Permit CITY OF TIGARD PLUMBING PERMIT
II
0 COMMUNITY DEVELOPMENT Permit #: PLM2010 00336
T t G A R. D 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 10/19/2010
Parcel: 2S102CA00213
Jurisdiction: Tigard
Site address: 13205 SW ASH DR
Subdivision: VIEWCREST TERRACE Lot: 11
Project: King
Project Description: Replace approximately 50' of sanitary sewer service.
Owner: FEES
KING, PAUL M CATHERINE Quantity Description Date Amount
13205 SW ASH DRIVE
TIGARD, OR 97223 50 If Sewer Service 10/19/2010 $62.54
PHONE: 1 12% State Surcharge - 10/19/2010 $8.70
Plumbing
10 ea Minimum Fee Adjustment - 10/19/2010 $9.96
Contractor: Plumbing
ABILITY PLUS DRAINAGE CO.
1813 SW MOSS ST
PORTLAND, OR 97219
PHONE: 503 - 246 -0474
FAX: 503 - 236 -9930
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 Iaw_ALI work will be done in accordance with approved plans. This permit will expire if work is not started within 10 1 days of
issu , or if work is s. •ended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopte.� / y the Orego
Ut Notification Center. T• : e rules a - set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain a opy of the r les /
o direct questions to OUNC by Ili , 50 . ' = 6699 or 1.800.332.2344.
Is ed By: / /AO Permittee Signature: „,
J A _...
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 o the project.
Approved plans are required on the job site at the time of each inspection.
Plumbing Permit Annlicati 11 66•• CElVED
City of Tigard r to � 9 he 1 No 6 33
:� 13125 SW Hall Blvd., Tigard, OR 972211 1 9 2010 u�aolo�
Phone: 503.639.4171 Fax: 503.598.1 T Plea
r Otter Perteit No.:
'r 1 _ ,� r r) Inspection Line: 503.639.4175
Internet: www.tigard-or.gov CITY OF TIGARD t Ready/By. n is: Si See Page 2 for
I.DING DIVISION NotifiedI O - Supplemental Information
TYP OF W FEE* SCHEDULE
❑ New construction ❑ Demolition For spedallnjornmtton use checklist
Description 1 Qty. 1 Ea. 1 Total
❑ Addition/alteration/replacement ❑ Other: New I- 2- family dwellings (includes 10011. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (1) bath 249.20
❑ 1- and 2 -family dwelling ❑ Commercial /industrial SFR (2) bath 350.00
El Accessory building ❑ Multi -family SFR (3) bath 399.00
❑ Master builder Each additional bath/kitchen 45.00
❑� Fire sprinkler ( sq. ft.) Page 2
JOB SITE INFORMATION AND ATI
Site utilities
Job site address: `3ZQ S .di) /) d- Catch basin or area drain J J 16.60
City /State/ZIP: �" Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: I Project name: Footing drain (no. linear 11.: _) Page 2
Cross street/directions to 'ob site: Manufactured home utilities 110.00
1 Manholes 1 1 16.601 .5r-4- ,ii, U � . I . G�cG2� S Rain drain connector 16.60
`'
T p �v�e.c,✓t vs[; C) • Sanitary sewer (no. linear ft.: , Page 2
Storm sewer (no. linear ft.: Page 2
Subdivision: , Lot no.: Water service (no. linear R: ) Page 2
Fixture or item
Tax map/parcel no.: Absorption valve 16.60
DESCRIPTION OF WORK Bade flow preventer Page 2
6 ..-01K-4/ - /- 'r/ Z�c Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
❑ PROPERTY OWNER I ❑ TENANT Drinking fountain 16.60
Ejectors/sump 16.60
Name: ( (Lt t.. q Expansion tank 1 16.60 1
Address: ( Fixture/sewer cap 16.60
City/State/ZIP: Floor drain/floor sink/hub 16.60
Phone: ( ) Fax: ( ) Garbage disposal 16.60
• APPLICANT ❑ CONTACT PERSON Hose bib 16.60
Ice maker 16.60
Business name: A >- y 1,4- ( c r <:,, 1 .„._ - (E, Interceptor /grease trap 16.60
Contact name: e - , 9 vt R "-L V Medical gas (value: S ) Page 2
Address: Primer 16.60
City /State/ZIP: Roof drain (commercial) 16.60
