Permit •
CITY OF TIGARD PLUMBING PERMIT
1111 C :;. COMMUNITY DEVELOPMENT Permit #: PLM2009 -00247
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 09/04/2009
Parcel: 2S112BD10200
Jurisdiction: Tigard
Site address: 14660 SW 79TH AVE
Subdivision: BRITTANY MEADOWS Lot: 38
Project: Brittany Meadows
Project Description: Installation of irrigation backflow device.
Owner: FEES
WEBBER PROPERTIES LLC Quantity Description Date Amount
12155 SW WILDWOOD ST
PORTLAND, OR 97224 1 ea Backflow Prevention - RES 09/04/2009 $27.55
PHONE: 503 270 -8424 1 12% State Surcharge - 09/04/2009 $4.35
Plumbing
9 ea Minimum Fee Adjustment - 09/04/2009 $8.70
Contractor: Plumbing
AMERICAN PLUMBING SERVICES INC
5905 N INTERSTATE AVE
PORTLAND, OR 97217
PHONE: 503 - 289 -6498
FAX: 503 - 247 -2429
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp:
Stories:
Total $40.60
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.
Sdp 02 09 01:09p American Backflow Service 503- 247 -2429 p.2
Plumbing Permit Application
Building Fixtures k M d VE D FOR OFFICE USE ONLY
1111 . City of Tigard Received n
a 13125 SW Hall Blvd., Tigard, OR ,2 x 72 23 0 2 2O0 Date/By: �y D p
/ *ta Permit No.� � 009 OO aye
Phone: 503.639.4171 Fax: 503.598.1960 Plan Review
Date/By: Other Permit No.:
Inspection Line: 503.639A175
CITY OF pp �, Pj� Date heady /By: hiris: See Pa e 2 for
TIGARD `+ TdGfSfl
Internet: www.tigard- or.gov rm t { g
ry rtl r1ll\If'`_ .=••• - I�eeS 7� , Notilied/Method;
r7 ,� e, a�nn�.. d _ - 77---- Supplemental Information
TYPE OF W FEE* SCHEDULE
❑ New construction ❑ Demolition For special information use checklist
Description Qtv. Ea. Total
Addition /alteration/replacement ❑ Other:
New 1- 2- fancily dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (1) bath 249.20
5 I- 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 I ❑ Other:
Fire sprinkler ( sq. ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities
Job site address: v 1 00 5 16.60
W � � .,� 0.V e . Catch b asin or area drain
City /State/ZIP: -`‘ -k ( ()Ii? q -) L. \ Drvwell, leach line, or trench drain 16.60
Suite/bldg. /apt. ro_: l Project name: Footing drain (no. linear ft.: ) Page 2
Manufactured home utilities 110.00
Cross street/directions to job site: si Q a
5 ' rj` Manholes 16.60
Rain drain connector 16.60
Sanitary sewer (no, linear R.: ) Page 2
Storm sewer (no. linear ft.: ) Page 2
Subdivision: 1 Lot no.: Water service (no. linear ft.: ) t Page 2
Tax map. /parcel no.:
Fixture or item
Absorption valve 1 16.60
DESCRIPTION OF WORK Backflow preventer 1 • Page 2
Backwater valve ■ 16.60
Clothes washer 16.60
Dishwasher ■ 16.60
PROPERTY OWNER ❑ TENANT Drinking fountain 16.60
Ejectors /sump MN 16.60
Name: ` ' 0
Expansion tank 16.60
Address: 1 \* o W -7q71-.2.__ �UJ2
Fixture /sewer cap 16.60
City /StateIZ1P- -N\ i.x 012 CO 4 Floor drain/floor sink/hub 16.60
Phone: (s03) t61. W.A Fax: ( ) Garbage disposal 16.60
APPLICANT ❑ CONTACT PERSON Hose bib 16.60
Ice maker 16.60
Business name: .Y1 C4tan t utAryl S cx v w. . 4
Interceptorigrease trap 16.60
Contact name: vim, ._ t . ` . .. i ia Medical gas (value: $ ) Page 2
Address: Sa175 - �n , � mi.Q . Primer 16.60
City /State/Z1P: fy 9 4., -1 Roof drain (commercial) 16.60
Phone: ( w. ) ,a-.,„,,, . ■ l Fax: : I ) -' y Sink /basin'Iavatory 16.60
Tubishower /shower pan 16.60
E- mail O 1Cii -Y\ x•
Y x.'J` 'Q�t J S 9 -J[V\t-'40- (O YY1 Urinal 16.60
CONTRACTOR Water closet 16. 60
Business name: • •a as ` , Water heater 16.60 it.
