Permit CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit #: PLM2009 -00208
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 08/03/2009
Parcel: 2S1 13 B000600
Jurisdiction: Tigard
Site address: 16060 SW 85TH AVE
Subdivision: SEWER TREATMENT PLANT Lot: 0
Project: Clean Water Services
Project Description: Install (6) catch basins /area drains, (3) manholes, and (420) feet of storm sewer.
Owner: FEES
CLEAN WATER SERVICES Quantity Description Date Amount
2550 SW HILLSBORO HWY
HILLSBORO, OR 97123 6 ea Catch Basin or Area Drain 08/03/2009 $99.60
PHONE: 3 ea Manholes 08/03/2009 $49.80
420 If Storm and Rain Drain 08/03/2009 $240.60
1 12% State Surcharge - 08/03/2009 $46.80
Contractor: Plumbing
NORTHWEST EARTHMOVERS INC
PO BOX 1467
TUALATIN, OR 97062
PHONE: 503 - 625 -3100
FAX: 503 - 625 -3108
Type of Use: COM
Class of Work: ALT Type of Const:
Occupancy Grp:
Stories:
Total $436.80
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:
5 tag t oillS 1 - L k\d1AA 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 RECE
•
Building Fixtures FOR OFFICE USE ONLY
City of Tigard JUL 2 9 1'14' /By: Permit No.:��rn2�Ct .cm Gl�C J
M il
13125 SW Hall Blvd., Tigard, OR 97223
Plan Review
i y:
Phone: 503.639.4171 Fax: 503.598.1960 CITY OF TIC T�IBy: Other Permit No.:
Inspection Line: 503.639.4175 d /B u . ® See Page 2forf
TIGARD Internet: www.tigard- or.gov BUILDING DI 111)hin- te thod: 7'3( -09 Supplementallnformation
TYPE OF WORK FEE* SC DULE
New construction ❑ Demolition For special information use checklist.
1 Description I Qty. I Ea. I Total
❑ Addition /alteration /replacement ❑ Other: New 1 - 2 - family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (I) bath 249.20
❑ I- and 2- family dwelling RI Commercial /industrial SFR (2) bath 350.00
SFR (3) bath 399.00
❑ Accessory building ❑ Multi- family
Each additional bath/kitchen 45.00
❑ Master builder ❑ Other: Fire sprinkler ( sq. ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities
Job site address: 16 s w O G s LL 4 . Catch basin or area drain 6 16.60 9 ?., 6
City /State /ZIP: T7 (, Qr C a R 9 7 z t% J Drywell, leach line, or trench drain 16.60
/ /^� Footing drain (no. linear ft.: _) Page 2
a
Suite/bldg. /apt. no.: Project name: N • h ury T oil /' /, .)l y 4( e esS
Manufactured home utilities 110.00
Cross street /directions to job site: Re G c/ iv rove M erl ti Manholes 3 16.60 y q, a0
J Rain drain connector 16.60
5 G{/ ( i C I Ave d- O t r Ji vl 1 /f / : A ea / Sanitary sewer (no. linear ft.: _) Page 2
S 0 a. t ti on Ski ' S f /l A / 3 , 0 0 r t • t U r,t Je 'F t Storm sewer (no. linear ft.: _) q. Page 2 y', G
/ Water service (no. linear ft.: ) Page 2
Subdivision: I Lot no.:
Fixture or item
Tax map /parcel no.: Absorption valve 16.60
DESCRIPTION OF WORK Backtlow preventer Page 2
4/e w G e C e S S r o ct e / i o S/ lie- Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
Drinking fountain 16.60
CO OWNER I ❑ TENANT 16.60
Ejectors /sump
Expansion tank 16.60
Name: C /e, y We ter- r10 Y- ✓ t '['C.S P
Address: / Z, ,, 0 sit) 3'S ,4v,_ Fixture /sewer cap 16.60
City /State /ZIP: 7 6 a, ? -,Z� / Floordrain /floorsink/hub 16.60
( Garbage disposal 16.60
Phone: (SD3)S -8N 7S Fax: (603 jy ? - F 1q ( 16.60
Hose bib
❑ APPLICANT to CONTACT PERSON Ice maker 16.60
Business name: 5 4 , � Interceptor /grease trap 16.60
Contact name: R ni /1/a e . � Medical gas (value: $ ) Page 2
Address: S Primer 16.60
G rM
Roof drain (commercial) 16.60
City /State /ZIP:
Sink/basin/lavatory 16.60
Phone: (5 613 ) ..5 / 83 I Fax:: ( ) Tub /shower /shower pan 16.60
E -mail: Urinal I6.60
CONTRACTOR Water closet 16.60
Business name: Water heater 16.60
�I /vrfh wes - // t '� EQrt movers i c
Address: / 3 /, OD 541 c.�G /4 r E).i a ` A ,V r Other
Subtotal 3 r
Cit /State /ZIP: shoe- IvOOCI O R 9 7/ 90 Minimum permit fee: $72.50
Phone: (S, 3 ) ..25-.--3/1,0 Fax: (So 3 ) 6 2 s - 3/ U ' Residential backflow minimum permit fee: $36.25
CCB LIC.: �a
�'] ( p P lumbing Lic. no.: 34 ( 4r Plan review (25% of permit fee)
/
'- State surcharge (12% of permit fee)
Authorized signature: 7 ' i -II TOTAL PERMIT FEE 14.-No .0
Print name: Date: 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 \PLMF- PermitApp.doc 12/27/06 440- 4616T(10 /02/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
3,601 to 7,200 $220.00
Sewer - 1st 100' 55.00 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 Valuation: Permit Fee:
Storm & Rain Drain - 1st 100' 55
JQD 55 ,5.5 - $1.00 to $5,000.00 Minimum fee $72.50
Storm & Rain Drain - each•additional 100' 3 ? 0 46.40 / SS /o $5,001.00 to $10,000.00 $72.50 for the first $5,000.00 and $1.52 for each
Q ty. Fee (ea) Total additional $100.00 or fraction thereof, to and
Fixture or Item 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 $100.00 or fraction thereof, to
27.55 and including $25,000.00.
Rain permit fee $36.25) $25,001.00 to $50,000.00 $379.50 for the first $25,000.00 and $1.45 for
Rain Drain, single family ly dwelling 65.25 each additional $100.00 or fraction thereof, to
Inspection of existing plumbing or and including $50,000.00.
specially requested inspections - per hour 72.50 $50,001.00 and up $742.00 for the first $50,000.00 and $1.20 for
Subtotal: 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.
k ❑ Any new commercial building with water service 2" and
accurately report fixtures could result in increased sewer fees greater, except systems designed and stamped by licensed
Quantity_ by (Fixture) Work Performed engineer.
Fixture Type: Replace
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 Isometric or Riser Diagram
Drinking Fountain ❑ Isometric or riser diagram is required for new buildings
Eye Wash
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)
Rec. Vehicle Dump Station
Shower -Gang
-Stall
Sink -Bar/Lavatory *Note: If the fixture work under this permit results in an
-Bradley
- Commercial increase of sewer EDUs, a sewer permit will be issued and
- Service fees assessed for the sewer increase must be paid before the
1 Swimming Pool Filter plumbing permit can be issued.
Washer - Clothes
Water Extractor
Water Closet - Toilet
Urinal
Other Fixtures:
is \Building \Permits\PLM- PermitApp.doc 12/27/06