Permit CITY T PLUMBING PERMIT
IA DEVELOPMENT SERVICES PERMIT #: PLM2004 -00320
.,� 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 7/12/2004
SITE ADDRESS: 10230 SW 72ND AVE PARCEL: 1S136AB-01700
SUBDIVISION: METZGER ACRE TRACTS ZONING: R -4.5
BLOCK: LOT: 004 JURISDICTION: TIG
CLASS OF WORK: OTR GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: R3 FLOOR DRAINS: TRAPS:
STORIES: WATER HEATERS: 1 CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES:
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Replace water heater with same.
FEES
Owner:
Description Date Amount
MCBRIDE, ALBERT N [PLUMB] Permit Fee 7/12/2004 $72.50
VIRGINIA A
10230 SW 72ND [TAX] 8% State Surcharl 7/12/2004 $5.80
PORTLAND, OR 97223 Total $78.30
Phone:
Contractor:
OWNER
REQUIRED INSPECTIONS
Phone : Rough -in Insp
Final Inspection
Reg #:
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 -6 • • ' .
Iss ed By: • rig /� / �G�''� j Permittee Signature: &1
Call (503) : 9-4175 by 7:00 P.M. for an inspection needed the next business day
Building Fixtures
Plumbing Permit Applic lUr.1 C'1,',- ' FOR OFFICE USE ONLY
City Of Tigard Da ° tr e y i� p C / PermitNo.: i / p./pv� , 00 3,9 13125 SW Hall Blvd., Tigard, OR 97223 ° �ji Plan Review `/ f 7
Phone: 503.639.4171 Fax: 503.598.1960 �)�, � //y1x✓ I Date/By: Other Permit No.:
_
24- Hour Inspection Line: 503.639.4175 i, t.•' I t
®
, �,. _.t � Date Ready/By: : See Page 2 for
Internet: www.ci.tigard.or.us C‘---') �'' } ➢ N Notified/Method: Supplemental Information
TYPE OF WIi1Ni; ` • - • - • FEE* SCHEDULE
❑ New construction ❑ Demolition For special information use checklist.
Description 1 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 (l) bath 249.20
X 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: j 0 SLI) r 7c; A f}-(7g_ Catch basin or area drain 16.60
City/ State/ZIP: - f q , o -,z.... q '7 Z Z 3 Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: I Project name: 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.: ) Page 2
Storm sewer (no. linear ft.: ) Page 2
Subdivision: I Lot no.: Water service (no. linear ft.: ) Page 2
Fixture or item
Tax map /parcel no.:
Absorption valve 16.60
DESCRIPTION OF WORK .. Backflow preventer Page 2
R 6-424,4e, 6 -0-((5 r zA t KA- /ll4e-- 6f4-! Backwater valve 16.60
Gt),-4-1-E,C 1 (� . E' Clothes washer 16.60
-
���"�` Dishwasher 16.60
❑' PROPERTY OWNER I ❑ TENANT Drinking fountain 16.60
Ejectors sump 16.60 I
Name: i5 s.' (44( /Al l,4 U- [c4FZ4O6 Expansion tank 16.60
Address: 1p Z 7 d w 7Z nJD "4_1,4a. Fixture/sewer cap 16.60
City/State/ZIP: y' G' p r Q,P 91 y2/3 Floor drain/floor sink/hub 16.60
Phone: (.529-3) Z.6t - 7 7.- Fax: ( ) Garbage disposal 16.60
- • • ❑ APPLICANT • - ❑ CONTACT PERSON Hose bib 16.60
- 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
- CONTRACTOR . : ' Water closet 16.60
Business name: Water heater / 16.60
Address: Other:
City/ State/ZIP: Subtotal
Minimum permit fee: $72.50
Phone: ( ) Fax: ( ) Residential backflow minimum permit fee: $36.25 7�
CCB Lic.: Plumbing Lic. no.: Plan review (25% of permit fee)
C -- State surcharge (8% of permit fee) 5'
Authorized signature: //7��j��„ _, +1 _2,i i� ig TOTAL PERMIT FEE 70 r 30
Print name,, ,4 � J � � , i c _diz e .oa . Date: / O This permit application expires if a permit is not obtained within
`t' 180 days after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
i:\ Building \Permits\PLMF- PennitApp.doc 12/03 440- 4616T(10/02/C0M/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 Permit Fee: • ..
Footing drain - 1" 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 ValuatlOn • Permit Fee'"
Storm &Rain Drain - 1st 100' 55.00 $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: $50,001.00 and up $742.00 for the first $50,000.00 and $1.20 for
each additional $100.00 or fraction thereof.
Fixture Work:
Are you capping, moving or replacing existing fixtures? If
"yes", please indicate work performed by fixture. Failure to
accurately report fixtures could result in increased sewer fees * .
Quanti by (Fixture) Work Performed
Fixture Type: Replace
N Moved Existing Capped Comments regarding fixture work:
Baptistry/Font
Bath - Tub /Shower
- Jacuzzi/Whirlpool
Car Wash -Each Stall
-Drive Thru
Cuspidor/Water Aspirator
Dishwasher - Commercial
- Domestic
Drinking Fountain
Eye Wash
Floor Drain/sink - 2"
-3"
-4"
Car Wash Drain
Garbage - Domestic
Disposal - Commercial *Note: If the fixture work under this permit results in an
- Industrial increase of sewer EDUs, a sewer permit will be issued and
Ice Mach./Refrig. Drains
Oil Separator (Gas Station) fees assessed for the sewer increase must be paid before the
Rec. Vehicle Dump Station plumbing permit can be issued.
Shower -Gang
-Stall
Sink - Bar/Lavatory
Quantity Total
- Bradley
Commercial Isometric or riser diagram is required if fixture quantity
- Service total is >9.
Swimming Pool Filter
Washer - Clothes
Water Extractor Plan Review
Water Closet - Toilet Plan review is required if fixture quantity total is >9.
Urinal
Other Fixtures:
•
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