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Permit
Rl CITY OF TIGARD PLUMBING PERMIT COMMUNITY DEVELOPMENT Permit #: PLM2009 -00080 TIGAj D 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 04/08/2009 Parcel: 2S110CB08900 Jurisdiction: Site address: 12420 SW ST ANDREWS LN Subdivision: Lot: 0 Project: MOUNTAIN VIEW ESTATES Project Description: Back flow for irrigation. Owner: FEES ACCENT RESIDENTIAL HOMES INC Quantity Description Date Amount 12583 SW AUTUMNVIEW ST 1 ea Backflow Prevention - RES 04/08/2009 $27.55 TIGARD, OR 97224 1 12% State Surcharge - 04/08/2009 $4.35 PHONE: Plumbing 9 ea Minimum Fee Adjustment 04/08/2009 $8.70 Contractor: - Plumbing PERFECTION LANDSCAPE INC 22107SHWY213 OREGON CITY, OR 97045 PHONE: 503 - 632 -2274 FAX: 503 -632 -2279 Type of Use: Class of Work: 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 the rules App Issued By: Q �n A ( � lI PermiUee Signature: rp n 1� x 7.� LcQ l 1 � 1�( t 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. Plumbin A pp li ca ti on NQ 9 OE1(1S 200 31 • a�VOt1 OISI!I � AlIO Building Fixtures tl FOR OFFICE USE ONLY , City of Tigard sOOZ L }� R eceived (1 `, g ateBy: �< 7 Coq Permit No. �� L��zooq O�G12 u 1 3125 SW Hall Blvd., Tigard, OR 97223 an Review to /By: ipq C ; Phone: 503.639.4171 Fax: 503.598.19603 I Other Permit No.: 20�t�n T I G A R D ate Ready /By: Inspection Line: 503.639 Juris' ® See Page 2 for Internet: www.tigard- or.gov Notified/Method: Supplemental Information T YPE OF 'WORK . . • FEE* SCHEDULE- El New construction El Demolition For special information use checklist Description I Qty. Ea. Total El Addition/alteration/replacement El Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection) 'CATEGORY OF CONSTRUCTION SFR (1) bath 249.20 El 1- and 2- family dwelling El Commercial /industrial SFR (2) bath 350.00 El Accessory building El Multi-family SFR (3) bath 399.00 Each additional bath/kitchen 45.00 ❑ Master builder El Other: _ Fire sprinkler ( sq. ft.) Page 2 . JOB SITE. INFORMATION AND LOCATION Site utilities Job site address: \ 2_1-4 Z N , Ay\ (Iv ,./ Catch basin or area drain 16.60 City/State /ZIP: Drywell, leach line, or trench drain 16.60 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: J Lot no.: Water service (no. linear ft.: _) Page 2 Fixture or item Tax map /parcel no.: Absorption valve 16.60 . ' • - - - DESCRH!TION.OF WORK - t Backflow preventer Page 2 l � e 1 -Q (0 �J Backwater valve 16.60 Clothes washer 16.60 Dishwasher 16.60 Drinking fountain 16.60 ❑ 'PROPERTY OWNER _ 1 ' - -❑ TENANT 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 ' ❑ APPLICANT El CONTACT' PERSON` 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 Sink/basin/lavatory 16.60 Phone: ( ) Fax:: ( ) Tub /shower /shower pan 16.60 E -mail: Urinal 16.60 - ,ONTRACTOR Water closet 16.60 Business name: .7.- pfPGT2G </ .eL.dJ "#- 2 Water heater 16.60 Address: „70/ 4 , 7 �e / � / 43 Other: City /State /ZIP: ©/2e . �G Subtotal `,6i`� , •�- T Minimum permit fee: $72.50 Phone: ( ) 3 2 _ Z Z 7 L( Fax: ( ) Residential backflow minimum permit fee: $36.25 CCB Lic.: i,;. 266"‘ Plumbing Lic. no.: Plan review (25% of permit fee) WA_________ O State surcharge (12% of permit fee) Authorized signat TOTAL PERMIT FEE Print name: Date:! permit This mit a lication expires if a permit is not obtained within ��t /� t°: �f /U 180 days after it has been accepted as complete. *Fee m ethodology set by Tri- County Building Industry Service Board. 1 \ Building\Permits\PLMF- PermitApp doc 12/27/06 440- 46I6T(10 /02 /COMMBB) Plumbing Permit Application - City of Tigard - Page 2 - Supplemental Information Fee Schedule: Residential Fire Suppression Systems: Site Utilities :: Qty. ' • Fee (ea) Total:` ,S.quare Footage Per "Fe • Footing drain - Is 100' 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 Systems: Water Service - each additional 100' 46.40 Storm & Rain Drain - 1st 100' 55.00 `Valuation: Permit - Feet ' $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 Qty.' Fee (ea)' To additional $100.00 or fraction thereof, to and c,Flxtll're ,Or m Ite , _ 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 each additional $100.00 or fraction thereof, to Inspection of existing plumbing or and including $50 specially requested inspections - per hour 72.50 Subtotal: $50 and up $742.00 for the first $50,000.00 and $1.20 for each additional $100.00 or fraction thereof. Commercial Fixture Work: . . Plan Review for Installations Are you capping, adding or replacing fixtures? If "yes ", Plan review is required for any of the following. please indicate work performed by fixture. Failure to Please check all that apply. accurately report fixtures could result in increased sewer fees ❑ Any new commercial building with water service 2" and Quantity by (Fixture) Wiirk Performed greater, except systems designed and stamped by licensed .. , engineer. ' Typer Replace- . ! . Previous ; ,"Capiied Added`' Existing ❑ New exterior plumbing site utilities for any complex structure Baptistry/Font as defined in OAR918- 780 -0040. Bath - Tub /Shower ❑ Medical gas and vacuum systems for health care facilities. - Jacuzzi /Whirlpool ❑ Any multipurpose fire sprinkler system. Car Wash -Each Stall ❑ Any complex structure as defined in OAR918- 780 -0040. -Drive Thru Cuspidor /Water Aspirator Submit 2 sets of plans with any of the above. Dishwasher - Commercial - Domestic Drinking Fountain ISOmetriC: Or Riser Diagra>rYa ' _ . Eye Wash ❑ Isometric or riser diagram is required for new buildings Floor Drain /sink - 2" that meet the qualifications above. -3" - 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 - Bradley *Note: If the fixture work under this permit results in an - 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: i \Building\Permits\PLM- PermitApp doc 12/27/06