Phone: ( ) Fax:: ( ) Sink/basin/lavatory 16.60
Tub/shower/shower pan 16.60
E -mail: 4 9(0S Cl`` vat 1- I- Pio-,I CQ�
( - ( Urinal 16.60
CO inRACT01,1 Water closet 16.60
Business name: At) ) 11( s 1? 1. t 5 C C C Water heater 16.60
Address: h 3 2.7 3 t .J , 'o, 41..../ le Other:
1 . y P_ _ ft - 1 6 l0 '? l Subtota -
City/State/ZIP: rQYI 1 . Q 1L _ `� L7 7 Minimum permit fee: 872.50
Phone: ( 63) - 2,544 2 614 7t4 Fax: c 73 4 5 i 34 Residential backflow minimum permit fee: 836.25
CCB Lic.: /CSG ( Litt Plum ing Lic. no.: ZLa _77' p Plan review (25 %ofpermit fee)
State surcharge (8% of permit fee)
Authorized signature: -
TOTAL PERMIT FEE
I Print name: (Q.,,e i &N..- (1 I Date 10/j ESA This permit application expires if a permit b not obtained within
180 days after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
I:u Iding\Pcmiu\PLM- PcmitApp.doc 06/26/06 440.4616T(10V2/COM/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 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
Sewer - 1st 100' 55.00 3,601 to 7,200 5220.00
Sew
�(j 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: Permit Fee:
$1.00 to $5,000.00 Minimum fee $72.50
Storm & Rain Drain - each additional 100' 46.40 55,001.00 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 5100.00 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 S100.00 or fraction thereof to
(minimum permit fee $3625) 27.55 and including $25,000.00.
Rain Drain, single family dwelling 65.25 $25,001.00 to 550,000.00 $379.50 for the first 525,000.00 and $1.45 for
Inspection of existing plumbing or
each additional $100.00 or fraction thereof to
specially requested inspections - per hour 72.50 and including $50,000.00.
Subtotal: each and up 5742.00 for the first $50,000.00 and $1.20 for
each additional $100.00 or fraction thereof
Fixture Work: Plan Review for Plumbing Installations
Are you capping, adding or replacing fixtures? If "yes", Plan review is required for any of the following.
please indicate work performed by fixture. Failure to Please check all that apply.
accurately report fixtures could result in increased sewer fees * . ❑ Any new commercial building with water service 2" and
Quaadty by (Fixture) Work Performed greater, except systems designed and stamped by licensed
Future Type: engineer.
Previous Capped Added , Existing ❑ New exterior plumbing site utilities for any complex structure
Baptistry/Font as defined in OAR918- 780-0040.
Bath - Tub/Shower ❑ Medical gas and vacuum systems for health care facilities.
- Jacuzzi/Whirlpool ❑ Any multipurpose fire sprinkler system.
Car Wash - Each Stall ❑ Any complex structure as defined in OAR918 780
-Drive Thru
Cuspidor/Water Aspirator Submit 2 sets of plans with any of the above.
Dishwasher - Commercial
- Domestic
Drinking Fountain Isometric or Riser Diagram
Eye wash ❑ Isometric or riser diagram is required for new buildings
Floor Drain/sink - 2" that meet the qualifications above.
- 3"
- 4"
Car Wash Drain Comments regarding fixture work:
Garbage - Domestic
Disposal -Commercial
- Industrial
Ice Mach./Refrig. Drains
Oil Separator (Gas Station)
Rec. Vehicle Dump Station
Shower 'rang
-Stall *Note: If the fixture work under this permit results in an
Sink S
- Bardl /Lay vatory increase of sewer EDUs, a sewer permit win be issued and
-Commercial fees assessed for the sewer increase must be paid before the
- Service plumbing permit can be issued.
Swimming Pool Filter
Washer - Clothes
Water Extractor
Water Closet - Toilet
Urinal
Other Fixtures:
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