Permit CITY OF TIGARD PLUMBING PERMIT
11111 2 COMMUNITY DEVELOPMENT Permit #: PLM2011 -00083
Date Issued: 03/17/2011
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Parcel: 2S104AB03900
Jurisdiction: Tigard
Site address: 13420 SW SCOTTS BRIDGE DR
Project: Shepsman Subdivision: MORNING HILL NO. 3 Lot: 72
Project Description: Replace approximately 100' of water service.
Contractor: MP PLUMBING CO Owner: SHEPSMAN, ESTHER L &
PO BOX 393 HARTMANN, JAMES A
CLACKAMAS, OR 97015 13420 SW SCOTTS BRIDGE DR
TIGARD, OR 97223
PHONE: 503 - 655 -9161 PHONE:
FAX: 503 - 655 -1726
FEES
Quantity Description Date Amount
100 If Water Service 03/17/2011 $62.54
Specifics: 1 12% State Surcharge - 03/17/2011 $8.70
Plumbing
Type of Use: SF 10 ea Minimum Fee Adjustment - 03/17/2011 $9.96
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 quest to O G b - _ •ng 503.232.1987 or 1.800.332.2344.
Issued By: i ` /j ` Permittee Sign ure:
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.
Plumbing Permit Application = L. t, ' ; .,
Building Fixtures MAR 17 2011 1 (11t t;i I It I 1 ,i ll\I l
City of Tigard ` ®� Pe rmit No.: � , , / /.' QOD' 3
6 Ph one: 503 F ax : 503 e a 13125 SW Hall Blvd., Tigard, OR 97223 960 Plan Review Other Purmil No.
_ Date/By:
1 I 1 , :, 1') Inspection Line: 503.639.4175 Date Ready /Hy: runs; ld See Page 2 for
In ternet: www.tigard Notifted/Meuted: supplemental Information
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❑ New constntction ❑ Demolition For special information use checklist
Description I Qty. I Ea. I Total
hi Addition /altcration/replaeement ❑ Other: New 1- 2- family dwellings (includes 100 II. for each utility connection)
SFR (1) bath 312.70
W.
I. 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. It.) Pagc 2
Site utilities:
Job site address: ' l..r 505 ( l � /1 p � & Catch basin or area drain 18,76 " 8V�` ` Drywell, leach lino, or trench drain 18.76
City /State/ZIP: 7\ f �(1 ` t l linear R.: Page 2
Suite/bldg./apt, no.: Project name: .r 11 .I,at, ,111) Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76 _
Rain drain connector 18.76
Sanitary sewer (no. linear It.: _) Page 2
Stone sewer (no. linear It.: ___,) Page 2
Water service (no. linear f.: t pb) Pagc 2 lC 2 ,S1.1
Subdivision: I
Lot no.: Fixture or Item:
Tax map/parcel no.: Backtlow preventer 31.27
` , ' ,,':,,'",-- ' ' ' ' ' :" .,' -- '*..-71;IIMICIINIMITITITPNIadi Backwater valve 12.51
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r ;, .;., .,1 .AII rr.N:(.;1J.7Tl91;(1.>bI4%.1 0 ✓f flN,.11"kj,,llP34 "1 Ciumesw h 2502
► • .� �• i .. /. t l Dishwasher 25.02
{ tt 0 riallt ! Drinking fountain 25.02
Ejectors/sump 25.02
4 1+ , ^1 Expansion tank 12.51
Name.
