Permit •
CITY OF TIGARD PLUMBING PERMIT
I COMMUNITY DEVELOPMENT Permit #: PLM2009 -00262
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 09/24/2009
Parcel: 2S 105 DA 17700
Jurisdiction: Tigard
Site address: 14610 SW CATALINA DR
Subdivision: Lot: 0
Project: Kim
Project Description: Install backflow for irrigation.
Owner: FEES
KIM, SUNGMIN Quantity Description Date Amount
14610 SW CATALINA DR
TIGARD, OR 97223 1 ea Backflow Prevention - RES 09/24/2009 $27 55
PHONE: 1 12% State Surcharge - 09/24/2009 $4.35
Plumbing
9 ea Minimum Fee Adjustment - 09/24/2009 $8.70
Contractor: Plumbing
EXPRESS PLUMBING
1420 SE EASTVVOOD
PORTLAND, OR 97222
PHONE: 503 - 380 -6323
FAX:
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp:
Stories:
Total $40.60
Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By: a ` ! 1 Permittee Signature: /
Call 503.639.4175 by 7:00 a.m. for an inspection that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Plumbing Permit Application
RECEDED --- : �; -''' - ' - :. - - � ,
FOR OFFICE USE ONLY
City of Tigard SE P 2 4 ? ! iew permit i 13 125 SW Hall Blvd, Tigard, OR 97223 0
Phone: 503.639.4171 Fax: 503.598. ] 9 Date /By: Other Permit No.:
Inspection Line: 503.639.4175171' OF
T I GARD BUII.DING DIVISION Date Ready/By: Juns See Page 2 for
. Internet: www.tigard- or.gov Notified/Method • 1C' Supplemental Information
-- 1' 11'E , ,,, , WO K ° . .,, : �F. 4 . - - , , � , et FEE *., S , .,
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❑ New construction ❑ Demolition For special information use checklist.
Description Qty. I Ea. j Total
V Add iti on/al ter ati on/rep lacement ❑ Other: New 1 - 2 - family dwellings (includes 100 ft. for each utility connection)
;, \ �s.,t y +',;, »;= �e�..,`;' m;, .,5f'' +:'*i,�*„s °'a}� 1�.: ?'- ,"� +!:�:a.r�2"w� 3fiS5a :;'a. .. "V.�� ^ =�.4�` r`'E °': ^`n.$, u'm'
_, 1 1 w _ >._ 'GATEGOR"' OF @ONSTRICTIDN ' �:,
„:" �: ��` �nK t ��` ���- �� .�- .- .�.,��m�...�-_�,,.�• >:���� .����>�'s����,��:��'_. ' �sg=��w�� SFR(1)bath 249.20
rg 1- and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 350.00
❑ Accessory building ❑ Multi - family SFR (3) bath 399.00
Each additional bath/kitchen 45.00
❑ Master builder ❑ Other:
� , s , 7 ' = - , ;,,,, `. ,w ,,> .°_- r , ..� , •rv. ..,- . .
r:,:° . M Y : s ,
M Fire sprinkler ( sq. ft) Page t
- Zi p, . ii B I
JO SLL$ INFORMA ION V,R P s & E Y Site utilities
i Job site address: I y (V I O � Ccc i I i n a Dr. 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
rn 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
Fixture or item
Tax map /parcel no.:
: :4Pile t ,:,�.: ,wVx•4: ,x�. am..a `" - ' N4t '':,:.;rue.•- '3;WY.. ;:-:',;; , '' •�= .'`;,4,�" 44
Absorption valve 16.60
-; ,gi "SbESCR'iP1T.)bN _. :... •
as xk <� _ xs ::;a.az. _tit) 1VORK , .€ a s £ r Backflow preventer 1 Page 2
PA 40 iC' [(.4A01 k) 'Cs:1r Backwater valve 16.60
1 C r i ci 't �1 inIn . Clothes washer 16.60
` ✓ ' 1 Dishwasher 16.60
r:-: ,., . ,__ ;, .$- t -t ' v. _. s ,=.-. ;00 Drinking fountain 16.60
- w':° ®' rP ,, :44 ,: 21. (A k:.= ER§ <, "' '" - $ _ §-':TI NA m f
.. , r'hi "'r „», s`> x..x:^s :vaa..r ¢ ; . ,,=:; a,?rai ?� ".a `, � ' ..:::r..- ::mu: •. �: r.:, ,Y -',w ,.; :^ ° �w'` ,. ' '--...
