Permit CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit #: PLM2009 -00307
1312 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 10/23/2009
.TIGARD Parcel: 2S103BA00104
Jurisdiction: Tigard
Site address: 11890 SW ANN ST
Subdivision: LERON HEIGHTS Lot: 4
Project: Hutchinson
Project Description: Connect existing SF to sewer. Install up to 100' sewer service.
Owner: FEES
HUTCHISON, PERRY C Quantity Description Date Amount
11890 SW ANN ST
TIGARD, OR 97223 100 If Sewer Service 10/23/2009 $62.54
PHONE: 1 12% State Surcharge - 10/23/2009 $29.10
Plumbing
2 hr Inspections - Existing 10/23/2009 $180.00
Contractor: Plumbing or Requested
APOLLO DRAIN & ROOTER SERVICE
2208 NW BIRDSDALE #8
GRESHAM, OR 97030
PHONE: 503- 239 -8801
FAX: 503 - 669 -9568
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp:
Stories:
Total $271.64
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 the rules
or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
\ �I
Issued By: �1/4S7A0aLy \, Permittee Signature: CT�Xf Av.
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.
Oct. 23. 2009 2:OOPM No. 5150 P. 2
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, . , •' Plumbing Permit Applica ,
Building Fixtures CETVED FOR OFFICE LJSL l ,, t7 ).'a, s
City of Tigard OCT 2 3 2009 . d Pen „il No.: ,
13125 S W Hall Blvd., Tigard, OR 97223 Date/fi ' , �i p 46 _ cyst
t ;p �, 1 � gg � g , Plan Review
• Phone; 503,639.4171 Fax: �� _ Sn � Oci '
�11i1VI"TIGARD nateroy: Other Permit NO. {/IJIC�
Inspection Line: 503.639.41iaUILDINGDIV1 y y Ell See Pape for
TI _, A n.TJ D ote !R /(3 ;
Internet; wwi�,lignrfJ or.gov Noii fied /lenlod; ' - Supplemental rr
"I YPE O1P. WORK FEE* SCHEDULE
❑ New construction ❑ Demolition Fnr rpeeinl it(furnzr,(iwr use checklist.
ti Descri lion 01 . Ea. Total
oL. ldilion/alleration/replacement J ❑ Other; New 1- 2 -famil dwellings (includes 100 B. for each Milky connection)
CATEGORY OF CONSTRUCTION , SPR (1) bath 312.70
.4 I- and 2- family dwelling El Commercial /industrial SFR (2) bath 437.78
SFR (3) both 500.32
❑ Access my building ❑ Multi- f6,nil
Each additional bath/kitchen 25.02
El Master builder El Other: Fire sprinkler ( sq. It,) Page 2
JOI3 SITE INFORMATION AND LOCATION Site utilities:
Job site address; %('30 c'-'
�� d d ,f _ Cnt hiiSin or area drain 18 76
y Dryweli, leach line, or trench drain 18.76
City /State /ZIP: �7 �7 73.
' � Footing drain (no, linear (i,: , ,1 Page 2
Suite/bldgiapl, no,: 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 (I.; I Page 2
Storm sewer (no. linear IL; _) t Page 2
Water service (no. linear IL; ) Page 2
Subdivision: Lot no.: Fixture or item:
Tax map /garnet no.: Backllow preventer 31.27
Backwater valve 12.51
DESCRIPTION 0e' WORK ••
a` \
r`t Clothes washer 25.02
!1 .. V L , - e:-_ <.JU I p_ -. Dishwasher
25.02
. ■ ,V C. AIll la ! .A... Drinking fountain 25,02
0 LA ,. 9 .. • P w •. A l i ik ± .� t ( , EJcclors /sump 25.02
28 ROP RTY OWNF,I1.. ❑TENANT 4 Expansion taut: 12,51
Name: - ( � �`I� f ��� , ` Future/sewer cap 25.02
I r floor drain/floor sink/hub 25,02
Address: Garbage disposal 25,02
City /State /ZIP:
Hose bib 25.02
Phone: 6cf-,) 5 ?)023, Fax: ( ) Ice maker 12.51
' ''''PPLICANT • lntercc,
❑ . CONTr \CT • PE RSON I for /grease trap 25.02
Business name: , Medical gas (value: $ ) Page 2
Printer 12 51
Contact name: ...
