Permit CITY OF TIGARD PLUMBING PERMIT
1114
Is COMMUNITY DEVELOPMENT Permit #: PLM201000325
T I GAR D 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 10/12/2010
Parcel: 2S104DC06300
Jurisdiction: Tigard
Site address: 13740 SW FERNRIDGE TER
Subdivision: MORNINGSTAR Lot: 4
Project: Hall
Project Description: Replace irrigation backflow
Owner: FEES
HALL, B J Quantity Description Date Amount
13740 SW FERNRIDGE TER
TIGARD, OR 97223 1 ea Backflow Preventer 10/12/2010 $31.27
PHONE: 503-579-5775 1 12% State Surcharge - 10/12/2010 $8.70
Plumbing
41 ea Minimum Fee Adjustment - 10/12/2010 $41.23
Contractor: Plumbing
LAYCOCK GARDENS LLC
20816 NW YONCALLA CT.
PORTLAND, OR 97229
PHONE: 503 - 439 -8827
FAX: 503- 439 -8827
Type of Use: SF
Class of Work: OTR 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: 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
Building Fixtures R 1 r) li 0 1 4 1 ( 1 . 1 O r i .1
City of Tigard n - - : n d ye d Permit No .:
II
a 13125 SW Hall Blvd., Tigard, OR 97223 , x • � ` �// //b / P i / ° L�l�ZO /� - 00 3.2
0 Phone: 503.639.4171 Fax: 503 D Inspection Line: 503.639.4175 . a ew Oth Permit No.:
T 1 G A R. C
TIGARD See Page: fo
Internet: www.tigard or.gov BUILDING DIVISION
Date fi�etthod: r Supplemental In
TYPE OF WORK FEE* SCHEDULE
❑ New construction ❑ Demolition For special information use checklist
Description 1 Qty. 1 Ea. 1 Total
I-Addition/alteratio ep acement ) ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION SFR(1)bath 312.70
711- and 2- family dwelling ❑ Commercial/industrial SFR (2) bath 437.78
❑ Accessory building ❑ Multi - family SFR (3) bath 500.32
Each additional bath/kitchen 25.02
❑ Master builder ❑ Other: Fire sprinkler ( sq. ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: % 3 3.. L1 V S1.--) Ter ✓1 r , -kr-ri Catch basin or area drain 18.76
City/State/ZIP: JState /ZIP: \ Drywell, leach line, or trench drain 18.76
ty T. `I q x- C a 1 7. 7 Z 7 Footing drain (no. linear ft.: � Page 2
Suite/bldg. /apt. no.: V I Project name: I4 , ) I Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
M 0 r N I IK j 5 7-� _ r - d r p a 4 Rain drain connector 18.76
Sanitary sewer (no. linear ft.: Page 2
G T e -I t n e I 4 r
` Storm sewer (no. linear ft.: ) Page 2
S - T• 9 A (ems Water service (no. linear ft.: Page 2
Subdivision: V I Lot no.: Fixture or item:
Tax map /parcel no.: Backflow preventer t 31.27 71. 7)...
DESCRIPTION OF WORK Backwater valve 12.51
1 Clothes washer 25.02
2 e 14 c e b (o IC-e- h D I C c. !t" I V U Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
❑ PROPERTY OWNER I 0 TENANT Expansion tank 12.51
Name: 13 A t 1 1 Fixture /sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address: 13 4.14 J Sv c e c oi If t 4
Garbage disposal 25.02
City/State/ZIP: T , c r c l o rt. T 1- Z,7 3 Hose bib 25.02
Phone: ( 5 ) ' . 9 5 1 I. JFax: ( ) Ice maker 12.51
❑ APPLICANT ❑ CONTACT PERSON Interceptor /grease trap 25.02
Business name: L g �/ c o G. 1 C 6 (- 1 Qs,, L L C Medical gas (value: $ ) Page 2
Contact name: / Primer 12.51
J ,) n ..+7,.. c .. L `f ( O 1 c Roof drain (commercial) 12.51
Address: a b 8. 1 (... N yo„ c 4 11 L 4 - Sink/basin/lavatory 25.02
City/State /ZIP: TI d r - -4 1 .1 0 rc s i2 'Z 9 Solar units (potable water) 62.54
Phone: (ca? ) 431 -j-z.. 4- I Fax: : ( Se 0,a.. -i Tub /shower /shower pan 12.51
E -mail: I e / ( v GI( -T eJ Col., (c. f } , 1..e
Urinal 25.02
CONTRACTOR Water closet 25.02
Water heater 37.52
Business name: C`- Wk- Water piping/DWV 5629
Address: J Other: 25.02
City/State /ZIP: Subtotal
Phone: ( ) Fax: ( )
Minimum permit fee: $72.50 ,.2 , s C
� CB L ic.: ' R L. ,1 I A/ // /Plumbing Lic. no.: Plan review (25% of permit fee)
State surcharge (12% of permit fee) J, 70
Authorized signature: TOTAL PERMIT FEE f/, .4
: �( )) Date: I /� I Z 1 J This permit application expires if a permit is not obtained within 180 days
Print name
/J / `� V I 1 after it has been accepted as complete.
I Q
•Fee methodology set by Tri-Countv Building Industry Service Board.
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: (minimum charge - 1/2 hour)
Site Utilities Qty. Fee (ea) Total Subtotal:
Footing drain - 1' 100' 50.03
Footing drain - each additional 100' 37.52 Residential Fire Suppression Systems:
Square Footage: Permit Fee:
Sewer - 1st 100' 62.54 0 to 2,000 $121.90
Sewer - each additional 100' 37.52 2,001 to 3,600 $169.69
3,601 to 7,200 $233.20
Water Service - 1st 100' 62.54 7 201 and greater $327.54
Water Service - each additional 100' 37.52 Medical Gas Systems:
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
each additional $100.00 or fraction thereof, to
Other Inspections or Fees Qty. Fee (ea) Total and including $10,000.00.
$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.
(minimum charge - 12 hour) $25,001.00 to $50,000.00 $379.50 for the first $25,000.00 and $1.45 for
Inspections outside of normal 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 (Fixture) Work Performed Plan Review for Plumbing Installations
Fixture Type: Replace Plan review is required for any of the following.
Previous Capped Added Existing
Baptistry/Font Please check all that apply.
Bath - Tub/Shower ❑ Any new commercial building with water service 2" and
- Jacuzzi/Whirlpool greater, except systems designed and stamped by licensed
Car Wash -Each Stall engineer.
-fie Thru ❑ New exterior plumbing site utilities for any complex structure
Cuspidor/Water Aspirator as defined in OAR918- 780 -0040.
Dishwasher - Commercial ❑ Medical gas and vacuum systems for health care facilities.
- Domestic ❑ Any multipurpose fire sprinkler system.
Drinking Fountain ❑ 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"
Isometric or Riser Diagram
Car Wash Drain ❑ Isometric or riser diagram is required for new buildings
Garbage - Domestic �� � s l g
Disposal - Commercial that meet the qualifications above.
- Industrial
Ice MachiRefrig. Drains
Oil Separator (Gas Station)
Rec. Vehicle Dump Station Comments regarding fixture work:
Shower -Gang
-Stall
Sink - Bar/Lavatory
- Bradley
- Commercial
- Service
Swimming Pool Filter
Washer - Clothes *Note: If the fixture work under this permit results in an
Water Extractor
Water Closet - Toilet increase of sewer EDUs, a sewer permit will be issued and