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
,..,,,, +s;. -r1.1. , «r, *..;� 1v. -4, s -,:,,. ; -- . a. v.w.w-ila.P=.1,IImp,v,u,r,.aimo - v - 1,rt ° Hose bib 16.60
- -° � „ APPLICANT 4 y. ' `' ® .911 C P NI .,
� ,, .��,,. // e '' :: -fix. 5 t _ ,- s "' „�ha e ��,.:. Ice maker 16.60
Business name: fi `(!MT/s.�1,71e C.$1 L (ti . 11 C Interceptor /grease trap 16.60
9 Contact name: ` C5n.7fl y /(-; m Medical gas (value: $ ) Page 2
`- Address: q4/ !� Ii) � *i � v . Primer 16.60
/0 City /State /ZIP: 9150A ' i OR oi 7a / Roof drain (commercial) 16.60
Phone: (ed3) cP ` � « c P C 9 Fax:: ( ) _ -��-� Sink /basin lavatory 16.60
Tub /shower /shower pan 16.60
E -mail: Urinal 16.60
;; 'r=m . "! :*;-;;iN: x' •_" 3.;:' i •:r° ";k +f.: i ' ` `s�-.;. ,.; -- ,� r .:< =- ; vow
,--�:€;
r.> CONT 4CTOR tP n .t <. .:
�� "� ��. �� ��: ..���3.��.w., r,�h�.:.�xt P ...._ Water closet 16.60
Business name: $ it.'iS' /A ' Lum4 j a Water heater 16.60
•
Address: `Z7-d • 8.6- . st 4000D Gf Other:
City /State /ZIP: Mt D ORe �lraaa Subtotal
Minimum permit fee: $72.50
Phone: (!3 ,69 2 Fax: ( ) Residential backflow minimum permit fee: $36.25) ,3( . 2
CCB Lic.: /2S��6S� Plumbing Lic. no.: 3-",,?6A--e Tjts Plan review (25% of permit fee)
r/' State surcharge (12% of permit fee) y. 3 f5
Authorized signature: ,i p�%1,24 f�. , • 1 ' \x
TOTAL PERMIT FEE 0 , ( p 0
\ Print name: sh O 71 Zki) fib, Date:q._ 4R, _09 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 \Buildmg\Permits\PLM- PermitApp.doc 12/27/06 440- 4616T(10 /02 /COM/WEB)
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
4 -YA t i a,! ` x ., .'!FFe ea ,N " U- tfl1':. ,' �" ........5., ; 't° �,r " me . 'gyp
Y4 S1te iltila _ }.:. �i e :. ; Square Footiage . ' P -1„, e. ti .._
Footing drain - 1 100' 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 , . , ti
Valuati Fee N` 4V5
Storm & Rain Drain - 1st 100' 55.00 ° 0
$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
-• ^, additional $100.00 or fraction thereof to and
F1Xt _,r Yte `' ; Q ee (ea)' N Total 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 $50,000.00.
specially requested inspections - per hour 72.50
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 ou capping, addin or replacing fixtures? If "yes",
=nx -:? ; > . 4¢ v `<
Y adding P g • ar.1an ReYiew for !lamb,M44.sta l a lP,,,I W - ' a,
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.
❑ Any new commercial building with water service 2" and
tFixture.T�ype '.. plac " greater, except systems designed and stamped by licensed
;:41itriii . a , u PPceviousA engineer.
Baptistry/Font
Bath - Tub /Shower ❑ New exterior plumbing site utilities for any complex structure
as defined in OAR918- 780 -0040.
- Jacuzzi/Whirlpool
Car Wash - Each Stall ❑ Medical gas and vacuum systems for health care facilities.
Drive Stall ❑ 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 ..
`tea= (p'k: Af - , g, ' "'.W: �,': , ," ' `n- . 4 w W' n`K - ?: "4
Eye Wash ° " re UTllf'tT1Gz013C'„ S�r�1'd ralTl
Floor Drain /sink - 2" ❑ Isometric or riser diagram is required for.new buildings
that meet the qualifications above.
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 I
•
Urinal .
•
Other Fixtures: •
i.\ Building \Permits\PLM- PermitApp.doc 12/27/06