10/21/2009 $14.26
Plumbing
Contractor:
SAMMY LEE MUNSEY PLUMBING
11771 LONGSTANDING CT
OREGON CITY, OR 97045
PHONE: 503 - 333 -5499
FAX: 503 - 723 -4753
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp:
Stories:
Total $133.09
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: �/ � A Permittee Signature: ? ,� ,� n p
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 HECF-I'VEP
Building Fixtures I FOR OFFICE USE ONLY
CI of Tigard OCT 2 1 2009 Received j~
Date/B : Permit No.:p~ 2 O
n 13125 SW Hall Blvd., Tigard, OR 972261ILDING o~ ~jGO Plan Review
Phone: 503.639.4171 Fax: 503.598.19 Date/By: Other Permit No.:
Inspection Line: 503.639.4175 DIVISION Date Ready/By: ® See Page 2 for -knis
'M I Internet: www.tigard-or.gov Notified/Method: Supplemental Information
TYPE OF WORK FEE" SCHEDULE
❑ New construction ❑ Demolition For special information use checklist
Description Qty. Ea. Total
Addition/alteration/replacement ❑ Other: New I- 2-family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (1) bath 312.70
t- and 2-family dwelling ❑ Commercial/industrial SFR (2) bath 437.78
❑ Accessory building ❑Mu!ti-family SFR (3) bath 500.32
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: 610 S (mot/ g 7 rU y7' Catch basin or area drain 18.76
City/State/ZIP: Drywell, leach line, or trench drain 18.76
Footing drain (no. linear fl.: Page 2
Suite/bldg./apt. no.: Project name: Manufactured home utilities 50.03
Cross street/directions to job site: E0`F Cq Manholes 18.76
L ( Rain drain connector 18.76
rxzp Sanitary sewer (no. linear ft.: Page 2
Storm sewer (no. linear ft.: Page 2
Water service (no. linear ft.: Page 2 V
Subdivision: Lot no.: Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
J Clothes washer 25.02
Q Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
PROPERTY OWNER ❑ TENANT Expansion tank 12.51
Name: Ge3ft G. ~e Fixture/sewer cap 25.02
Floor drairt/floor sinkAub 25.02
Address: 15 S i /-4f
Garbage disposal 25.02
City/Slate/ZIP: Q'K -'~-2 ~e_ Hose bib 25.02
Phone: ( A 92 Fax: ( ) Ice maker 12.51
APPLICANT ❑ CONTACT PERSON Interceptor/grease trap 25.02
Business name: Ya7'0- _q e - Medical gas (value: $ ) Page 2
( Primer 12.51
Contact name: qt
- - 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: Q Water piping/DWV 56.29
Address: /AAj'-d21 Nigh" 25.02
City/State/ZIP: Subtotal
Minimum permit fee: $72.50
Phone: (5(g ?J 6 - t14 C~ Fax:( ) Plan review (25% of permit fee)
CCB Lic.: I Plumbin Lic. no.:
State surcharge (12% of permit fee)
Authorized signature: OA--'X TOTAL PERMIT FEE
Print name: ate: 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 Building Industry Service Board.
1:SBuildingtPermits\PLMU-PermitApp.doc 10/01/09 440-4616T(10/02/C0M/WE13)
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 - I 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 62,54 Medical Gas Systems:
Water Service - each additional 100' 37.52
Storm & Rain Drain - 1st 100' 62.54 Valuation: Permit Fee:
$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
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 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
Tub /Shower ❑ New exterior plumbing site utilities for any complex structure
Bath -Tub/Shower -Jacuzzi/Whirlpool - Tub/Showerlpool as defined in OAR918- 780 -0040.
Car Wash Each Stall ❑ Medical gas and vacuum systems for health care facilities.
-Drive Thru ❑ 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
3 " 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 lumbin permit can be issued.
Water Extractor p g p
Water Closet - Toilet
Urinal
Other Fixtures:
I:\Building\Permits\PLMF- PermitApp.doc 2 ;