Permit k -',' CITY OF TIGAR PLUMBING PERMIT
-. ° COMMUNITY DEVELOPMENT Permit . #: PLM2010 00216
°�' � 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued; 07 /02/2010
TiGAR D,' Parcel: 2S103CD05300
Jurisdiction: Tigard •
Site address: 11660 SW TERRACE TRAILS DR
Subdivision: TERRACE TRAILS Lot 14
Project: Petersen
Project Description: Backflow for irrigation.
Owner: FEES
PETERSEN, DALE STEVEN & TRACY A Quantity Description Date Amount
11660 SW TERRACE TRAIL DR
TIGARD, OR 97223 1 ea Backflow Preventer 07/02/2010 $31.27
PHONE: 1 12% State Surcharge - 07/02/2010 $8.70
Plumbing
41 ea Minimum Fee Adjustment - 07/02/2010 $41.23
Contractor: Plumbing
FOREST LANDSCAPE INC
3975 NW SUSBAUER RD
CORNELIUS, OR 97113
PHONE: 503 - 648 -8308
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 workwill 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 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: / / ,- Permittee Signature:
s
CaII 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 A•p,plication
0cy6 �� o «l tw ` � ' r > pro 1� '' r a x " ,4 a� � , �e',b ) � r 1 vo,m
Building Fixtures �g,� , �a �� FOR OFFICE , uSEI ONLY 0, 6
�s{ '��t Received
7 n. l F W Ha B d., T OR 97223 2 . �� Date/By: ��� �� V ' PermitNo. t •
7 D L/YI 1�
Pla Revie
" h Phone: 503. 4171 Fax: 503.598.1'960 0-. � y: O ther Permit No.:
Ttz rlr T Ins ection Line 503 639.4175 G`�l ```` �� Date `Date ReadylBy. Tuns ®S ee Page , 2 for
.TIGARD Internet wwwtigard-or.goy V' Nottfied/Metho 7' Su`ppleinentallnformahon
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. e e .4 _,�, -. r,, C _ * .; °" FE *SCHEDULE =t"
... § • TYPE O WORK v, , = - ei. .- ` , . ., . r , v .. - „ a .. , .r ,
❑ New construction ❑ Demolition
For special information use checklis£
- Description 1 Qty. 1 Ea. 1 Total
® Addition /alteration/replacement. ❑ Other: ;New 1 - 2 - family dwellings (includes 100 ft. for each utility connection)
r e CATEGORY 0FrCONSTRIICTION mil , . a „'g ` - SFR (1) bath 312.70
.r, , •... _ . . .:� y._
® 1 - and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 437.78
SFR (3) bath 500.32
❑ A building ❑ Multi= family
Each additional bath/kitehen 25.02
❑ Master builder - . Other: Fire sprinkler'( sq. ft.) Page 2
4 ; • "` JOB S TE I INI~ORMATION " LOCATIO � i a Site utilities:.
±_�� ��° � ,����� ,-..�, .� :tea.- . a _� N ...,.�
Job site address :: 11660_SW Terrace'TrailsDr Catch basin or area drain 18.76
Drywell, leach line, or trench drain 18.76
City /State /ZIP :' Tigar, OR 97223
- Footingdrain (no. linear ) Page 2
Suite/bl /apt.:no.: Project name. Petersen lawn. irrigation Manufactured home utilities 50.03
- Cross.street/directions to job site: 115th Manholes 18.76
Rain drain connector 18.76
Sanitary sewer (n O. linear ft.: Page 2
_ - - - - -- - - Storm sewer (no. linear.ft.: - ) Page 2
Water service (no. linear ft.: Page 2
Subdivision: Lot no.: Fixture<or item:
Tax,'map /parcel no. Backflow°preventer 1 31.27 31.27
•
r I Backwater valve 12.51
oESCRTPTION OF W ORK s
.._ -� a _ .. r �. t , tar ri; Clothes washer 25.02
Connect lawn irrigation to main water meter
Dishwasher 25:02
Drinking fountain 25.02
Ejectors /sump 25.02
� IROPERTY OWNER f r .l l _ ' .. TEN 2 Expansion tank 12:5,1
- .Fixture /sewer. cap 25.02
Name: Dale.Petersen
. Floor drain /floor Sink/hub 25.02
Address: 11'660 SW Terrace Tr Dr •
Garbage disposal 25.02
City/State /ZIP:< Tigard, OR 97223 Hose b'ib 25.02'
Phone: "(503)805 -9888 Fax:' ( ) Ice maker 12.51
r ii AP1?LICANT - d �` CONTA Tx PERSON ; Interceptor grease trap 25.02
Vam .. . - a �., _;< _ . . ,.i t ,, . .44._. +.2,. _..
'Business name: Property Owner • Medical 'gas (value'$, ) Page 2
Pruner' 12.5 1-
•Contactname_:: .
