Permit CITY OF TIGARD PLUMBING PERMIT
• '- COMMUNITY DEVELOPMENT Permit #: PLM2011 00041
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 02/03/2011
Parcel: 2S103BB07500
Jurisdiction: Tigard
Site address: 12512 SW 123RD AVE
Project: WYLDER Subdivision: LAKE TERRACE Lot: 3
Project Description: Replacing 40 ft. of water service. Electrical permit may be required if replacement piping affects house grounding.
Contractor: ANCTIL PLUMBING INC. Owner: WYLDER, RICHARD D
16900 SW MERLO ROAD 12512 SW 123RD AVE
BEAVERTON, OR 97006 -0000 TIGARD, OR 97223
PHONE: 503 - 642 -7323 PHONE:
FAX: 503 - 642 -7755
FEES
Quantity Description Date Amount
40 If Water Service 02/03/2011 $62.54
Specifics: 1 12% State Surcharge - 02/03/2011 $8.70
Plumbing
Type of Use: SF 10 ea Minimum Fee Adjustment - 02/03/2011 $9.96
Class of Work: ALT Plumbing
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: A,
■p-Aer y41
Call 50 .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.
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Plumbj> Permit Application
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City Of Ta ll"d Roocivad
• 13125 SW Hall Blvd., Tigard, OR 97223 Date/By; X- �'� Permit No.: i' _ c t
Phone: 503.639,4171 Fax: 503.598,1960 Plan Bedew
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Inspection Line: 503.639.4175 Mee Permit No.:
Internet- www tigard or gov Data Ready/By r .
, a > t , r u n a Notinearmethod. s See Pape l for
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kt .ifri..,, a �alrlVL tt� t xtviii4n�lt `.�,t1�l,�iaU,.t�.,F l�vrc T +Sirs ;�fierS�l1�`Jtliih'1�iii3l � `.� �l
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❑ New construction El Demolition For s amnion use cltecklt
A cidition/altecation/replacement Desori , tion
❑ Other:
It Total
New 1- 2- family dwell
1 9 f r � r !. !?' . i 1: k ti' � + is , � � FpHlJLRZI . i n i - ;IiltiM'gil C(3lPF.l ;, r'x xQLtt'C , P . I includes utility
��; �1,� � �j q ??((�� r � 6 1 00 ft fur each itY connection ki hE 7i l 't?' „ ''' ` '!hS. ��� pp "x '' s� 1 rplLk f t�ltg rid � 4'�i tli { Tir.l � � , D
RIE1fi74Sttld� li1t,:VY,it1tt�J:�1� rC, > +,.2' f�Fd�H +.1,ra7fi lit fit; }. i , r i {w., l{,htt�11�� +,.,d ,, SFR (1) bath I� 312.70
F - and 2- family dwelling CI Commercial/industrial . SFR (2) bath
IIIII • Accessory building Cl Multi - family SFR (3) bath 500.32
Each additional bath/kitchen 25.02 MI
Q Master builder Q Other:
1}1 Fire sprinkler L__ sq. R)
J xf ,µ {iliS''' r u 1 ,1} f) i t f ,° x Jx' N{{ f � rr i "S ,I . 4 • rl r t it ”' es tt r tld ltdilt a;s4untaatt I' }ns4i:v in ti gn # 1 i , 11 i i f �i,
• Job site address: ' 2. 2._ (A ) / a A.9 , t 5 ( Catch basin or area drain 1 &76
Drywofl, leach line, or trench drain
Suite/bldg./apt no Footing drain (no, linear it.:
Project name; %)
Cross street/directions eotions to job site: M anufactured home utilities 50.03
Manholes IIIIIIMMINE
Rain drain connector ME 1$.76 NMI
Sanitary sewer (no, linear ft.: „_,) IIIII Page 2 MN
Storm sewer (no. linter ft_: _,,,)
Subdivision: Water service (no. linear $: g b rim Sr ' :
Lot no.: Fixture or item:
Backflow preventer 11111 31.27
Tax map/parcel no.:
„ t i IAA 111, i 'i , I .rr+f ,Y� ,�� 111F7 a f to 1 ri� , y r
,t° ; J J t ? in., ttr •, 6� , s' 'lis 4 ,. F t ,i+ .. Pi s i �� S :i1 ' i 4.
