Permit CITY OF TIGARD 41 PLUMBING PERMIT
- COMMUNITY DEVELOPMENT ®�'�� Permit #: PLM2010 00211
T 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 D ate Issued: 06/29/2010
1i GARD
Parcel: 2S102AD01700
Jurisdiction: Tigard
Site address: 9025 SW BURNHAM ST
Project: City of Tigard Subdivision: Lot: 0
Project Description: Relocate storm sewer lines. 5/31/11, REPRINTED TO CORRECT DESCRIPTION TO "RELOCATE RAIN
DRAINS'.
Contractor: OWNER Owner: CITY OF TIGARD
9025 SW BURNHAM
TIGARD, OR 97223
PHONE:
PHONE: 503 - 639 -4171
FAX:
FEES
Quantity Description Date Amount
90 If Storm and Rain Drain 06/29/2010 $62.54
Specifics: 1 12% State Surcharge - 06/29/2010 $8.70
Plumbing
Type of Use: COM 10 ea Minimum Fee Adjustment - 06/29/2010 $9.96
Plumbing
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 Not ication Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. You may obtain a copy of the rules
or dir questions to G NC s :Iling $3.232.1987 or 1.800.332.2344. -.
Is ed By: y / ` Permittee Signat �/
Call 503.639.4175 by 7:00 a.m. for the next available inspection date.
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.
CITY ® F TIGARD PLUMBING PERMIT
�
COMMUNITY DEVELOPMENT Permit #: PLM201000211
1 3125 SW HaII Blvd., Ti and OR 97223 503.639.4171 Date Issued: 06/29/2010
T>jcr�Rra 9 Parcel: 2S102AD01700
Jurisdiction: Tigard
Site address: 9025 SW BURNHAM ST
Subdivision: Lot: 0
Project: City of Tigard
Project'Description: Relocate storm sewer lines.
Owner: FEES
CITY OF TIGARD Quantity Description Date Amount
9025 SW BURNHAM
TIGARD, OR 97223 90 If Storm and Rain Drain 06/29/2010 $62.54
PHONE: 503-639-4171 1 12% State Surcharge - 06/29/2010 $8.70
Plumbing
10 ea Minimum Fee Adjustment - 06/29/2010 $9.96
Plumbing
Contractor:
OWNER
PHONE:
FAX:
Type of Use: COM
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 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 • -. - • . • OUNC by calling 503.246.6699 or 1.800.332.2344.
Issu d By: 4 / 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
, " r "ull , °� 4,1, M1lgv�a .i ,r u i r a p v i
Building Fixtures FOR o FI ICL USE o� NLI
City of Tigard R eceived Permit No:: 11-/-1,91910
n 13125 SW Hall Blvd., Tigard, OR 97223 Date/By: /, 9 �A '��
C ' ',Phone: 503.639.4171 Fax: 503.598.1960 Plan Review • Date/By: - Other Permit No.:
'Inspection Line: 503.639.4175 D ate Read iB Juris: ® -See Pa a 2.for
AGARD Ready /By: B
Internet: WWwaigard- origov Notified/Method: Supplementallnformation
'TYPE . /OF WORK : , FEE *• SCHEDULE ; ,
1111\1'w construction• ❑Demolition Fors�eeia! information use check /is&
Descti tion Q . Ea. Total'
Addition /alteration/replacemeiit
0 Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF * CONSTRUCTION '. SFR (1) bath 312 -.70
0 P- 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 NFORMATION' ,AND, OCATION Site utilities:
f�1AAA / ,
Job site address: q A5- art, r tv`'°t'. Catch basin or area dram 18.76 ,
Drywell, leach line, or trench drain 18.76
City/State /ZIP:
-4- 1 , u �.J .. Oa_. 9721.3
�( Footing drain (no. linear ft.: ) Page 2
Suite/bldg. /apt. no.: 1 Project name: Manufactured home utilities 50.03
Cross street/directions to job. site: Manholes 18.76
,45 l /_ Rain drain connector 18.76
r� Sanitary sewer (no. linear ft.: ) Page 2
Storm sewer (no. linear ft.: •10 q' Page 2
Water service (no. linear ft.: ) Page 2
. Subdivision: 1 Lot no.: Fixture or item:
Ta•map /parcel no.: Backflow preventer 31.27
DESCRIPTION OF "WORK.,
Backwater valve 12.51
Clothes washe 25.02
/4 d V 5 o 0-7 <iA 17/Z 4 '/J r' f 4 " " Dishwasher 25.02
Drinking fountain 25.02
Ejectors /sump 25.02 r . • a _ _ 'OWNER' ; . ; ❑f TENANT'- Expansion tank 12.51
PROPERTY `OW
Fixture /sewer cap 25.02
Name: C t,
t /, e" 1
Floor drain /floor sink/hub 25.02
Address: / j / Yez// f sits,- LJ / Garbage disposal 25.02
City /State /ZIP: lC
/ 2,1,i Q 4' fa_ Hose bib 25.02
Phone: (563) 7/ g Z 6 O,S Fax: (3 jy6 i/ &e go Ice maker 12.51
IN APPLICANT . '13 .ONTACT PERSON , Interceptor /grease trap 25.02
Business name: C 7 7r/ 9 r*��
Medical gas (value: $ ) Page 2
Primer 12.51
Contact name: ") l GA !V 1 j .5e
Roof drain (commercial) r 12.51
Address: / ? j / Z 6 t(--J • iiG� Ci G Sink/basin/lavatory 25.02
City /State /ZIP: ti ,.t. f2 ` G' .. 7/ Z 47 Solar units (potable water) 62.54
Phone: ( 7/g 24,25 Fax: : (,3( 6 `1r 9 gey'e' Tub /shower /shower pan 12.51
E -mail: 10 G.1 /0 -7-) ke" ,Q - -� (/ Urinal 25.02
� : Water closet 25.02
• , CONTRACTOR, a - a heater Water h t 37.52
Business name: C> 1.■-- 00 t ' 2 Water i m DWV 56.29
P P g/.
Address: Other: 25.02
City /State /ZIP: Subtotal
Phone: ( ) Fax: ( ) .. Minimum permit fee: $72.50 72
CCB Lic.: Plumbing Lic. no.: Plan review (25% of permit fee) -0
State surcharge (12% of permit fee) q .70
Authorized signature: ��.... TOTAL PERMIT FEE g 2
Print name: N /,......4/ Al ?5,52.° "/ Date: � Z /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\PLMU- PermitApp.doc 10/01/09 440- 4616T00 /02 /COM/WEB)
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Qty `Fee:(ea) -,To . ,.
Site�Ut ><1><fies" � °t a l ' ` S ,q.uare ` Foo t ' Permrt;Fee: . •
Footing drain - is' 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
• Valuation:: Permit°Fee •
Storm &Rain Drain - 1st.100' 62.54 $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
Qty,. Feei(ea) Total.
each additional $100.00 or fraction thereof, to
Ott s her Ins ection or:Fees°
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 $25,001.00 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.
Quanfi (Fixtuie)'Work?Performed' ; ❑ Any new commercial building with water service 2" and
• Fi titre:Type:' Replace: greater, except systems designed and stamped by licensed
• - 'Previous : Capped- Added `Existing! engineer.
Baptistry/Font
Bath - Tub /Shower ❑ New exterior plumbing site utilities for any complex structure
- Tub/Shower as defined in OAR918- 780 -0040.
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 lIgothetilCioe Riser.Diagram .
Floor Drain/sink - 2" - ❑ Isometric or riser diagram is required for new buildings
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