Permit •
n
CITY OF TIGARD PLUMBING PERMIT
` COMMUNITY DEVELOPMENT Permit #: PLM2011 -00215
13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 07/08/2011
TIGARD 13125 2S110CB10200
Jurisdiction: TIGARD
Site address: 15408 SW ARLINGTON TER •
Project: Arlington Heights No. 3, Lot 90 Subdivision: ARLINGTON HEIGHTS NO. 3 Lot: 90
Project Description: Install residential backflow preventer for irrigation.
Contractor: ZAK'S LANDSCAPING Owner: TIMBERLAND HOMES INC
4909 SE BRITTON AVE 12670 SW 68TH AVE #300
MILWAUKIE, OR 97267 TIGARD, OR 97223
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PHONE: 503 - 620 -8860
PHONE: 503 - 229 -4179
FAX:
FEES
Quantity Description Date Amount
1 ea Backflow Preventer 07/08/2011 $31.27
Specifics: 1 12% State Surcharge - 07/08/2011 $8.70
Plumbing
41 ea Minimum Fee Adjustment - 07/08/2011 $41.23
Type of Use: SF Plumbing
Class of Work: OTR
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, ate of OR. S.ecialt Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expi e if work is not st• ed within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requir you to f low th- rules adopted by the Oregon
Utility ttfication Cen - Those rules are set forth in OAR 952- 001 -0010 through OAR 9'2- 001 -H90 You ay obt•.in a copy of the rules
or di ct questions to OUNC e - lin' 50 .232.1987 or 1.800.332.2344.
Iss ed By: // Permittee Signature:
4Ib 4111 11111111110. '
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 FOR OFFICE USE ONLY
City of Tigard D 7 g !1 ,I PermitNo.: L11� / /�eo��
j ig a 13125 SW Hall Blvd., Tigard, OR 97223
0 Phone: 503.718.2439 Fax: 503.598.1960 an Review
Date/By: Other Permit No.:
D
T l G A R D Inspection Line: 503.639.4175 Date Ready/By: Juris: I ® See Page 2 for
Internet: www.tigard- or.gov Notified/Method: Supplemental Information
�,( TYPE OF WORK FEE* SCHEDULE
�I New construction El Demolition For special information use checklist.
Description I 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 0 Commercial/industrial SFR (2) bath 437.78
)4
❑Accessory building SFR (3) bath 500.32
El 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: (S L' S Ind I t k, Catch basin or area drain 18.76
' It' `1'-'e I� 1t �� m Drywell, leach line, or trench drain 18.76
City /State /ZIP: '1-'i ‘,"t 0 (2. 91 22
Footing drain (no. linear ft.: ) Page 2
Suite/bldg. /apt. no.: j 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
Q Water service (no. linear It.: ) Page 2
Subdivision: mi J �V, �e j, �' I Lot no.: 1 0 Fixture or item:
Tax map /parcel no.: Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
1 Clothes washer 25.02
t NS ' 1 ` 1 lam t+61'+ ,101\"h S �S.1 -f. w Dishwasher 25.02
k) `J Q C,,k.CI d,. J AQAA (,� I I VI t ` itAl .S 1 � 1 3S0 Drinking fountain 25.02
Semi t AK k'"VC/e MI 13 110 Ejectors /sump 25.02
❑ PROPERTY OWNER I ❑ TENANT Expansion tank 12.51
Name: TlIb 14.4 k eS 1 1 1I -C. Fixture /sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address:
Garbage disposal 25.02
City /State /ZIP: Hose bib 25.02
Phone: (9)3) ( - Ss 6 Q Fax: ( ) Ice maker 12.51
❑ APPLICANT ❑ 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: Sink/basin/lavatory 25.02
City/State /ZIP: Solar units (potable water) 62.54
Phone: ( ) Fax: : ( ) Tub /shower /shower pan 12.51
E -mail: Urinal 25.02
Water closet 25.02
CONTRACTOR
LA Water heater 37.52
Business name: 2k K I S LA S C J A- (I^ �� Water piping/DWV 56.29
Address: y O q q SE D fl'�"�{n (TV< , 1N) • I WIVM f` t Other: 25.02
City/State /ZIP: 5I P 1 Subtotal
Phone: (503 ) 2 Z °► ' 1-0 i 9 Fax: ( ) l.P►1n-6413(."?e Minimum permit fee: $72.50
Plan review (25% of permit fee)
CCB Lie.: 1 i 3 $ � � 'Phmtbtl g ions.: I � b5 State surcharge (12% of permit fee)
Authorized signature: / /� TOTAL PERMIT FEE
Print name: p / �� This permit application expires if a permit is not obtained within 180 days
/ fr ......... Date: fJ
after it has been accepted as complete.
*Fee methodology set by Tri -County Building Industry Service Board.
I:\ 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 - lst 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
Storm & Rain Drain - 1st 100' 62.54 Valuation: Permit Fee:
$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 Inspections or Fees Qty. Fee (ea) Total each additional $100.00 or fraction thereof, to
P 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 , C a pped Added Relocate
e ) - Plan `review is required.f a ny of any following. . -
Work Performed: Please check all that apply.
Baptistry/Font Pp y'
Bath Tub /Shower ❑ Any new commcrcial building with water service 2" arid
-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"
4„ - Isometric or Riser Diagram
Car Wash Drain ❑ Isometric or riser diagram is required for new buildings
Garbage - Domestic - food g q g
Disposal - Domestic 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 • • i
- 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 P
Water Closet - Toilet fees assessed for the sewer increase must be paid before the
Urinal plumbing permit can be issued.
Other Fixtures:
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