Permit •
CITY TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT
PERMIT #: PLM2007 -00481
TIGARD_i 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 10/26/2007
PARCEL: 2S112BD -05800
SITE ADDRESS: 14736 SW 76TH AVE ZONING: R -7
SUBDIVISION: PROSPECT MEADOWS LOT: 001 JURISDICTION: TIG
PROJECT: SAFSTROM
Project Description: Connect existing house to water service and new meter.
CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: R3 FLOOR DRAINS; TRAPS:
STORIES: WATER HEATERS: CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES:
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LINE: 100 ft
DISHWASHERS: RAIN DRAIN: ft
Owner: FEES
NICK SAFSTROM
14736 SW 76TH AVE Description Date Amount
TIGARD, OR 97224 [PLUMB] Permit Fee 10/26/2007 $72.50
[TAX] 8% State Surcha 10/26/2007 $5.80
Phone : 503 -572 -4869 Total $78.30
Contractor:
LEGEND PLUMBING
PO BOX 23338
TIGARD, OR 97281 REQUIRED ITEMS AND REPORTS
Contact # : PRI 503- 6 2 4� 05 8 2 0,
FAX 503- 624 -0582
Reg #: LIC 163964
PLM 34 -470PB
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable laws. 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 than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 0001 -0010 through OAR 952 - 0001 -0100. You may obtain copies of
these rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued ' =y: /fir S / / ; Permittee Signature: 4 Ai
Call 503.639.4175 by 7:00 a.m. for an inspection that business gay.
This permit card shall be kept in a conspicuous place on the job site until co • leti • of the project.
Approved plans are required on the job site at the time of each i spec on.
'- uinbing Permit Application
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wilding Fixtures ;� •,„,• Z s -.., • .OFFICE "USt'''o NLY ; t r r ;,rp{ -'
City of Tigard
Received
Date/By l e p7 Permit No.: f/ A)7- -ea48'
q 13125 SW Hall Blvd., Tigard, OR 97223
Plan Review
: -11 Phone: 503.639.4171 Fax: 503.598.1960
Date/By Other Permit No.:
l I G A P R D Inspection Line: 503.639 Date Ready /By: �Jur 0 See Page 2 for
. / Internet: www.tigard - or.gov Notified/Method: ` t 1p Supplemental Information
' TYPE OF WORK ' FEE *, SCHEDULE ,
❑ New construction ❑ Demolition For special information use checklist
Description I 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 249.20
•
❑ 1- and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 350.00
❑ Accessory building ❑ Multi- family SFR (3) bath 399.00
Each additional bath/kitchen 45.00
❑ Master builder ❑ Other:
Fire sprinkler ( sq. ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities
Job site address: 1147; (P 5_ 7 6 »• Catch basin or area drain 16.60
City /State /ZIP: T Fr2.D o (f_ 9 7 22'( Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: l Project name: A nz j Footing drain (no. linear ft.: _) Page 2
V Manufactured home utilities 110.00
Cross street/directions to job site:
Manholes 16.60
Rain drain connector 16.60
Sanitary sewer (no. linear ft.: ) Page 2
Storm sewer (no. linear ft.: ) Page 2
Subdivision: Lot no.:
Water service (no. linear ft.: /6/6"c Page 2 53
Fixture or item
Tax map /parcel no.:
Absorption valve 16.60
DESCRIPTION OF WORK Backflow preventer Page 2
/VP,) tee_ felt Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
El PROPERTY OWNER I ❑ TENANT, Drinking fountain 16.60
Ejectors /sump 16.60
Name: ,._ %' /1//Gf. jAPFraoji Expansion tank 16.60
Address: /923. s W 76'`° A-v'e Fixture /sewer cap 16.60
City /State /ZIP: / 1 4- i 0 £ 912 Zl1` Floor drain/floor sink/hub 16.60
Fax: ( ) Garbage disposal 16.60
Phone: ( o1) 5 L' �/ �� 9 1 6.60
Hose bib
❑ APPLICANT ❑ CONTACT PERSO
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
Sink/basin/lavatory 16.60
Phone: ( ) Fax:: ( ) Tub /shower /shower pan 16.60
E -mail: Urinal 16.60
' . " CONTRACTOR' " Water closet 16.60
Business name: Ntiere Ail) /064073 /Aid Water heater 16.60
Address: t, Other:
City /State /ZIP: Subtotal
Minimum permit fee: $72.50
Phone: ( ) Fax: ( ) Residential backflow minimum permit fee: $36.25 •
CCB Lic.: /ta qe( Plumbing Lic.no.:JG X70/8 Plan review (25% of permit fee)
State surcharge (8% of permit fee) 5 SO
Authorized signature: x TOTAL PERMIT FEE 78. 3,p
Print name:
, Date: 0 ' _ 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.
I:\ Building \Permits\PLMF- PermitApp. doc 12/27/06 440- 4616T(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 - 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
Storm &Rain Drain - 1st 100' 55.00 Valuation: Permit. Fee:
$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
Inspection of existing plumbing or each additional $100.00 or fraction thereof, to
and including $50,000.00. •
specially requested inspections - per hour 72.50
Subtotal: $50 and up $742.00 for the first $50,000.00 and $1.20 for
each additional $100.00 or fraction thereof.
Fixture Work: Plan. Review for Plumbing - Installations
Are you capping, adding or replacing fixtures? If "yes", Plan review is required for any of the following.
please indicate work performed by fixture. Failure to Please check all that apply.
accurately report fixtures could result in increased sewer fees ❑ Any new commercial building with water service 2" and
Quantity by(Fixture) Work Performed greater, except systems designed and stamped by licensed
Fixture Type: - . Replace engineer.
Previous Capped Added -. Existing ❑ New exterior plumbing site utilities for any complex structure
Baptistry/Font as defined in OAR918- 780 -0040.
Bath - Tub /Shower ❑ Medical gas and vacuum systems for health care facilities.
- Jacuzzi /Whirlpool • ❑ Any multipurpose fire sprinkler system.
Car Wash -Each Stall ❑ Any complex structure as', defined in OAR91,8- 780 -0040.
-Drive Thru
Cuspidor /Water Aspirator Submit 2 sets of plans with, any of the above.
Dishwasher - Commercial .
- Domestic • •
Drinking Fountain Isometric, or Riser Diagram
Eye Wash ❑ Isometric or riser diagram is required for new buildings
Floor Drain/sink - 2" that meet the qualifications above.
-3"
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 ::. •.:.:, W.
- Bradley *Note: If the fixture work under this permit results in an
- 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