Permit CITY OF TIGARD PLUMBING PERMIT
g COMMUNITY DEVELOPMENT Permit #: PLM2009-00265
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 09/29/2009
Parcel: 2S102CCO2600
Jurisdiction: Tigard
Site address: 13885 SW 102ND AVE
Subdivision: FRELEON HEIGHTS NO.2 Lot: 12
Project: Gill
Project Description: Connect existing SF to sewer.
Owner: FEES
GILL, EDWARD W & Quantity Description Date Amount
CORYELL, JANET L, 13885 SW 102ND AVE
TIGARD, OR 97223 100 If Sewer Service 09/29/2009 $55.00
1 12% State Surcharge - 09/29/2009 $8.70
PHONE: Plumbing
18 ea Minimum Fee Adjustment - 09/29/2009 $17.50
Contractor: Plumbing
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 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: _ n , p Permittee Signature: / ‘ 1 � �IVI /r !✓ / Ai
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 RECEIVE
FOR OFFICE ESE ONLI'
City of Tigard SEP 2 9 2009 R eEew
D Permit No.: 13125 SW Hall Blvd, Tigard, OR 97223 Phone: 503639.4171 Fax: 503.598.1960 s Other Permit No .
CITY OFTIG' Date/By: �1 �, )1
Inspection Line: 503.639.4175
T 1 GAR D Internet: www.ti azd BUILDING DIVI or. ov SIO t o Ready/By: See Pa ge 2 for
g g �t S upplementallnformation
i F - ° S ri ': *t' -t - •: lE - 1 i x '�, rr �.
,.. .. . & - : '"` e GA a .� tl
El New construction ❑ Demolition F or special informat use c h ec klist
Description I Qty. 1 Ea. 1 Total
❑ Addition/alteration/replacement .,,,,,, Other: New 1 - 2 - family dwellings (includes 100 ft. for each utility connection)
`, t1Ti`OQTZ'' � 4iVe.`I' `V` . SFR (1) bat 249.20
❑ 1- and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 350.00
El Accessory building ❑ Multi - family SFR (3) bath 399.00
Each additional bath/kitchen 45.00
❑ Master builder ❑ Other:
Fire sprinkler ( sq. ft.) Page 2
''. i JOB �fl!* *4.kT..O A'1 F x r Site utilities
X,. Job site address: / 3' � SL) / Ca _t � Catch basin or area drain 16.60
City /State /ZIP: ( l £76R- 9 7 Z r - - Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: Project name: � f ..1/
Footing drain (no. linear ft.: Page 2
Manufactured home utilities 110.00
Cross street/directions to job site: Manholes 16.60
Rain drain connector 16.60
Sanitary sewer (no. linear ft.: i p Page 2 5 5 00
Storm sewer (no. linear ft.: _) Page 2
Subdivision: Lot no.:
Water service (no. linear ft.: Page 2
Fixture or item
Tax map /parcel no.: Absorption valve 16.60
* ,.,..... < = 9 :, 4 ,_ Backflow preventer Page 2
Q on 1 .1.0Q,4 - e l ` , Yto '.F i () toy( Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
�� - 1, sf Drinking fountain 16.60
Ejectors /sump 16.60
Name: Expansion tank 16.60
Address: Fixture /sewer cap 16.60
City /State /ZIP: Floor drain /floor sink /hub 1 6.60
Phone: ( ) Fax: ( ) Garbage disposal 16.60
,,.� -, ;° s° 0 • a 030 0 Hose bib 16.60
1 ° : • .A ,a4 „`::^. ..c7 •xaae.r.. ._ ..''''''� t „M,. a'�. 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: ( ) I Fax:: ( )
Sink/basin/lavatory 16.60
Tub /shower /shower pan 16.60
E-mail: Urinal 16.60
*: a
. . �" ".: ' t .. .� . .,r. , , Water closet 16.60
Business name: Water heater 16.60
Address: C W n Q r Other:
City /State /ZIP:
Subtotal
Minimum permit fee: $72.50 7. SO Phone: ( ) Fax: ( ) Residential backflow minimum permit fee: $36.25
CCB Lic.: Plumbi Li , j ..:^ Plan review (25% of permit fee)
■X /' / / 1 y //� State surcharge (12% of permit fee) 70
Authorized signature: / �,/
` t ` TOTAL TOTAL PERMIT FEE 8 + -2O
Print name: Date: / 0°/ This permit application expires if a permit is not obtained within
j " / (( 180 days after it has been accepted as complete.
*Fee methodology set by Tri -County Building Industry Serv Board.
1.\ Building \Permits\PLM- PermitApp.doc 12/27/06 440- 4616T(1 0 /02 /COMIwEB)
fy,u8S.
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site Utilities Qty o ;. Total S r ua , t Ot Cr r it
Footing drain - IS' 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: " Pa of :
$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) Tota 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 00 o t e first $ .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.
�,..
QqantifY by (Fixture) Work>rfoi•med ❑ Any new commercial building with water service 2" and
rs Type Replace greater, except systems designed and stamped by licensed
4? .,"� �_,,��, l s= a >• 9 'tin_ engineer.
Baptistry/Font
Bath - Tub /Shower ❑ New exterior plumbing site utilities for any complex structure
as defined in OAR918- 780 -0040.
- Jacuzzi/Whirlpool
Car Wash - Each Stall ❑ Medical gas and vacuum systems for health care facilities.
- Drive Stall ❑ 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
Isometriceolr 1r Dia
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
- 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
P L , 1 o- a I .7 b ,; •
tftfiLSONV1LL OR 87070
(503) EQ2-110a11 FAX f1 `?D i754 V
CUSTOMERS ORDER NO. PHONE DATE
11/2/2009 839 AM Sales Order #8255 6 �— . f j /2 C
Sore: 1 Ordered: 11/22009 �'�� / /`"� , - . /
Associate: HenryG { �' f
Valley Landscape Center 1 1 (—) r
18230 SW Pacific Hwy ADDRESS
Tualatin OR 97062 . i j tj 1 r J
503 - 692 -0606
Bill To: Gill . / + 1(Li 1 01? 722
503 849 5244 � SOLI) BY CASH C.O.D. CHARGE` ON ACCT. MDSE. RETD. PAID OUT
!N.S'TRUCTIONS: Customer will be home SiCar
(---- Mcdonald see customer for dumping instr if ; ate., • - DESCRIPTION PRICE .. - • AMOU T-':' • lot home call cell #
Drder Status: Open
3/8" River Rock (Pea Gravel) i I
i Yard(s) $32.00
$160.00 �'
11 -1 am delivery t I
$0.00
$0.00
)elivery - Zane 1 Dump
$35.00 $35.00 P r*, t.r 1 t' _ ` i ' • : ,,�! C C `' '�,
p
_J
i 1 \
Total Item(s) Ordered: 7
Total Item(s) Delivered: 0
Tdal Item(s) Due: 7 2 I
E I
Subtdal: $195_00 r I
TOTAL: $195.00 -
•
Deposit Balance: $195.00
Balance Due: $0.00
'ercent Unfilled: 100 I
Deposit History
late Receipt # Amount Payment
1/2/2009 68780 $195.00 Credit Card
4ll deliveries inside curbline are at the direction and
sk of the customer.
i I
TAX
RECEIVED BY
TOTAL
All claims anpetucoid goods MUST be accompanied by this bill. THANK Y A p
•
Tr, Rearthr: a00- 22 es Pebs.(s;l;.