� 1, ttRCZtdair ;4�fl>f� r,n.r !, t it J. t11 i.,,rt,t „�4n��+ {�,il }l� 3 t trt 4[ . iix J d4;u k tll�J ",�,
m�� J j,. r Clothes w asher 25.02
Dishwasher
�� 25.02 MS
Drinking fountain
25.02 MEN
p + � : a , a iul„ s r ,7 „ Ejectors/sump 25.02 MN
; ,; ,r o � ' I! + tt}4xiP Ir 1{ i t E ,E t 1 }tg,�: I {��n` „tl ��
., `nai Y1�iS .' � gY ,, „ , , ,v!h:t1 ..„ ,. .1, ,; 1:„ 1( r{ ;y� „ 1'iif , 11,,dIJ E lank
t / / Fixture/sewercap 111.11 25,02
Acidreormilmmilliimiiimiliiiiiiim
Floor drain/floor sink/hub EMI 25.02 IIIIIIIIII
Garbage disposal ME 25.02 MEM
Phone: ( ) Hose bib , ME
,H , u �u i { -. , Inc maker 25.02
`I' :P r, f tl t I �l- J� i .. J.. `1 sU� } �p i u +t1r{:Itlryfi�9 tlFm J77fHt{ttl'c(r {t'
[ r !,i x ?.,,, n. , ii t Li ES111 t,.,,�1 12 t� o � Io �'� Interco tor/ p
r nl' N11ii c 21 IrtEh, u i t F l$ [ra 25.02 MINI Business name: Medical gas (value: $
Pate !
Contact name: 12.51
Address: Roof drain (commercial) IMEGI
City/State/ZIP: Sink/basin/lavatory UM 25.02 ME
Phone: ( )
Solar units (potable water) 62,54 MI
'
Tub/shower /shower pan 12.51
E-mail: immirommeningnmen
n E
. i „ l 1 ,1,,, : !iI r + f�� °;1�: ��d! I .� ;n { � m { �l { rE +`P.!',S�i� j..,��k?t} ttfh �ij� water ClOSd � 2..02
Business name: tt. / _
Address: U `� K Water piping/DWV 56.29 MIME
+ p E ' Le, /2 Q Other: r •a • • g 4 e0 25.02 —
Plaont : �+ Subtotal
CCB Lie.: y r
2 $ / Plumbing Lie_ . `� % Plan review (25% of permit fee)
Authorized signature: State surcharge (12% o£
r .... - • I ( t,MI it fee) r i
„� TOTAL PERMIT FEE ;, •
Ali I t Date: 2--3-1( Phis permit application expires if a permit is not obtained within 150 days
after it has been accepted as complete.
*Fee methodology set by Tri- County Building Industry Service Board.
t; l8uildinglPeimitslPLKJ -perrnitAyp. 10/tuna 1 " 2- k
440- a616T(10/02/Cpht/W5B �„r"\
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Su S. • ression S stems:
git :. ; `Ir' Y' ... , 01:!n "f!r ;t 'Y r',' i,i1`,I1 ° 2 ' i �[{rymi , �. �,C.� T 1 ' :11,31,15, }�SG ° ,y�y , {1![�til<�lP a J a S
7�. I Vt3 'N7:1fl'E S'Itt lb ,7 31, i�Cnf r }]kiilOr h : ��li fi ff� i ; �,t Y: _ , ;4 WAt i ,, , , , ,,, (1
Footing dram - 1" 100' m 6,7,1 u,fSt' I C' f ..). 11
50 0 to2,000 $121.90
'
Footing flrain each additional 100' 37.52 2100 to 3,600 $169.69
Sewer - 1st 100' 62.54 3,601 to 7,240 $233.20
7 201 and „ - ater $327.54
Sewer -each additional 100' 37.52
Water Service - 1st 100' 62.54
Water Service - each additional 100' �jry �+ Medical Gas S stems -
illi l��l LL! � �'�tit � i I n 1 {, 7 '` R I i ! 'a .iii f aPt 4
Storm &Rain Drain 1st 100' 62.54 f $1 . rvat � 5 1 ,t 4 t Ii °tf, ° ' ' 7 i , . l ,i I it,`. i.'lr,t , �° ii- , 1 1 - } t ` a
Storm Rain Drain -each additional 100' $ to $5 000.00 Minimum fee $72.50
3 7.52
� .; , �,; . s! ° ";43114:4 Nil 1.1.1 5,001.0 � to ' $72.50 for the first $5,000.00 and $1.52 for
a f a it ; G , � {'`� ,laf r. y Ili
each additional $100.00 or fraction thereof, to
C izt tt i 1 E si tf , s n +,, " j} and includin; $10 000.00.
