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Permit " j ~:, p CITY OF TIGARD PLUMBING PERMIT _ . Permit #: PLM2009 -00211 w 4. _ : COM MUNITY DEVELOPMENT ' "` "" 13125 SW Hall Blvd.. Tigard OR 97223 503.639.4171 Date Issued: 08/04/2009 ;Tr{ CA`R'D 9 Parcel: 2S 111 CD01400 : tl fi :4,0 ,.r,)i Jurisdiction: Tigard Site address: 15606 SW SUMMERFIELD LN Subdivision: Lot: 0 Project: Melone Project Description: Move w /h. . Owner: FEES TOPOLSKI, CHARLES F Quantity Description Date Amount 15606 SW SUMMERFIELD LN TIGARD, OR 97224 100 If Water Service 08/04/2009 555.00 PHONE: 1 12% State Surcharge - 08/04/2009 $8.70 Plumbing 18 ea Minimum Fee Adjustment - 08/04/2009 $17.50 Contractor: Plumbing 1 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 at 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: n I (^ C Q A n Permittee Signature: 'gicii i 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 RECEIVED ,, p , , !4 �, FOR 10 FIC1 (IS ._ONL1 • . 'City y of Tigard 4.' '11 0 4 71109 Received Date/By: No.: ry M '�ci .of III q 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review t ' / � - (O[ 0 Phone: 503.639.4171 Fax: 503.598.196OITY OF TIGARD Date/By: Other Permit No.: '" " inspection Line: 503.639.4175 D ate Ready/By: Ju ris ® See Page 2 for 'TIG BUILDING DIVISION r Internet: www.tlgard or.gov Notified/Method: r( Supplemental Information TYPE OF WORK FEE* SCHEDULE ❑ New construction ❑ Demolition For special information use checklist Description 1 Qty. I Ea. ] Total Addition/alteration /replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection) CATEGORY OF CONSTRUCTION SFR (1) bath 249.20 1*,1- and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 350.00 ❑ Accessory building ❑ Multi- family SFR (3) bath 399.00 ❑ Master builder ❑ Other: Each additional bath/kitchen 45.00 Fire sprinkler ( sq. ft.) Page 2 JOB SITE INFORMATION AND LOCATION Site utilities Job site address: I 5O (.0 �l rn mar l -Q d L n Catch basin or area drain 16.60 _ City /State /ZIP: Drywell, leach line, or trench drain 16.60 Suite/bldg. /apt. no.: I Project name: Footing drain (no. linear ft.: ) Page 2 Cross street/directions to job site: Manufactured home utilities 1 10.00 Manholes 16.60 Rain drain connector 16.60 Sanitary sewer (no. linear ft.: ) Page 2 Storm sewer (no. linear ft.: ) Page 2 Subdivision: I Lot no.: Water service (no. linear ft.:100) , Page 2 55-d0 Fixture or item Tax map /parcel no.: Absorption valve 16.60 DESCRIPTION OF WORK ' Backflow preventer Page 2 M O V 1.00thir Backwater valve 16.60 p 1"' 1.l / dksci toil Clothes washer 16.60 a l VG • Dishwasher 16.60 ❑ PROPERTY OWNER Drinking fountain 16.60 ❑ TENANT Ejectors /sump 16.60 Name: Expansion tank 16.60 Address: Fixture /sewer cap 16.60 City /State /ZIP: Floor drain/floor sink/hub 16.60 Phone: ( ) Fax: ( ) Garbage disposal 16.60 ❑ APPLICANT ❑ . CONTACT. PERSON Hose bib 16.60 Ice maker 16.60 Business name: Interceptor /grease trap 16.60 Contact name: Medical gas (value: $ ) Page 2 Address: Primer 16.60 City/State/ZIP: Roof drain (commercial) 16.60 Phone:( ) Fax::( ) Sink./basin/lavatory 16.60 Tub /shower /shower pan 16.60 E -mail: Urinal 16.60 CONTRACTOR Water closet 16.60 Business name: Water heater 16.60 Address: ©1 :nx r- Other: City /State /ZIP: Subtotal Minimum permit fee: $72.50 72.50 Phone: ( ) Fax: ( ) Residential backflow minimum permit fee: $36.25 CCB Lic.: Plumbing Lic. no.: • Plan review (25% of permit fee) State surcharge (12% of permit fee) $• 7 0 !Authorized signature: 0 TOTAL PERMIT FEE 81-20 Print name: Date: 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 \ Building \Permits\PLM•PermitApp.doc 12/27/06 440- 46I6T(10/02 /COM/WEB) 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' 55.00 0 to 2,000 $115.00 Footing drain - each additional 100' 46.40 2,001 to 3,600 $160.00 3,601 to 7,200 $220.00 Sewer - 1st 100' 55.00 7,201 and greater • $309.00 Sewer - each additional 100' 46.40 Water Service - 1st 100' 55.00 Medical Gas Systems: Water Service - each additional 100' 46,40 Valuation: Permit Fee: Storm &Rain Drain - 1st 100' 55.00 $1.00 to $5,000.00 Minimum fee $72.50 Storm & Rain Drain - each additional 100' 46.40 $5,001.00 to $10,000.00 $72.50 for the first $5,000.00 and $1.52 for each Fixture or Item Qty. Fee (ea) Total additional $100.00 or fraction thereof, to and including $10,000.00. Commercial Back Flow Prevention Device 46.40 $10,001.00 to $25,000.00 $148.50 for the first $10,000.00 and $1.54 for Residential Backflow Prevention Device each additional $100.00 or fraction thereof, to (minimum permit fee $36.25) 27.55 and including $25,000.00. Rain Drain, single family dwelling 65.25 $25,001.00 to $50,000.00 $379.50 for the first $25,000.00 and $1.45 for each additional $100.00 or fraction thereof, to Inspection of existing plumbing or and including $50,000.00. specially requested inspections - per hour 72.50 $50,001.00 and up $742.00 for the first $50,000.00 and $1.20 for Subtotal: each additional $100.00 or fraction thereof. 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 ❑ 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. Drive tall ❑ 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. Car Wash Drain Garbage - Domestic Comments regarding fixture work: Disposal - Commercial - Industrial Ice Mach./Refrig. Drains Oil Separator (Gas Station) Rec. Vehicle Dump Station Shower -Gang -Stall Sink - Bar/Lavatory *Note: If the fixture work under this permit results in an - Bradley P - Commercial increase of sewer EDUs, a sewer permit will be issued and - Service fees assessed for the sewer increase must be paid before the Swimming Pool Filter plumbing permit can be issued. Washer - Clothes _Water Extractor _ Water Closet - Toilet Urinal • Other Fixtures: is\ Building \Permits\PLM- PermitApp.doc 12/27/06