Permit CITY OF TIGARD PLUMBING PERMIT
2 COMMUNITY DEVELOPMENT Permit #: PLM2011 -00001
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 01/05/2011
Parcel: 1 S133CD08200
Jurisdiction: Tigard
Site address: 11845 SW MORNING HILL DR
Project: Sander Subdivision: Lot: 0
Project Description: Replacing 30 ft. of water service.
Contractor: LIBERTY PLUMBING Owner: SANDER, RAYMOND
19363 WILLAMETTE DRIVE #232 11845 SW MORNING HILL DR
WEST LINN, OR 97068 TIGARD, OR 97223
PHONE: 503 - 888 -8830 PHONE:
FAX: 503 - 699 -7630
FEES
Quantity Description Date Amount
30 If Water Service 01/05/2011 $62.54
Specifics: 1 12% State Surcharge - 01/05/2011 $8.70
Plumbing
10 ea Minimum Fee Adjustment - 01/05/2011 $9.96
Type of Use: SF Plumbing
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 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: Permittee Signature: / t
Call 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.
RECEIVED
Plumbing Permit Application
Building Fixtures JAN 04 2011 FOR OFFICE l NE: ONLI
City of Tigard i
Re eed. !/Y�
F TIGARD ;� Permit ermitNo.: �„ 4I - uff n
• 13125 SW Hall Blvd., Tigard, Plan Review
■ . Phone: 503.639.4171 FaillIAMW3 DIVISION Datafty: Other Permit No.:
T I G A R D Inspection Line: 503.639.4175 Ike Ready/BY: ruro: 6J See Page 2 for
Internet: www.tigard- or.gov Notified/Method: "7'c6 Supplemental Information
TYPE OF WORK FEE* I_ SCHEDULE
❑ New construction ❑ Demolition For special information use checklist
Description I Qty. I Ea. I Total
Addition/alteration/re lacement ❑ Other. New 1- 2-family dwellings (includes 100 ft for each utility connection)
p I y �s ( ry )
CATEGORY OF CONSTRUCTION SFR (I) bath 312.70 1
V1.1- 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 I Site utilities: j
Job site address: 1 1 Sj(.- 1,L' An l7rr'1 t �-i - t.L� Catch basin or area drain 18.76
V i Drywell, leach line, or trench drain 18.76
City/State/ZIP: - t" f [ ck, Oa, 3
t C' .tit Footing drain (no. linear ft.: Page 2
Suite/bldg. /apt. no.: t Project name: S C1/1 , -- ic i+Ylr.,�( Manufactured home utilities 50.03
Cross street/directions to job site: Manholes I 18.76
l N pc - o SW g
l 75 I Rain drain connector 18.76
1 Sanitary sewer (no. linear ft.: _) Page 2
II Storm sewer (no. linear ft.: ) Page 2
/ s
1 /
Water service (no. linear ft.: ) i Page 2 y;' , 2_ 6Z ,. C 7
Subdivision: Lotl o.: Fixture or item: 1
Tax map /parcel no.: Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
; Clothes washer 25.02
rtis k1 iAiC. r' � i t / e c:�r. L.,
5 1 Dishwasher 25.02
9 (o y �. t d. [e as ....e, i a-4 a Sk 4.- 04- 1�a.•S Drinking fountain 25.02
Ejectors/sump 25.02
❑ PROPERTY OWNER I ❑ TENA'T Expansion tank 12.51
Fixture/sewer cap 25.02
Name: Y I ' '(ot (riPir- i Floor drain/floor sink/hub 25.02
Address: Garbage disposal ! 25.02
City /State/ZIP: I hose bib 25.02
Phone :( ) Fax :( ) I Ice maker 12.51
❑ APPLICANT ❑ CONTACT , RSON Interceptor /grease trap 25.02
Business name: Medical gas (value: $ ) Page 2
Primer I 12.51
Contact name:
Roof drain (commercial) 12.51
Address: Sink/basin/lavatory 25.02
City/State/ZIP: I Solar units (potable water) 62.54
Phone: ( ) Fax: : ( ) Tub /shower /shower pan 12.51
E -mail: Urinal 25.02
CONTRACTOR Water closet 25.02
Water heater 37.52
Business name: 1 1 7 -4 ?Ikjtyv11.71 try, 1 - l - , Waterpiping/DWV 56.29
Address: 1 \\ Z (�,,tt S AL�i
- • ' _ Other: 25.02 i
City/State/ZIP: K c. AMv l or_ et 11 Subtotal , /) .p.