Inspection of existing plumbing or for $ 10,001.00 to $25,000.00 $148.50 fbr the first $10,000.00 and 1.54 for
which no tree is specifically indicated 90.00/hr
(minimum charge -1/2 hour) each additional $10000 or fraction thereof, to
Inspections outside of norntaf business gQ,Op and including $25,000.00.
hours (minimum ch n - 2 hours) $25,001.00 to $50,000 -00 $379.50 for the first $25,000.00 and $1.45 for
Reinspection -Fees 90,00/hr each additional $100.00 or fraction thereof, to
and includin_ $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 ch. _e -1/2 hour each additional $100.00 or fraction thereof
Subtotal:
MEW A11■1110
Commercial Fixture Work:
Are you capping, adding or replacing fixtures? If "yes ", 1 t ' 1►+ r t, 1 ' at>zEt
please indicate work performed by fixture. Failure to i I,l "�' ; � j``r '��'' tE m�I ` ! !'C At- a
Plan review is required for any of the for �,�
accurately re 2 art fixtures could result in increased sewer fees*. Please check all that apply.
❑ Any new commercial building with water service 2" and
Fixture Type; ' '''''')''''P4::''' greater, except systems designed and stamped by licensed
Baptistry/Font engineer.
Bath llrblShowcr ❑ New exteilor plumbing site utilities for any complex structure
Tub/S i/whirl.00l as defined in OAR918- 780 -0040.
Car Wash Each Start ❑ Medical gas and vacuum systems for health care facilities.
-Drive Thru =Mill � ❑ Any multipurpose fire sprinkler system.
Cusridor/WatcrAs.irator 171 Any complex structure as defined in OAR918 -7$0 0040.
Dishwasher -Commercial IIMIMII
•Dorncstic� Submit 2 sets of plans with any of the above.
_ Drinking Fountain
_
Eye Wash 8
FloorDraiNsink Tl'i . '1l�j �,� s' 3601.ei'!!YYm .It a ..'� �* 1 t ' p `tt �
- 2" .N.� xncielRr. ,tit C • , r.-„ *w ... , r • , r ¢i' ,t' l'''''''1"47'''''
, f
■ Isometric or riser diagram is required for new buildings
a" that meet the q ualifications above.
Car Wash DrainI
Garbage - Domestic
Disposal - Commercial
- Industrial Ell Comments regarding fixture work:
Ice Maeh./Refrig. Drains
Oil Separator St on �
Rec. Vehicle Dump Station
Shower -Gang MIMI..
-Stall
Sink - Bar/Lavatory -
- Bradley
- Commercial s -`
Service *Note: If the fixture work under this permit results in an
Swimming l'ool Falter increase of sewer EDO, a sewer permit will be issued and
Washer - Clothes MOM --IMMO= fees assessed for the sewer increase must be paid before the
Water Extractor � plumbing permit can be issued.
Water Closet - Toilet'
Urinal _
rinli al=1111111
Other Fixtures: 111.1.1111.111
http:// www. tigard- or. gov/ city_ hall /departm cuts /cd/docs/PLMF- PermitAppploc