Roof drain (commercial) 12.51
Address: 5 ink/basin /lavatory 25.02
City /State /ZIP: - Solar units "(potable :water) 62.54
Phone: ( ) Fax: ( ) Tub % /shower'pan 12.51
• Urinal 25.02
Email dalep @alpmesw com -
_ Water closet 25.02
v x 3'CONTRACTOR
, � ..;. �_. ., � ��z - ,c ...n ���ir ..�; ...:::-.e..0.1. Water heater 37.52
Business name. Corey Petersen . ' Water piping /DWV 56.29.
.. 3 � s
si-,ls /Ie - r Other:
Addre � �� �nA1 /�� � _�� Othec 25.02
City /State /ZIP P - "' ..AS Subtotal
Phone�f593j?997 -=0A07 SV '- (� { &"� � 3b_ ;Fa2t ( ) Minimum permit fee: $72.50 igiSigigi
g Plan;revlew (25% Of permit fee)
CCB L1c.: 1 lumbin Lic. no:: (':
// Stat (12% of perrrlrt fee) s
Authorized,signature � , /!�__ -..(• TOTAL PERMIT FEE e .
.., , s permit application expires if a,permit rs not obtained within 180 days'
Print name: Zy9 GG /pF //r.fG'n� Date: Z TYt T .724. after rt has been accepted as complete ,
ted
• *Fee.methodologyset by Tri- County "Building Industry Service Board.
I :\ Building \Permits\PLMU- Permi1App doc 10 /01 /09 440- 4616T(10/02/COM /.WEB)
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: (minimum charge 1/2 hour)
"" Fe ea Total
Subtotal:
S1t0 1111 Qty ) o
Footing drain - l' 100' 50.03
Footing drain - each additional 100' 37.52
R Fire Su cession, Systems:
1?P Y-
sewer - 1st 100' 62.54
Squa re Footage , Permit Fe_ e T AI
0 to 2,000 $121.90
Sewer - each additional 100' 37.52 2,00 L to 3,600 $169.69
.,
3,6011'6 7,200 $233.20.
Water Service - 1st I00' 62.54 7,201 and greater $327:54
Water Service -each additional 100' 3.7.52 Medical Gas Systems: •
Storm & Rain Drain - 1st 100' 62.54 V a l ua t i on PermltFee .: „
$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
each additional $100.00' or fraction thereof, to
e Q Fee (ea)
o To tal and •including $10,000.00. •
®therTnspect>< OrwFeeS. t _ �, x ¥;: $10,001.00 to $25,000.00 $148.50 for the first $10,000;00 and $1.54 for
Inspection of existing plumbing =or for each additional $100:00 or fraction thereof, to
which no fee is specifically indicated, 90.00/hr and including.$25,000.00:
(minimuin charge.— 1/2 hour) 525,001.00 to $50,000.00 5379.50 for the first$25,000`00 and $1.45 for
Inspections outsideofnormal business 90.00 /hr each, additional $100.00 or fraction thereof, to
hours (minimum. - charge —2 hours) and including'$50,000:00.
Reinspection.Fees 90.00/hr $50,001.00 and up $742.00 for the first $50 ;000.00 and $1.20 for
each additional;$ 100 :00 or fraction thereof.
Additional plan review for revisions 90.00/hr
Urinal
Other Fixtures:
Commercial Fixture Work: •
Are you capping, adding, or replacing fixtures? If "yes.",
please indicate work performed by fixture. Failure to
accurately report fixtures could result in increased sewer fees*.
Quantity�by (Fixt��e� work rerform�a P1an,Rev eMr Plumbing Installations ?
tore Type x ,r .': alt ' Replace
,. 'Added;, .- > 'Existing ,
Plan review is required for any of the followi ng.
Baptistry/Font Please check all that apply.
Bath Tub /Shower El Any new commercial building with water service 2" and
- Jacuzzi /Whirlpool greater, except systems designed and stamped by licensed
Car Wash - Each Stall engineer.
- Drive Thru New exterior plumbing site utilities for any complex: structure
Cuspidor /Water Aspirator as defined in OAR918- 780 -0040.
Dishwasher - Commercial o Medical gas and vacuum systems for healthcare facilities.
- Domestic I=1 Any multipurpose fire sprinkler. system.
Drinking Fountain 0 Any complex structure as defined in OAR918 -780 -0040.
Eye Wash
Floor Drain /sink - 2" Submit 2 sets of plans with any of the above.
- 3"
•
Car Wash Drain Isometric or Riser D><a ram .
Garbage - Domestic 0 Isometric or riser diagram is :required fornew'buildings
Disposal - Commercial that meet the qualifications above. •- Industrial .
Ice Mach. /Refrig. Drains
Oil Separator (Gas'Statidn)
Rec. Vehicle Dump Station Comments regardiig fixture work:
Shower -Gang
-Stall
Sink - Bar/Lavatory
- Bradley _
- Commercial
- Service
•
Swimming Pool. Filter • .
Washer - Clothes
water Extractor *Note: If the fixture work under this permit results in an
Water Closet - Toilet increase of sewer EDUs, a sewer permit will be•issued. and
Macintosh HD: Users: dpetersen :Documents:PLMF - PermitApp.doc 2