Roof drain (commercial) 12,51
Address: Sink/basin/lavatory 25.02
City/Stole /ZIP: Solnr units (potable water) 62,54
Phone: ( ) Fax:: ( ) ' Tub /shower /shower tan 12.51
T lnnil: w
Urinal 25,02
CONTIiACTt7It Water closet _ 2,5,0
Water heater 37.52
-
Business name: I
A( /i .<iT.I1[ r".1.-, Water piping/DWV 56,29
Address; p _ ,
t til� G 4. co �' Other- ol f . 25.02
City /State/ZIP: Ai ,A.,/. `.. li el7 r Subtotal
Phone; (---../ - v . e , Minimum permit fee: $72.50
CCB Lie.: jg2rEMIIIIIII Plumbing Lie. no.: 7 (//3 -6p de Plan review (25% of permit fcc)
/ P ' � State surcharge (12% of permit fcc) • Authorized signature: ,,,,
a �t- �!, —
TOTAL PERMIT FEE ',
Print name: ' y 1 a / Dale: / !IONA .11th permit applicatim, expires if a permit Is not obiaiacd within ISO clays
rifler ii has been accepted ns complete,
'Fro methodology. Set by Tn- County Budding Industry Service Board.
t:\n uilding \Permiu■PLbttl- Pcrmi,App,,loc 10 /01! 440- 4616T(10,62JCOmInft)
c ccr o. Gi rd.
Oct. 23. 2009 2:0OPM No. 5150 P. 3
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
Pooling drain - each additional 100' 37.52 2,001 to 3,600to 3,600 $169.69
3,601 to 7,200 $233.20
Sewer - 1st 100' ( 62,5 .1 7.201 and greater $327,51
Sewer - each ndditional 100' 37.52
WaterService - ist 100' 62.54 Medical Gas Systems:
Water Service - each additional 100' 37,52 •
Storm & Rain Drain - 1st 100' 62,54
ValYtatiO • •Pex•mit Fee::: .
$1.00 to $5,000.00 Minimum fee $72.50
Storm & Rain Drain - each addilional 100' 37.52 $5,001.00 to $10,000.00 $72.50 for the first $5,000.00 and $1.52 for
t Qty. Fee,(en) Total each additional $100.00 or fraction thereof, to
'Other .Inspections or 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 norm al 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
Rcinspection Fees 90.00 /hr and including $50,000.00.
Additional plan review for revisions 90.00Au $50,001,00 and up $742,00 for the first $50,000.00 and $ 1 ,20 far
(minimum charge — 1/2 hour) each additional $100.00 or fraction thereof.
Subtotal:
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Commercial Fixture Work:
Are you capping, adding or replacing fixtures? ff'�yes ", Plan Review far Plumbin Installations .
please indicate work performed by fixture. Failure to Plan review is required for any of the following.
accurately report fixtures could result in increased sewer fees * . Please check all that apply.
Quantity by (Fixture) Work Performed ❑ Any new Commercial building with water service 2" and
Fixture Type: Replace greater, except systems designed and stamped by licensed
Previous Capped Added Existing engineer,
13nplistry/Pont ❑ New exterior plumbing site utilities for any complex structure
Both - Tub/Shower as defined in OAR9I8 -780 -0040.
- Jacuzzi/Whirlpool
Car Wash each 51811 ❑ Medical gas and vacuum systems for health care facilities.
- Drive Thru ❑ Any multipurpose fire sprinkler system,
Cuspidor/Water Aspirator ❑ Any complex structure as defined in UAR91$ 780 0040.
Dishwasher -Commercial
Domestic Submit 2 sets of plans with any of the above.
Drinking Fountain
Lye Wash :. Isometric or Riser Diagrams • .
Floor Drain/sink - 2" � — ❑ Isometric or riser diagram is required for new buildings
that meet the gaalifiCatiOnS above.
Car Wash Drain
Garbage - Domestic
Disposal - Commercial
industrial Comments regarding fixture work:
lee Mach. /Refrig. Drain
Oil Separator (Gas Station)
Rec. Vehicle Dump Station
Shower' - Gang
Stall
Sink - Oar/1-avatory
- Bradley
- Commercial *Note: If the fixture work under this permit results in an
- Service increase of sewer EDUs, a sewer permit will be issued and
Swimming Pool Filter fees assessed for the sewer increase must be aid before the
Washer - Clothes P
Water Extractor plumbing permit can be Issued.
Water Closet - Toilet
Urinal
Other Fixtures: —
http: / /www.tigerd- or.gov /city_ hall / departments /cd /docsfPLMF- PennitAp cloc
OCTOC t. 29, 2009 11: 07AM, Nor 5295 P. 1 P. 02
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All claims au pools MUST be accompanIad by ails bill.
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T o R oggr,' T HNK YOU
640.2 - 30 or neb9.com
HANK
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