Permit CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT f Permit #: PLM2010 -00382
�� Date Issued: 02/09/2011
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.243=
Parcel: 1 S135ACO2400
Jurisdiction: Tigard
Site address: 9425 SW LONGSTAFF ST
Project: Grigoryan Subdivision: Lot: 0
Project Description: Replacing 100 ft. of water service and 100 ft. of sanitary sewer. 2/9/11, reprinted to add (1) sink, (1) lay, water
repiping (2 runs) and (1) toilet.
Contractor: OWNER Owner: GRIGORYAN, ROBERT
23920 NE 28TH ST.
CAMAS, WA 98607
PHONE:
PHONE: 360 - 907 -7882
FAX:
FEES
Quantity Description Date Amount
100 If Sewer Service 12/01/2010 $62.54
Specifics: 100 If Water Service 12/01/2010 $62.54
1 12% State Surcharge - 12/01/2010 $15.01
Type of Use: SF Plumbing
Class of Work: ALT 1 ea Sink 02/09/2011 $25.02
Type of Const: 1 ea Lavatories 02/09/2011 $25.02
Occupancy Grp: 2 ea Water Piping /DWV 02/09/2011 $112.58
Stories: 1 ea Water Closet 02/09/2011 $25.02
0 12% State Surcharge - 02/09/2011 $22.52
Plumbing
Total $350.25
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 • ' . ork is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility otification er. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. You may obtain a copy of the rules
or d' ect questions to OU • • ; 'ng 503.232.1987 or 1.800.332.2344.
Iss ed By: //
Permittee Signatur =:
1
Call 503.639.4175 by 7:00 a.m. for the next available insp• on 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.
1
CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit #: PLM2010 -00382
TiGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued:
Parcel: 1S 135ACO2400
Jurisdiction: Tigard
Site address: 9425 SW LONGSTAFF ST
Project: Grigoryan Subdivision: Lot: 0
Project Description: Replacing 100 ft. of water service and 100 ft. of sanitary sewer.
Contractor: OWNER Owner: GRIGORYAN, ROBERT
23920 NE 28TH ST.
CAMAS, WA 98607
PHONE:
PHONE: 360- 907 -7882
FAX:
FEES
Quantity Description Date Amount
100 If Sewer Service 12/01/2010 $62.54
Specifics: 100 If Water Service 12/01/2010 $62.54
1 12% State Surcharge - 12/01/2010 $15.01
Type of Use: SF Plumbing
Class of Work: ALT
Type of Const:
Occupancy Grp:
Stories:
Total $140.09
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 -0090. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: /
Perm Signat 4, / j � �
CaII 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.
Plumbing Permit Application
Building Fixtures 0 %) R • FOOFFICE USE ONLY
i�
City of Tigard �� 1% Received Date/By: hi J ` /6 0i/ �7�- P J)Gl �vU3 8
Permit No.: p
n 13125 SW Hall Blvd Tigard, O' ` >•' 223
t Plan Review
Phone: 503.639.4171 Fax: 503.598. Other Permit N
G ' DateBy: er erm o.: ' c L )ltl` -CX,un
T I G A R D Inspection Line: 503.639.4175 ' \$\ Date Ready/By: r l21 See Page 2 for
Internet: www.tigard- or.gov �,sj o c) 1 0% Notified/Method: Supplemental Information
TYPE OF WOR1 � FEE* SCHEDULE
❑ New construction ❑ For special information use checklist.
Description Qty. 1 Ea. Total
❑ Addition/alteration/replacement ❑ Other: New 1 - 2 - family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (1) bath 312.70
❑ 1- 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 INFORMATION AND LOCATION Site utilities:
Job site address: q Y ,FLl //# # Catch basin or area drain 18.76
City /State /ZIP: Drywell, leach line, or trench drain 18.76
Footing drain (no. linear ft.: ) Page 2
Suite/bldg. /apt. no.: I Project name: v 4)/e7r,;(9-7 Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
Rain drain connector 18.76
Sanitary sewer (no. linear ft.: ( ) ( Page 2 644451'/
Storm sewer (no. linear ft: • ) Page 2
Water service (no. linear ft.: ( ) / Page 2 6),j
Subdivision: I Lot no.: Fixture or item:
Tax map /parcel no.: Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 25.02
r Dishwasher 25.02
�" • � �
-�i Drinking fountain 25.02
1 c . f- -.- c ke i o61 cs ,,, 4 , Ejectors /sump 25 af_
V ❑ PROPERTY OWNER I ❑ TENANT Expansion tank 12.51
y� _ a � _ .,� 6: e. Fixture /sewer cap 25.02
Name: KlL7 �/r/! (,
Floor drain/floor sink/hub 25.02
Address: G 3 g 2.47 2.1
Garbage disposal 25.02
City /State /ZIP: k•-.4-- fe / o - Q 2 Hose bib 25.02
Phone: (3.0 9 ?- 7 Pcz Fax: ( ) Ice maker 12.51
❑ APPLICANT ❑ CONTACT PERSON Interceptor /grease trap 25.02
Business name: Medical gas (value: $ ) Page 2
Primer 12.51
Contact name:
Roof drain (commercial) 12.51
Address: Sink/basin/lavatory 25.02
City /State /ZIP: Solar units (potable water) 62.54
Phone: ( ) Fax: : ( ) Tub /shower /shower pan 12.51
E -mail: Urinal 25.02
Water closet 25.02
CONTRACTOR
Water heater 37.52
Business name: Water P1n i P g/D WV 56.29
Address: Other: 25.02
City /State /ZIP: Subtotal
Phone: ( ) Fax: ( ) Minimum permit fee: $72.50 Os -- V Q
CCB Lic.: � Plumbing Lic. no.: Plan review (25% of permit fee)
/)�• State surcharge (12% of permit fee) 1 S CFI
V Authorized si Print name: gnature Date: (! /// / TOTAL PERMIT FEE ji/o.. del
V p i t // //1 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\PLML- PermitApp.doc 10/01/09 440- 46I6T(10 /02/COM/WEB) * ( C) /V tri<
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 - li 100' 50.03 0 to 2,000 $121.90
Footing drain - each additional 100' 37.52 2,001 to 3,600 $169.69
Sewer - 1st 100' 62.54 111 3,601 to 7,200 $233.20
...S� -� 7,201 and greater $327.54
Sewer - each additional 100' 37.52
Water Service - 1st ,100'
1 64,5 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
Other Inspections or Fees Qty. Fee (ea) Total each additional $100.00 or fraction thereof, to
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.
Quantity by (Fixture) Work Performed ❑ Any new commercial building with water service 2" and
Fixture 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
Jacuzzi /Whirlpool as defined in OAR918- 780 -0040.
Car Wash Each Stall ❑ Medical gas and vacuum systems for health care facilities.
Drive Thru ❑ Any multipurpose fire sprinkler system.
Cuspidor/Water Aspirator ❑ Any complex structure as defined in OAR9 18-780-0040.
Dishwasher - Commercial
Domestic Submit 2 sets of plans with any of the above.
Drinking Fountain
Eye Wash Isometric or 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 aid before the
Washer - Clothes p
Water Extractor plumbing permit can be issued.
Water Closet - Toilet
Urinal
Other Fixtures:
I:\Building \Permits \PLMF - PermitApp.doc 2
Property Owner Statement
Regarding Construction Responsibilities
Oregon Law requires residential construction permit applicants who are not licensed with the
Construction Contractors Board to sign the following statement before a building permit can be
issued. (ORS 701.055 (4))
This statement is required for residential building, electrical, mechanical, and plumbing permits.
Licensed architect and engineer applicants, exempt from licensing under ORS 701.010 (7), need not
submit this statement. This statement will be filed with the permit.
Please check the appropriate box:
I own, reside in, or will reside in the completed structure and my general contractor is:
Name CCB# Expiration Date
I will inform my general contractor that all subcontractors who work on the structure must be
licensed with the Construction Contractors Board.
or
I will be performing work on property I own, a residence that I reside in, or a residence that I will
reside in. If I hire subcontractors, I will hire only subcontractors licensed with the Construction
Contractors Board. If I change my mind and hire a general contractor, I will select a contractor
who is licensed with the CCB and will immediately give the name of the contractor to the office
issuing this Building Permit.
I have read and understand the Information Notice to Homeowners About Construction Responsibilities,
and I hereby certify that the information on this homeowner statement is true and accurate.
•
Print Name o ; ppli . nt
a � /2//(-
Signature of 'ermit • pplicant Date
Permit #: P 0O-- )C Je /on IU -00e �y
1.G eyr) ■0 4t(v604
Address: ej s(-..) L j. S')zrf{ ,S} • � � t
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Issued by: 3. ).. Date: l 1 +il
This Copy for Permit Offices