Fixturrlsrwcr cap 25.02
Floor drain/floor sink/hub 25 -02
Address: •--
Garbage disposal 25.02
City /State/ZIP: Hose bib 25.02
Phone: ( ) Fax: ( ) ice maker 12.51
interceptor /grease trap - 25.02
Business name: Medical gas (value: $ ) Page 2
Primer 12.51
Contact name:
Root' drain (commercial) 12.51
Address' Sink/basin/lavatory 25.02
City /StateZIP: Solar units (potable water) 62.54
Phone: ( ) Fax: : ( ) Tub/shower /shower pan 12.51
E -mail: Urinal 25.02
Water closet - 25.02
Water heater 37.52
11 M 111FAMAIMII Water piping/DW V 56.29
Address: 0 P • de Other: 25.02
City /State/ZIP: 4, 0 ! S la' �tI =
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Subtotal t l 54
Phone: ( S a ) J A S ! . - q 1 / 4:7 t Fax: (< ) (t -CS - 17 i p Minimum permit fee: $72.50 1;) ,
CCB Lie.: i + Plumbing Lic. no.: ' - Plan review (25% of permit fee) IP State surcharge (12% of permit fee) '',1 Q
Authorized signature: A
kb , -i r TOTAL PERMIT FEE IZ.AO
Print name' Date'
This permit appikarloa eapiree if a permit is not obtained within ISO days
r \ i) \ . after it has been accepted as complete.
•lee methndoingy set by Tri- County Building Industry Service Huard,
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Plum bins Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Sue • ression S stems:
Footing drain - 1 100' 50.03 0 to 2.000 $121.90
Footing drain - torch additional 100' 37.52 2 001 to 3 600 $ 169.69
3,601 to 7,200 $233.20
Sewer - 1st 100' 62.54 7,201 and -; ter $327.54
Sewer • each additional 100' 37.52
Water Service - 1st 100' 62.34
Medical Gas S stems:
Water Service - each additional 100' _ 37.52 „
Storm & Rain Drain - 1st 100' 62.54
$1.00 to $5,000.00 Minimum roc $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
each additional $100.00 or fraction thereof, to
v n ridi, • ?', au and utoludu 510,000.00,
Inspection of existing plumbing or for 510,001.00 to $25,000.00 $148.50 for the first $10,000.00 and S1.54 for
which no fee is specifically indicated 90.00/hr III each additional $100.00 or fraction thereof, to
minimum ch : _e - 1/2 hour and includin : $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 cha e - 2 hours each additional $100.00 or fraction thereof, to
Reinspection Fees _ 90.00/hr and inclu ._ $50 000.00,
Additional plan review for revisions - 90.00/hr $742.00 for the first $50,000.00 and $1.20 for
minimum c e - 1/2 hour each additional $100.00 or fraction thereof,
Commercial Fixture Work:
Are you capping, adding or replacing fixtures? If "yes",
please indicate work performed by fixture. Failure to
accurately report fixtures could result in increased sewer fees * .
r
• Plan review is required for any of the following.
.
a r� r er r , , q �a
r r any lowin
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Please check all that apply.
.s. /Font -11.011111111111
An y new Commercial building with water service 2" and
Bath - Tub/Shower ❑
-Jacuzzi/Whirl. .1 greater, except systems designed and stamped by licensed
Car Wash - Each Stall engineer.
- Drive , - -= ❑ New exterior plumbing site utilities for any complex structure
C •idor/Watcr Aspirator - __ as defined in OAR918 780 0040.
Dishwasher -Commercial 1111111 ❑ Medical gas and vacuum systems for health care facilities.
- Domestic - -- ❑ Any multipurpose fire sprinkler system.
Drinkin : Fountain - -- ❑ Any complex structure as defined in OA1t918- 780 -0040.
Floor Drain/sink - 2" - -- Submit sets of plans with any of the above.
-3
Car Wash Dram ��� ■ Isometric or riser diagram is required for new buildings
Garbage - Domestic- non -fond
Disposal - Domestic -food related
- -- that meet the ualifications above.
-Commercial -food related M
- ltuiustrial -food related
Ice Mach. /Refri__ Drains
s . •razor Gas Station Comments regarding fixture work:
Rec. Vehicle Dum Station
Shower -Gang - --
-Stall IMMIlille=0
Sink/Lav - Non -food related
- Bradley
-Comme cial -food related 1.1.111111111111
- Service - --
sr n pool Filter
*Note: If the fixture work under this permit results in an
Washer - Clothes p
water Extractor - -- increase of sewer EDUs, a sewer permit will be issued and
Water Closet - fees assessed for the sewer Increase must be paid before the
Urinal plumbing permit can be issued.
Other Fixtures: - --
http: / /www.tigard or•gov /City hall/dcparunents /cd/docs /PLMF- PenniLApedvc
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