Permit CITY OF TIGARD PLUMBING PERMIT
1 COMMUNITY DEVELOPMEN Permit #: PLM2011 -00093
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 04/06/2011
Parcel: 1 S136CA01600
Jurisdiction: Tigard
Site address: 11655 SW PACIFIC HWY
Project: Raz Transportation Subdivision: Lot: 0
Project Description: 38 ft. of water service.
Contractor: OWNER Owner: AMAN, WALTER S CREDIT SHELTER TR
AMAN, WALTER S MARITAL TRUST ET AL
BY STEPHEN D AMAN TR
19217 SW 119TH AVE
TUALATIN, OR 97062
PHONE: PHONE:
FAX:
FEES
Quantity Description Date Amount
38 If Water Service 04/06/2011 $62.54
Specifics: 1 12% State Surcharge - 04/06/2011 $8.70
Plumbing
10 ea Minimum Fee Adjustment - 04/06/2011 $9.96
Type of Use COM Plumbing
Class of Work: ALT
Type of Const:
Occupancy Grp:
Stories:
Total $81.20
Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. S. cial Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work not - arted within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to folio the rul-s adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. ou ma obtain a copy of the rules
or direct questions to OUNC . ailing 503.232.1987 or 1.800
Issued By: 7. i P ittee Signature:
Call 503.639.4175 by 7:00 a.m. for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Mar 25 11 11:46a Mark Hagg 503 283 4074 p.2
Plumbing Permit Application ?'-
Site Utilities FOR OFFICL I, SE ONLY
City of Tigard Received /
Date/By: (7 ✓/d Permit No.: PZA v)if Al 91
1111 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
C Phone: 503.718.2439 Fax: 503.598.1960 Dd Other Permit No.:
Inspection Line 503 639 4175
TIGARD Date Ready By lofts t PI See Page 2 for
Internet wwv< ttgard -or gov N
tmfi ed 'Method: Supplemental Information
. .- �. : ; � r g_, . "- ? _ '...:.:,..%::::'-:72
- etc .� : : : : � _ _ _ .
❑ New construction ! ❑ Demolition For specialinformarlon use checklist.
y Description I Qty. f Ea. 1 Total
❑ Addition/alteration /replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
- 4 3 !" O I6 1 :O `J$t f ' t r SFR (I) bath 312.70
❑ 1- and 2- family dwelling �,[( \Commercial/industrial SFR (2) bath 437.78
CI Accessory budding El M ulti - family SFR (3) bath 500.32
❑ Master builder Each additional bath /kitchen 25.02
❑� Fire sprinkler ( sq. R) Page 2
JQ$ i '1<'>iQ1�T l0 a '� .: Y Site utilities: ,
,. [ ._ ° z
Job site address Catch basin or area drain 18.76
� C
Drywell, leach line, or trench drain 18.76
City/State/ZIP: If
Footing drain (no. linear ft.: ) Page 2
Suite/bldg. /apt. no.: Project name: • , %
f , / Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
Rain drain connector 18.76
Sanitary sewer (no. linear ft.: __J Page 2
Storm sewer (no. linear ft.: __) Page 2
Water service (no. linear ft.: 3.2b 1 Page 2 (p). ,3
Subdivision: Lot no.: fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
. x
A 4:4: ' :i; lag V p "` _ t
; f a t ; Backwater valve 12.51
; , --i4744.1.:-7„..4 ' • ,...
1 - 7 . ..
, _�__ l .. _ >l ,7 , : = _ a r ° . a Clothes washer
,
`Q S . - cf / c l/if \C.( 25.02
Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
' Q - pJ giettyk min 0 = Expansion tank 1251
Name: Fixture /sewer cap 25.02
Address:
Floor drain /floor sink/hub 25.02
Garbage disposal 25.02
City/State/DP:
Hose bib 25.02
' Phone: ( ) Fax: ( ) Ice maker 12.51
m B i :'' 1 . r"; s w
:_ _ , "�;, •s s . . __ s} ' ._ :s � 6�.E � "� m c 8�+ -�, Interceptor /grease trap
v.: . 25.02
Business name:, �/, 4Z _ Medical gas (value: $ ) Page 2
Contact name: Primer 12.51
A Roof drain (commercial) 12,51
Address: / / ,,�� t ) r�' zot -f• „. / "..t.) / Sinkrbasin/lavatory 25.02
City /Slate /ZIP: / 7/ /C 7 2 z z 7 Solar units (potable water) 62.54
Phone: ( 2 Fax: ( ) Tub/shower/shower pan 12.51
E -mail: Urinal 25.02
z s "t c ! l! s x z' _* n : Water closet 25.02
. - _ .- ._ _' : ;1 - - -! 2:4`;--1:...,4.44- M -A ., = < 1-_ - .t i4i ." I'` Water heater 37.52
Business name: t � A / ie --
Water piping/DWV 5629
Address:
Other: 25.02
City /State/ZIP: Subtotal ( ,
Phone: ( ) Fax: ( ) Minimum permit fee: $72.50 •7 S-•(3
CCB Lie.: Plumbing Lic. no.: Plan review (25% of permit fee) �
State surcharge (12% ofpermit fee) r 70
Authorized signature: TOTAL PERMIT FEE
Print name: ,v 4 7 Gc/ Date:Y // This permit application expires ifs 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:t auildingTermitsU 'LML- 14.-mitApp.doe 16`00) 440- 4616T(I0Po2ICOMMEB)
Mar 25 11 11:46a Mark Hagg 503 283 4074 P.3
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Sur t ression S stems:
�l=oi lge> �
Footing drain - I' 100' 50.03
I.
0 to 2,000 5121.90
•
Footing drain - each additional 100' 77.57 2,001 to 3,600 $I69.69
3,601 to 7,200 $23320
Sewer - 1st 100' 62.54 , 7201 and greater $327.54
Sewer - each additional 100' 37.52
Water Service - 1st 10 0' 62.54
6 ,1, Medical Gas Systems:
Water Service - each additional 100' 37.52 -- s
Storm &Rain Drain - 1st 100' 62.54 d 4' : _ ° " ' .elr'>I nf t . 1-77i7' : ;
$1.00 to $5,000.00 Minimum fee $72.50
Storm & Rain Dram - each additional 100' - 37.52 $5,001.00 to $10,000.00 $72.50 for the first $5,000.00 and 51.52 for • ' each additional $100.00 at fraction thereof. to
ii p � 70 gq. ~ � 1 �` and including $10,000.00.
Inspection of existing plumbing or for 410,001.00 to $25,000.00 $148.50 for the first $10,000.00 and $1.54 for
which no fee is specifically indicated 90.00/Iv
(minimum charge - 112 hour) each additional 5100.00 or fraction thereof, to
and including 525,000.00.
Inspections outside of normal business 90.00/hr 525,001.00 to 550,000.00 5379.50 for the first $25,000.00 and $1.45 for
hours (minimum charge -2 hours) each additional $100.00 or fraction thereof, to
Re inspection Fees r 90.00 /hr 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 31.20 for
(minimum charge - 1/2 hour) each additional: S 100.00 or fraction thereof. I
Subtotal:
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 * .
' : Quant Fbitnr
i by e.Type ' = -
'ixture Type for = ,r - :V ' i lnig la
Vi'otrkpetioimetl. G ^ '= ,S+ktat „ Rt41Fe Plan review is required for any of the following.
Baptistry /Font Please check all that apply.
Bath Tub/Shower ❑ Any new commercial building with water service 2" and
- Jacuzzi/Whirlpool greater, except systems designed and stamped by licensed
Car Wash -Each Stall engineer.
-Drive Thru ❑ New exterior plumbing site utilities for any complex structure
Cuspidor /Water Aspirator as defined in OAR918- 780 -0040.
Dishwasher - Commercial ❑ Medical gas and vacuum systems for health care facilities.
- Domestic ❑ Any multipurpose fire sprinkler system.
Drinking Fountain ❑ Any complex structure as defined in OAR918 -780 -0040.
Eye Wash
Floor Drain/sink - 2" Submit 2 sets of plans with any of the above.
- .
3"
3 - >et'g Ott' IS.er D,agrank _ .
Car Wash Drain
Garbage Domestic non - food ❑ Isometric or riser diagram is required for new buildings
Disposal - Domestic-food related that meet the qualifications above.
- Commercial -food related
- Industrial -food related
Ice MachfReCrig. Drains
Oil Separator (Gas Station) Comments regarding fixture work:
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 p
Water Extractor increase of sewer EDUs, a sewer permit will be issued and
Water Closet - Toilet _ fees assessed for the sewer increase must be paid before the
Urinal plumbing permit can be issued.
Other Fixtures:
http: //w ww. t igard- or.gov/ city _hall /departmentsled/docs,PL MU -Permi tAp2 doc