Phone: ( R) C o - S `S Fax: ('S(N) I Minimum permit fee: $72.50 7 5 - 0
Plan review (25% of permit fee) 1
4
CCB Lic.: 5� t9L5 �j Plumbing Lie. no.: S Ng 3 1-96 State surcharge (12% of permit fee) Sf l 1;�
Authorized signature: ti ti`s �' �t✓ ' �c � `�• TOTAL PERMIT FEE t 10
[ Print name: ' 1,V'y1 X111 -� /7 Date: 1 - 3 [ .. This permit application expires it a permit is not obtained within ISOldays
1 (, G++� after it has been accepted as complete.
„ Fw.,,..,Fvri..ln.n, a-t M, T,.r'nnMv n,, Win° fnA..ar,.r Cr..nrr Rn•.rr
2 dOQ :20 IT b'O Uef'
Plumbing Permit Application - City of Ti and
Page 2 - Supplemental Information I
Fee Schedule: Residential Fire Suppression Systems:
Site Utilities Qty. Fee (e9) Total Square Footage: Permit Fee:
Footing drain -1 100' 50.03 0 to 2,000 $121.90 I
Footing drain -each additional 100' 37.52 ' 2,001 to 3,600 $169.69
3,601 to 7,200 $233.20
Sewer - 1st 100' 62.54 I 7,201 and greater $32734
Sewer - each additional 100' - 37.52 i
Water Service - 1st 100' 62.54 1I Medical Gas Systems:
Water Service - each additional 100' , 2. z ` 37.52 '; 7, j 1 'Valuation: Permit Fee:
Storm & Rain Drain - 1st 100' 62.54 I $1.00 to $5,000.00 Minimum fee $72.50
Storm & Rain Drain - each additional 100' 37.52 I $5,001.00 to $10,000.00 $72.50 for the first $5,000.00 and $1.52 for I
Q ty. Fee (ea) To each additional $100.00 or fraction thereof, tq
Other Inspections or Fees 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 fo
. which no fee is specifically indicated 90.001hr each additional $100100 or fraction thereof, t
(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 lust $25,000.00 and $1.45 fo
hours (minimum charge — 2 hours) each additional $100!00 or fraction thereof,
Reinspection Fees 90.00/hr I I 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 fo
(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 futtures could result in increased sewer • es * . Please check all that apply. .
Quantity by (Fixture) Work Performed' ❑ My new commercial building with water service 2" and
Fixture Type: Repla -'{ greater, except systems designed and stamped by licensed
Previous Capped Added Existin: engineer.
Baptistry/Font I
Bath -Tub/Shower
1 ❑ New exterior plumbing site utilities for any complex structu
- Jacuzzi/Whirlpool as defined in OAR918- 780 -0040.
Car Wash -Each Stall ID Medical gas and vacuum systems for health care facilities.
-Drive Stall ❑ Any multipurpose fire sprinkler system.
Cuspidor/Water Aspirator I ❑ Any complex structure as defined in OAR918- 780 -0040.
Dishwasher - Commercial I
- Domestic Submit 2 sets of plans with any of the above.
Drinking Fountain
Eye Wash I Isometric or Riser Diagram
Floor Drain/sink - 2" I ❑ Isometric or riser diagram is required for new building
I that meet the qualifications above. '
- 4"
Car Wash Drain I
Garbage - Domestic I
Disposal -Commercial
- Industrial 1 Comments regarding fixture work:
Ice Mach./Refrig. Drains
Oil Separator (Gas Station) I
Rec. Vehicle Dump Station
Shower - Gang I
-Stall I
Sink -Bar/Lavatory
- Bradley
I
-Commercial * Note: If the fixture work under this permit results in an
-Service 1 increase of sewer EDUs, a sewer permit will be issued and
Swimming Pool Filter fees assessed for the sewer increase must be paid before t ie
Washer - Clothes plumbing permit b e issued.
Water Extractor P g P
Water Closet - Toilet I ..
Urinal 1
Other Fixtures: i
I
E d00 :20 TT t.0 uer