Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Permit
• .; CITY OF TIGARD PLUMBING PERMIT COMMUNITY DEVELOPMENT Permit #: PLM2009 -00299 T, - RQ 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 10/21/2009 Parcel: 1S 133DD00700 Jurisdiction: Tigard Site address: 11689 SW 129TH PL Subdivision: VILLAGE AT SUMMER LAKE PARK 2 Lot: 46 Project: Barbu Project Description: Install (2) w/c and (2) lays. Owner: FEES BARBU, DAN Quantity Description Date Amount 11689 SW 129TH PL TIGARD, OR 97223 2 ea Lavatories 10/21/2009 $50.04 2 ea Water Closet 10/21/2009 $50.04 PHONE: 1 12% State Surcharge - 10/21/2009 $12.01 Plumbing Contractor: OWNER PHONE: FAX: Type of Use: SF Class of Work: ALT Type of Const: Occupancy Grp: Stories: Total $112.09 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: ) ")� ( L L Q1 1juj 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 RECEIVED s �N i ' . ?a. h �. �, gr:,` aj (r i .lGy."f,PA. Building Fixtures 2 1 y a . s , y , .. "'. 4O I I l . .I. , , x Y`?u x ' ` itsi 0 2009t°-- 'a a Received �'��y'�Q / ��Q �/ ,- City of Tigard Date/By:. Permit No.: �/� 1' '�-K/7 'W" ` 1 r ' V 13125 SW Hall Bivd., Tigard, OR 9722 ■ C : Phone: Y OF TIGARD Plan Revew Other Permit No.: s.+ Inspection Line: 503.639.4175 Fax: 503.59 b DING DIVISION Date/By: - I'll G'A' R D' Date Ready /By: r See Page 2 for Internet: www.tigard - or.gov Notified/Method: C Supplemental Information TYPE OF WORK FEE* SC ❑ New construction ❑ Demolition For special information use checklist Description 1 Qty. 1 Ea. 1 Total E8 Addition/alteration /replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection) CATEGORY OF CONSTRUCTION SFR (1) bath 312.70 [:il 1- and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 437.78 building SFR (3) bath 500.32 ❑ Accessory g ❑ 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: // 6 cSL4' /29 -e4 PL. Catch basin or area drain 18.76 ! J� Drywell, leach line, or trench drain 18.76 Cit y 7 /State /ZIP: 7 / ©� � Footing drain (no. linear ft.: ) Page 2 Suite/bldg. /apt. no.: I Project name: Manufactured home utilities 50.03 Cross street/directions 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 ft.: ) Page 2 Subdivision: I Lot no.: Fixture or item: Tax map /parcel no.: Backflow preventer 31.27 DESCRIPTION OF WORK Backwater valve 12.51 e r r - 1_ /�J� / Clothes washer 25.02 ' /folc ' g 7 ,SSllilr: - Co 10h acid TWO 70iriT-4 J 4 Dishwasher 25.02 7A2 Ci 4eett f draw" Clio, Wa -04 / (1 p % S Drinking fountain 25.02 '(.loot race ; i .('/tM, dpr inl /My Qu 7,C7T, Ejectors /sump 25.02 ❑ PROPERTY OWNER I ❑ TENA T / / / Expansion tank 12.51 Name: d "A/ 64/46 () Fixture /sewer cap 25.02 / zei .£UJ /2? 7.1 Fi Floor ge d sink/hub 25.02 Address: C Garbage disposal 25.02 City /State /ZIP: 1 a rb/ J Ode ?7223 Hose bib 25.02 Phone: (5Q 3) 71,, - 51255 Fax: (5b3i -- 372-674 Ice maker 12.51 ❑ 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 2 . 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 p i p to WV 56.29 Address: Other: 25.02 City /State /ZIP: e_)W Y \I( .IC Subtotal Phone: ( ) Fax: ( ) Minimum permit fee: $72.50 CCB Lic.: Plumbing Lic. no.: Plan review (25% of permit fee) State surcharge (12% of permit fee) Authorized signature: '�4 TOTAL PERMIT FEE `1 Z , at t This permit application expires if a permit is not obtained within 180 days Print name: �� ,/ j ( J Date: �� /a♦' /C after it has been accepted as complete. *Fee methodology set by Tri- County Building Industry Service Board. 1:\ Building \Permits\PLMIJ- PermitApp.doc 10/01/09 440- 4616T(10 /02/COM/WEB) d 84•(2 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 - 1s' 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 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 I� 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 $25,001.0016 $50,000.00 $379.50 for the first $25,000.00 and $1.45 for hours (minimum charge - 2 hours) s . 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 :cdinmercial building with water service 2" ; Fixture Type: Replace . • • • greater, except 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 Thru ❑ Any multipurpose f re sprinkler system. Cuspidor/Water Aspirator ❑ Any complex structure as.defined in OAR918- 780 -0040. Dishwasher - Commercial Domestic Submit 2 sets of plan's 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 Water Extractor plumbing permit can be issued. Water Closet - Toilet Urinal Other Fixtures: . • ' . I:\Building \Permits \PLMF - PermitApp.doc 2 . • • • Property Owner Statement Regarding Construction Responsibilities Oregon Law requires residential construction permit applicants who are not licensed with the Construction Contractors Board to sign the following statement before a building permit can be issued. (ORS 701.055 (4)) This statement is required for residential building, electrical, mechanical, and plumbing permits. Licensed architect and engineer applicants, exempt from licensing under ORS 701.010 (7), need not submit this statement. This statement will be filed with the permit. Please check the appropriate box: I own, reside in, or will reside in the completed structure and my general contractor is: Name CCB# Expiration Date I will inform my general contractor that all subcontractors who work on the structure must be licensed with the Construction Contractors Board. or Y .. I will be performing work on property I own, a residence that I reside in, or a residence that I will reside in. If I hire subcontractors, I will hire only subcontractors licensed with the Construction Contractors Board. If I change my mind and hire a general contractor, I will select a contractor who is licensed with the CCB and will immediately give the name of the contractor to the office issuing this Building Permit. I have read and understand the Information Notice to Homeowners About Construction Responsibilities, and I hereby certify that the information on this homeowner statement is true and accurate. 4/59Y /3AQ.AU Print Name of Pe it Applicant /c 2 / /e-.0 ? Signature of Permit Applicant Date Permit #: Address: / /6cff O Vil I29 ?Lace T7,a rol OA 97223 Issued by: Date: E. This Copy for Permit Offices