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Permit
CITY OF TIGARD PLUMBING PERMIT ' COMMUNITY DEVELOPMENT Permit #: PLM2010 -00203 .;41%!'•' Date Issued: 06/22/2010 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Parcel: 2S102CCO2600 Jurisdiction: Tigard Site address: 13885 SW 102ND AVE Subdivision: FRELEON HEIGHTS NO.2 Lot: 12 Project: Gill Project Description: Replace 40' of water service and install backflow preventer. Owner: FEES GILL, EDWARD Quantity Description Date Amount 13885 SW 102ND AVE TIGARD, OR 97223 40 If Water Service 06/22/2010 $62.54 1 ea Backflow Preventer 06/22/2010 $31.27 PHONE: 503 - 968 -9039 1 12% State Surcharge - 06/22/2010 $11.26 Plumbing Contractor: OWNER PHONE: FAX: Type of Use: SF Class of Work: ALT Type of Const: Occupancy Grp: Stories: Total $105.07 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. r Issued 8 , ( / t , Permittee Signature: f � 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 IN Building Fixtures RECE �t;t- 7 ,..I t 1 3 _()I I „I t t n� * i Y W,. n �, . -rr:; .or.Fi�� " 2it1"Si�..? �. N S ,"'. �. t ,r.t ,..E'�, W. "S+�zu a :� 1`Jc�!d City f Ti and h 7 n 13 Received SW Hall Blvd., Tigard, OR 97223' ) Date/By: C ' / l I d Permi No.: Pc�24lo - 60 ,803 C Plan Review Phone: 503.639.4171 Fax: 503.598.1960 RD Date/By: Other Permit No.: Inspection Line: 503.639.4175 11Cla ,� Date Ready/By: Juris: ®See Page 2 for f I , \ IL: t ), ard -or. ov �1 Internet: www.tigard-or.gov g C`� o t r DI 1v Notified/Method: 1 Supplemental Information l ©1 TYPE OF t • ' FEE* SCHEDULE ❑ New construction ❑ Demolition For special information use checklist Description 1 Qty. I 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 ❑ 1- 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: �` Catch basin or area drain 18.76 Job site address: 1 CIO Drywell, leach line, or trench drain 18.76 City /State /ZIP: /l �j o 7� 3 / r y Footing drain (no. linear ft.: ) Page 2 Suite/bldg. /apt. no.: I Project name: 4. ; / / 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.: 9) Page 2 (pa • 5 Subdivision: Lot no.: Fixture or item: Tax map /parcel no.: Backflow preventer 1 31.27 4/ . # i 7 DESCRIPTION OF WORK Backwater valve 12.51 • Clothes washer 25.02 ' � ' ' Pj iYt P SA.i/ i2_ Dishwasher 25.02 II NI, f21914 (4-`.e.) • Drinking fountain 25.02 Ejectors /sump 25.02 " PROPERTY OWNER I ❑ TENANT • Expansion tank 12.51 Name: EA 0 A RD 1,L) C , / I � Fixture/sewer cap 25.02 Address: / 3 q to , /Da Ad � �� Floor disposal sink/hub 25.02 n Garbage ge dispsposasa l 25.02 City /State/ZIP: G�, t 2 , 9Z2 Hose bib 25.02 Phone: (5 . 6 r - 039 Fax: ( ) 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 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 piping/DWV 56.29 Address: (,/t.) N) Other: 25.02 City /State /ZIP: Subtotal Phone: ( ) Fax: ( ) Minimum permit fee: $72.50 93 . I< CCB Lic.: �� Plumb' g Li / Plan review (25% of permit fee) -t} / �, , State surcharge (12% of permit fee) / A AO Authorized signature: di / W TOTAL PERMIT FEE /05 7 �d Print name: l(J/`-) /q b A9 _ / / Date: `� -2 2 // D 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\PLMU- PermitApp.doc 10/01/09 440- 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 - 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 • 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 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 - hower Tub /S ower 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 3 that meet the qualifications above. 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