Permit r
CITY OF TIGARD PLUMBING PERMIT
S p
• COMMUNITY DEVELOPMENT Permit #: PLM2009 -00200
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 07/24/2009
Parcel: 2S109AA00600
Jurisdiction: Tigard
Site address: 14275 SW 125TH AVE
Subdivision: Lot: 0
Project:
Project Description: Install residential backflow for irrigation.
Owner: FEES
Quantity Description Date Amount
1 ea Backflow Prevention - RES 07/24/2009 $27.55
PHONE: 1 12% State Surcharge - 07/24/2009 $4.35
Plumbing
9 ea Minimum Fee Adjustment - 07/24/2009 $8.70
Contractor: Plumbing
RUBEN'S GREAT JOB
P.O. BOX 242
DAYTON, OR 97114
PHONE: 503 - 547 -8566
FAX:
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp:
Stories:
Total $40.60
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 t r s
or direct questions OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By: (y jl �( II '( Permittee Signature:
�A .0 llllll���i
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
RECEIVE .r
FOR OFFICE ( SE ONE\
Cl of Ti and Received permit No.:
• 131 SW Hall Blvd., Tigard, OR 97223 JUL 2 4 ?009 Date/By: J pi (1)7OO9, 0--)20c
Plan Review
Phone: 503.639,4171 Fax: 503.598.1960 Other Permit No.:
Inspection Line: 503.639.4175 CITY OF TIGAR Date/BY. TIGAKD Internet: www.tigard- or.gov BUILDING DI VISI 0 o Reade ®see for
tt Supplemeental ntal Information
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❑ New construction ❑ Demolition For special information use checklist.
Description I Qty. I Ea. 1 Total
] Addtti alteratio replacement El Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUC i`ItN , SFR (1) bath 249.20
1- and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 350.00
❑ Accessory building ❑ Multi- family SFR (3) bath 399.00
❑ Master builder 1=1 Other: Each additional bath/kitchen 45.00
Fire sprinkler ( sq. ft.) Page 2
f . . 4tA g "iNPORA A"1 IO AND' TA C .416N Site utilities
Job site address: i ti 2 7 2 C L; i Z s T "AVE Catch basin or area drain 16.60
City/State/ZIP: Drywell, leach line, or trench drain 16.60
y . T t (� rq a., � �,Z. q 7 Z 'L N, ryw
Suite/bldg. /apt. no.: Project name: Footing drain (no. linear ft.: ) Page 2
Manufactured home utilities 110.00
Cross street/directions to job site: Manholes 16.60
Rain drain connector 16.60
Sanitary sewer (no. linear ft.: ) Page 2
Storm sewer (no. linear ft.: ) Page 2
Subdivision: I Lot no.: Water service (no. linear ft.: ) Page 2
Tax map /parcel no.: Fixture or item
Absorption valve 16.60
T 1 ...: , , .. " "' . , , , ti . *, ,,b { .ke -. f u- Backflow preventer Page 2
c ,P1 C R Ft-0 (t-r11 6 Ai 10 41 J Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
Drinking fountain 16.60
�..- p .�n, � , -. ., - . ".fig= Ejectors /sump 16.60
Name: Expansion tank 16.60
Address: Fixture /sewer cap 16.60
City /State /ZIP: Floor drain/floor sink/hub 16.60
Phone: ( ) Fax ( ) Garbage disposal 16.60
`4 04' Ty ,p I c4 o t R O!T Hose bib 16.60
Ice maker 16.60
Business name:
Interceptor /grease trap 16.60
Contact name: Medical gas (value: $ ) Page 2
Address: Primer 16.60
City /State /ZIP: Roof drain (commercial) 16.60
Phone: ( ) I Fax: c ( ) Sink/basin/lavatory 16.60
Tub /shower /shower pan 16.60
E-mail: Urinal 16.60
i4 v . .,,ter. A �:, ^ . ;.1 m x »4:°,, 4•.,. -4 Water closet 16.60
Business name: p._‘;, SC N `s (-74E ANT 3a 3 Water heater 16.60
Address: 11). 'Z�12 Other:
City /State /ZIP: 0 A y T o A.; 012 q / Subtota
Minimum permit fee: $72.50 3(., 2S
Phone: (5c'3) 14 79' -- SS 6 Fax: ( ) Residential backflow minimum permit fee: $36.25
"€ -Lic.: 5S C3 9 Plumbing Lic. no.: Plan review (25% of permit fee)
'-`.- 1 -
�.� : State surcharge (12 %ofpermit fee) ` i,
Authorized signature: OA
f:v .1 TOTAL PERMIT FEE 4(). 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
1 \ Building \Permits\PLM- PermitApp.doc 12/27/06 440- 4616T(I0 /02 /COM/WEB)
Q. Li
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site Uti es
Qty Fee ( ea ) Total Square Footage: Per mit.Fee:
Footing drain - 1' 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 S stems:
Water Service - each additional 100' 46.40 € . , t a k
Storm & Rain Drain - 1st 100' 55.00 $1.00 to $5,000.00 Minimum fee $72.50
Storm & Rain Drain - each additional 100' 46.40 $5,001.00 to $10,000.00 $72.50 for the first $5,000.00 and $1.52 for each
�= "� :h Toil additional $100.00 or fraction thereof, to and
3+'�xtr 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
(minimum permit fee $36.25) 27.55 and including $25,000.00.
Rain Drain, single family dwelling 65.25 $25,001.00 to $50,000.00 $379.50 for the first $25,000.00 and $1.45 for
Inspection of existing plumbing or each additional $100.00 or fraction thereof, to
specially requested inspections - per hour 72.50 and including $50,000.00.
Subtotal: $50,001.00 and up $742.00 for the first $50,000.00 and $1.20 for
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 Plan review is required for any of the following
accurately report fixtures could result in increased sewer fees * . Please check all that apply.
, Quantit�b (Fi WorkPerfoltited ❑ Any new commercial building with water service 2" and
Fixture Type 1eptape greater, except systems designed and stamped by licensed
P rMvfotis Capped Added Existtng.. engineer.
Baptistry/Font
Bath - Tub /Shower ❑ New exterior plumbing site utilities for any complex structure
-Tub/Shower as defined in OAR918- 780 -0040.
Car Wash Each Stall ❑ Medical gas and vacuum systems for health care facilities.
Drive tall ❑ Any multipurpose fire sprinkler system.
Cuspidor/Water Aspirator ❑ Any complex structure as defined in OAR918- 780 -0040.
Dishwasher - Commercial
Domestic Submit 2 sets of plans with any of the above.
Drinking Fountain
Eye Wash a s ,"
Floor Drain /sink - 2" ❑ Isometric or riser diagram is required for new buildings
that meet the qualifications above.
-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 under this permit results in an
- Bradley ure wor uner p
- Commercial increase of sewer EDUs, a sewer permit will be issued and
- Service fees assessed for the sewer increase must be paid before the
Swimming Pool Filter plumbing permit can be issued.
Washer - Clothes
Water Extractor
Water Closet - Toilet
Urinal
Other Fixtures:
is \ Building \Permits\i'LM- PermitApp.doc 12/27/06