Address: C\ • , .
•
. .limiZlr le.. Other:
Citv!State/ZIP:? \ \, ` O� a', _ Subtotal
Minimum permit fee: $72.50
Phone: ( . ) -.. • • Q. Fax: (Sp .. L -i 4 Residential backflow minimum permit lee: $36.25
i t� Plumbing Lie.: • bin g Lic. no.: o� rtkA,, 50 ? Plan review (25% of permit fee) NMI State surcharge (12% of permit f e)
Authorized signature:
TOTAL PERMIT FEE r i t
Print name: a,; st., YY - r k _ Date: 91 This permit application expires ifa permit is not obtained within
�Y 180 days after it has been accepted as complete.
*Fee methodolo_av set by Tri- County Building Industry Service Boa
Sep 02 09 01:10p American Backflow Service 503- 247 -2429 p.3
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 5115.00
Footing drain - each additional 100' 46.40 • 2.001 to 3.600 $160.00
Sewer- 1st 100' 55.00 3,601 to 7,200 $220.00
7,201 and greater 5309.00
Sewer - each additional 100' 46.40
Water Service - 1st 100' 55.00 Medical Gas Systems:
Water Service -each additional 100' 46.40
Valuation: 1 Permit Fee:
Storm & Rain Drain - 1st 100' 55.00 51.00 to 55,000.00 Minimum fee $72.50
Storm & Rain Drain - each additional l00' 46.40 55,001.00 to 510,000.00 $72.50 for the first $5,000.00 and S1.52 for each
Fixture or Item Qty. Fee (ca) Total additional $100.00 or fraction thereof, lo and
including $10,000.00.
Commercial Bad: Flow Prevention Device 46.40 $10,001.00 to $25.000.00 $148.50 for the first S10,000.00 and 51.54 for
Residential Backflow Prevention Device 1 27.55 each additional 5) 00.00 or fraction thereof, to
(minimum permit fcc $36.25) 27.55 and including 525,000.00.
Rain Drain, single fancily dwelling 65.25 525,001.00 to 550,000.00 5379.50 for the first 525,000.00 and 51.45 for
Inspection of existing plumbing or each additional 5100.00 or fraction thereof, to
specially requested inspections - per hour 72.50 and including 550,000.00.
Subtotal 1 $50,001.00 and up 5742.00 for the first 550,000.00 and 51.20 for
7.55 each additional $100.00 or fraction thereof.
Commercial 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 *. CI Any new commercial building with water service 2" and
Quantity by (Fixture) Work Performed greater, except systems designed and stamped by licensed
Fixture Type: Replace 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 -0040.
-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
Garbage - Domestic Comments regarding fixture work:
Disposal - Commercial
- Industrial
ice Mach./Refrig. Drains
Oil Separator (Gas Station) 1
Rec. Vehicle Dump Station
Shower -Gang
-Stall
Sink - Bar /Lavatory
- Bradley _ *Note: if the fixture work under this permit results in an
- Commercial increase of sewer EDUs, a sewer permit will be issued and
- Service fees assessed for the sewer increase must be paid before the
Swimming Pool Filter plumbing permit can be issued.
Washer - Clothes
Water Extractor
Water Closet - Toilet
Urinal
Other Fixtures: