Permit CITY OF TIGARD PLUMBING PERMIT
111 COMMUNITY DEVELOPMENT Permit #: PLM2011 -00138
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 05/04/2011
Parcel: 2S105DD07100
Jurisdiction: Tigard
Site address: 14665 SW KLIPSAN CT
Project: MAUSS Subdivision: PACIFIC CREST SUBDIVISION Lot: 45
Project Description: Backflow for irrigation.
Contractor: ESEQUIEL ROBLES LANDSCAPING Owner: MAUSS, AMY E & ERIC M
7076 RIDGEMONT DR N 14665 SW KLIPSAN CT
KEIZER, OR 97303 TIGARD, OR 97223
PHONE: 503 - 997 -9874 PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Backflow Preventer 05/04/2011 $31.27
Specifics: 1 12% State Surcharge - 05/04/2011 $8.70
Plumbing
Type of Use: SF 41 ea Minimum Fee Adjustment - 05/04/2011 $41.23
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 questions to OUNC by calling 503.232.1 • = .r .800.33 .
Issued By: • •ermittee Signature: dril
Call 50 . • • .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 V
City of Tigard G�� Received / � } `,
11 1111 13125 SW Hall Blvd., Tigard, •' v Date/By: 5 y ii 0 / IXX�"tY) 4 3 87
, Jul : I Phone: 503.718.2439 Fax: 5 ■ %.. .1960 P Date By ew Permit No.: Other Permit No.:
Inspection Line: 503.639.4175 c�� Date Read /B ruris: ® See Pa e 2 for
T l (, A R D Internet: www.ti ard -or. ov p' ` h` Ready /By: �> S
g g t ,� .\ ' %- \$ \� Notified/Method: :4 Supplemental Information
TYPE OF WORK vv,- J FEE* SCHEDULE
❑ New construction ❑ � Ton For special information use check list
Description Qty. I Ea. I Total
❑ Addition/alteration/replacement ❑Other: New 1 - 2- family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (1) bath 312.70
❑ 1- 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. ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: + up c,45 c 5L j _, 1 ; p 5q ? C Catch basin or area drain 18.76
V " 'S Drywell, leach line, or trench drain 18.76
City /State /ZIP: l ' q 7 ," �- c 22'7, Footing drain (no. linear ft.: ) Page 2
Suite/bldg. /apt. no.: d Project name: Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
Rain drain connector 18.76
Sanitary sewer (no. linear ft.: ) Page 2
Storm sewer (no. linear ft.: ) Page 2
Water service (no. linear ft.: ) Page 2
Subdivision: Lot no.: Fixture or item:
Tax map /parcel no.: Backflow preventer I 31.27 3' , a. 7
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 25.02
(6+ Flo '6
Dishwasher 25.02
Drinking fountain 25.02
Ejectors /sump 25.02
❑ PROPERTY OWNER I ❑ TENANT Expansion tank 12.51
Name: y r ( FAGNise Fixture /sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address: (, ti C S $ L _„ s le-,; p 6 q., Cr Garbage disposal 25.02
City /State /ZIP: q ; p fd Olt, Q -) J2 5 Hose bib 25.02
Phone: ( ) V Fax: ( ) Ice maker 12.51
❑ APPLICAN. ❑ CONTACT PERSON Interceptor /grease trap 25.02
Business name: Medical gas (value: $ ) Page 2
� Primer 12.51
Contact name: ��- -
Roof drain (commercial) 12.51
Address: ---A3-26, 89-..,rL� rap-1,r I p ,/ Sink/basin/lavatory 25.02
City /State /ZIP: 17,6 DX- I Z 6 Solar units (potable water) 62.54
( d l�Tq qC '-r Tu b /shower /shower
Phone: � ii .g.7 C L O t Fax: ( ) pan 12.51 P
E -mail: Urinal 25.02
Water closet 25.02
(� CO ( NTC
TR R A / TOR ( -
� � v U ! L..4i `sCbpYJ Water heater 37.52
Business name: Water i in WV 56.29
Address: 7 `1 6 r_ 745 € jr ub r- n ,,^ Other: 25.02
City /State /ZIP: cci Z-7 ox__ ??,?, Subtotal
Phone: (�, � ?s-1, y_J Fax: ( ) Minimum permit fee: $72.50 7)..
CCB Lic.: -7 ` 7 '' / / 1 Plumbing Lic. no.: -77g-,-( Plan review (25% of permit fee)
State surcharge (12% of permit fee) g -70
Authorized signature: TOTAL PERMIT FEE 7.
This permit application expires if a permit is not obtained within 180 days
Print name: Date: after it has been accepted as complete.
*Fee methodology set by Tri- County Building Industry Service Board.
1:\Building\Permits\PLMU- PermitApp.doc 10 /01/09 440- 4616T(10 /02/COM/WEB)
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
3,601 to 7,200 $233.20
Sewer - 1st 100' 62.54 7,201 and greater $327.54
Sewer - each additional 100' 37.52
Water Service - 1st 100' 62.54 Medical Gas Systems:
Water Service - each additional 100' 37.52
Valuation: Permit Fee:
Storm & Rain Drain - 1st 100' 62.54 $1.00 to $5,000.00 Minimum fee $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
Other ec
Ins tions or Fees Qty. Fee (ea) Total each additional $100.00 or fraction thereof, to
Inspections and including $10,000.00.
Inspection of existing plumbing or for $10,001.00 to $25,000.00 $148.50 for the first $10,000.00 and $1.54 for
which no fee is specifically indicated 90.00/hr each additional $100.00 or fraction thereof, to
(minimum charge - 1/2 hour) and including $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 charge - 2 hours) each additional $100.00 or fraction thereof, to
Reinspection Fees 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 $1.20 for
(minimum charge 1/2 hour) each additional $100.00 or fraction thereof.
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 * .
Quantity by Fixture Type Plan Review for Plumbing Installations
Fixture Type for Replace/ Plan review is required for any of the following. Performed: Capped Added Relocate q Y g
Baptistry/Font Please check all that apply.
Bath - Tub /Shower El 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.
Isometric or Riser Diagram
Car Wash Drain ❑ Isometric or riser diagram is required for new buildings - Domestic - non -food s
g q g
Disposal - Domestic -food related that meet the qualifications above.
- Commercial -food related
- Industrial -food related
Ice Mach. /Refrig. 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
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:
I: \Building\Permits\PLMF- PermitApp.doc 2