Permit CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit #: PLM2011 -00094
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 03/25/2011
Parcel: 2S103DA06600
Jurisdiction: Tigard
Site address: 10975 SW MIRA CT
Project: Collett Subdivision: MIRA PARK Lot: 4
Project Description: Replace less than 100' of water service and repipe interior water lines.
Contractor: ALDER PLUMBING Owner: COLLETT, FRANK
PO BOX 551 10975 SW MIRA CT
DUNDEE, OR 97115 10975 SW MIRA CT
TIGARD, OR 97223
PHONE: 503 - 550 -8979 PHONE:
FAX:
FEES
Quantity Description Date Amount
100 If Water Service 03/25/2011 $62.54
Specifics: 1 ea Water Piping /DWV 03/25/2011 $56.29
1 12% State Surcharge - 03/25/2011 $14.26
Type of Use: SF Plumbing
Class of Work: ALT
Type of Const:
Occupancy Grp:
Stories:
Total $133.09
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
issuan . . • . . • suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Uti • Notification Center. hose - a - set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. You may obtain a copy of the rules
. direct questions to OUNC by C. ' g 50 . 987 or 1.800.332.2344.
sued By: /‘ 0 -avir
Permittee Signature:
r �
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
Building Fixtures
OrCJL l
Cl of Tigard Received L Q /y�Q� /
A5,..- Permit No: (/ r `^� / `f
• 13125 SW Hall Blvd., Tigard, OR 97223 Pla Re
�' a
Phone: 503.718.2439 Fax: 503.598.1960 Date/By: Re view
= g Other Permit No.:
T I G A H D Inspection Line: 503.639.4175 Date Ready/By: 7uris: ® See Page 2 for
Internet: www.tigard - or.gov Notitied/Method: Supplemental Information
TYPE OF WORK
New construction
1.1] Demolition FEE* SCHEDULE
❑ Addition/alteration/replacement Other: wekTe( (e , e For special information
Qt ych I checklist.
P P Description � Qty. I E a. I Total
CATEGORY OF CONSTRUCTION New 1- 2- family dwellings (includes 100 ft. for each utility connection)
SFR (1) bath 312.70
"ql.1- and 2- family dwelling ❑ Commercial /industrial -
SFR (2) bath 437.78
❑ Accessory building ❑ Multi- family SFR (3) bath 500.32
❑ Master builder ❑ Other: Each additional bath/kitchen 25.02
JOB SITE INFORMATION AND LOCATION Fire sprinkler ( sq. ft.) Page 2
Job site address: / 0 97 S S IN • rr 1 2 A Cr, Site utilities:
Catch basin or area drain 18.76
City /State /ZIP: n
a / j 0 1 `- . Drywell, leach line, or trench drain 18.76
Suite/bldg. /apt. no.: Project name: Footing drain (no. linear it: _) Page 2
Cross street/direcbions to job site: ' i 0 4' h A v - e t Manufactured home utilities 50.03
Manholes 18.76
Rain drain connector 18.76
Sanitary sewer (no. linear ft.: ) Page 2
Storm sewer (no. linear ft.: _) Page 2
Subdivision: Lot no.: Water service (no. linear ft.: ) Page 2 0"Z514
Tax map /parcel no.: Fixture or item:
,--e". DESCRIPTION OF WORK Backflow preventer 31.27
N c)7 v-i ' I ( to �� t 1 P Backwater Clothes washer re 12.51
thes wsher 25A2
•
j c,-4 -e (' se Iry 1 (, €_ Ol v# C f -e 1 (�•-(' C 1 1 Dishwasher 25.02
o+ V Ste- W e r V t l pve LA, 17 h P.� 1 j , Ct ,' pp e ' Drinking fountain 25.02
PROPERTY OWNER 1 ❑ TENANT 1 Ejectors/sump 25.02
C U)
Co 1 Expansion tank 12.51
Name: pfow L l \'P. - 4
Fixture /sewer cap 25.02
'
Address: /0 "`j c� . Y �M t f C.. C* Floor drain/floor sink/hub 25.02
City /State /ZIP: •T 19 4 11 1 0 2, Garbage disposal 25.02
Phone: ( ) Fax: ( ) Hose bib 25.02
❑ APPLICANT ?CONTACT PERSON Ice maker 12.51
' 1 o f (� �- t Interceptor /grease trap 2 2
Business name: I (,I jj t' '
p v t Ot Medical gas (value: $ ) Page 2
12.51
Contact name: �.. L �,-�" F V t/u Primer
Address: 1 - • �L `J 5 l Roof drain (commercial) 12.51
City/State /ZIP: b (A ,w . 0a, , `l I / S Sink/basin/lavatory 25.02
Phone: ( c SD - t 1 - ( Fax: : ( ) Solar units (potable water) 62.54
E -mail: Tub /shower /shower pan 12.51
Urinal 25.02
CONTRACTOR Water closet 25.02
Business name: l 2\e r ` LA yv` - 1 wen Water heater 37.52
Address: O , Y �' 1 Water piping/DWV ' 56.29 50("n
City/State /ZIP: 13 to ix) A� O , q.-71 I Other: 25.02
Phone: (5-0 >) 5 �() __, Fax: ( ) Subtotal I (g t 1
Minimum permit fee: $72.50
CCB Lie.: " 01 0 , • Plumbing Lic. no.: 10 b 13
Plan review (25% of permit fee)
Authorized signature: , � (L, 'No, State surcharge (12% of permit fee) 14,1/
113 TOTAL PERMIT FEE
Print name:U 1 6 L c, v "� -}- V v r I Date: 5✓ es{ t
I \ Building \Permits\PLMU- PermitApp.doc 10/01/09 440- 4616T(10 /02/COM/WEB) O
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' 50.03 0 to 2,000 $121.90
Footing drain - each additional 100' 37.52 2,001 to 3,600 $169.69
Sewer - 1st 100' 62.54 3,601 to 7,200 $233.20
7,201 and greater $327.54
Sewer - each additional 100' 37.52
Water Service - 1st 100' 62.54 6 t ,
Water Service - each additional 100' 37.52 Medical Gas Systems:
Storm & Rain Drain - 1st 100' 62.54 Valuation: Permit Fee:
Storm & Rain Drain - each additional 100' 37.52 $1.00 to $5,000.00 Minimum fee $72.50
$5,001.00 to $10,000.00 $72.50 for the first $5,000.00 and $1.52 for
Other Inspections or Fees Qty. Fee (ea) Total each additional $100.00 or fraction thereof, to
Inspection of existing plumbing or for and including $10,000.00.
which no fee is specifically indicated 90.00/hr $10,001.00 to $25,000.00 $148.50 for the first $10,000.00 and $1.54 for
(minimum charge - 1/2 hour) each additional $100.00 or fraction thereof to
Inspections outside of normal business 90.00/hr and including $25,000.00.
hours (minimum charge - 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
Additional plan review for revisions 90.00/hr and including $50,000.00.
(minimum charge -1/2 hour) $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:
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 * . Plan Review for Plumbing Installations
Quantity by Fixture Type Plan review is required for any of the following.
Fixture Type for Replace/ Please check all that apply.
Work Performed: Capped Added Relocate ❑ Any new commercial building with water service 2" and
Baptistry /Font greater, except systems designed and stamped by licensed
Bath - Tub /Shower engineer.
-Jacuzzi/Whirlpool ❑ New exterior plumbing site utilities for any complex structure
Car Wash -Each Stall as defined in OAR918- 780 -0040.
-Drive Thai ❑ Medical gas and vacuum systems for health care facilities.
Cuspidor/Water Aspirator
Dishwasher Commercial ❑ Any multipurpose fire sprinkler system.
Domestic 111 Any complex structure as defined in OAR918- 780 -0040.
Drinking Fountain
Eye Wash Submit 2 sets of plans with any of the above.
Floor Drain/sink - 2"
3 " Isometric or Riser Diagram
4 ❑ Isometric or riser diagram is required for new buildings
Car Wash Drain
Garbage - Domestic non - food that meet the qualifications above.
Disposal - Domestic -food related
- Commercial -food related
- Industrial -food related
Ice Mach./Refrig. Drains Comments regarding fixture work:
Oil Separator (Gas Station)
Rec. Vehicle Dump Station
Shower -Gang
-Stall
Sink/Lav - Non -food related
- Bradley
- Commercial -food related
- Service
Swimming Pool Filter *Note: If the fixture work under this permit results in an
Washer - Clothes increase of sewer EDUs, a sewer permit will be issued and
Water Extractor fees assessed for the sewer increase must be paid before the
Water Closet - Toilet plumbing permit can be issued.
Urinal
Other Fixtures: