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Permit CITY OF TIGARD PLUMBING PERMIT COMMUNITY DEVELOPMENT Permit #: PLM2009 -00135 Date Issued: 06/02/2009 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503 639 4171 Parcel: 2S114BA14000 Jurisdiction: Tigard Site address: 16250 SW COPPER CREEK DR Subdivision: Lot: 0 Project: Carpenter Project Description: Install tankless water heater. Owner: FEES CARPENTER, CAROL J TRUSTEE Quantity Description Date Amount 16250 SW COPPER CREEK DR 1 ea Water Heater 06/02/2009 $16 60 TIGARD, OR 97224 1 12% State Surcharge - 06/02/2009 $8 70 PHONE Plumbing 56 ea Minimum Fee Adjustment 06/02/2009 $55.90 Contractor: - Plumbing NICHOLS PLUMBING PO BOX 68551, 4375 SE MARK KELLY COURT MILWAUKIE, OR 97268 PHONE 503 -653 -2069 FAX. 503- 513 -6402 Type of Use: SF 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 ork will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, if work is suspended for more the 180 days ATTENTION• Oregon law requires you to follow the rules adopted by the Oregon Utility tification Center. Those'rules .re set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100 You may obtain a copy of the rules Iss ed By: / / � / Permittee Sign.. ��i Call 503.639.4175 by 7:00 a.m. for an inspection that busines 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 Building Fixtures = F,O OFFICE USE ONLY, fi City of Tigard Received / � 9_ I 6 Permit No 9 c f7 y 9 '' ( J � / Q DateDate/By ( e q 13125 SW Hall Blvd , Tigard, OR 97223 Plan Review m Ph one 503 639 4171 F 503 598 1960 Other Permit No I. , Date/By TIGARD Inspection Line 503 639 4175 Date Ready /By 7.6": s ra See Page 2 for Internet www tigard -or gov Notified/Method 1 ig," Supplemental Information TYPE OF WORK FEE* SCHEDULE 111 New construction ❑ Demolition For special information use checklist. Description l Qty Ea Total Addition /alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft for each utility connection) CATEGORY OF CONSTRUCTION SFR (1) bath 249 20 -_J 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: — Fire sprinkler ( sq ft) Page 2 JOB SITE INFORMATION AND LOCATION Site utilities Job site address: - i i 1 '(• Catch basin or area drain 16 60 —.a • _ :'a l�J�i \ City /State /ZIP: \ \ \ 4' k 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: Lot no. • Water service (no linear ft ) Page 2 Fixture or item Tax map /parcel no.: - Absorption valve 16 60 7. D S TION OF Backflow preventer Page 2 ,\\ Z \ c c)c) QQ Backwater valve 16 60 Clothes washer - 16 60 Dishwasher 16 60 Drinking fountain 16 60 PROPERTY O R CI TENANT — Electors /sump 16 60 Name CC::)& ��Q 'r Expansion tank 16 60 Address: �0 `� Fixture /sewer cap 16 60 City /State /ZIP: Floor drain /floor sink/hub 16 60 Phone: ( ) Fax ( ) Garbage disposal 16 60 ❑ APPLICANT CI 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 ( ) I Fax::( ) Tub /shower /shower pan 16 60 E -mail. Urinal 16 60 CONT CT ys Water closet ' s, 16 60 4 Business name: n \ ��\' Water heater � v 16 60 bo Address: `7 2 7 5 fit. YI 1214, \l e,) e-- Other Subtotal City /State /ZIP: ti t tr(,U (} .4.1, � t 02 q a' 7 r0 Auii�� Fax: � y 0 Residential backllow Minimum permit fee $36 50 �� '� Phon• _ 1 , minimum ernut fee $36 25 CCB Lie.: \ J �� Plumbing Lic. no.: /�j 1 Plan review (25% of permit fee) . 44"--- State surcharge (8% of pemul fee) 5'. 70 Authorized signat e: = r 1'(( i !\ ' TOTAL PERMIT FEE n a i , 0 Print name• l e ` \' 5 Date• 0 This permit application expires if a permit is not obtained within l 180 days after it has been accepted as complete. *Fee methodology set by Tri- County Building Industry Service Board. I \Buddoig\l'ennos \PLMF- PenrntApp doc 12/27/06 440- 46167(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' 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 Valuation: Permit Fee: Storm & Rain Drain - 1st 100' 55 00 $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 Fixture or Item Qty. Fee (ea) Total additional $100 00 or fraction thereof, to and 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 Inspection of existing plumbing or each additional $100 00 or fraction thereof, to specially requested inspections - per hour 72 50 and including $50,000 00 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 Fixture Work: Plan Review for Plumbing 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) Work Performed greater, except systems designed and stamped by licensed Fixture Type: Replace engineer. Previous Capped 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 Diagram 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 \i3u idmg\Permns \PI.M- PernutApp doc 12/27/06