Permit CITY OF TIGARD PLUMBING PERMIT
71 = COMMUNITY DEVELOPMENT Permit #: PLM2009 -00210
13125 SW Hall Blvd., Ti OR 97223 503.639.4171 Date Issued: 08/03/2009
1 i ILIA Parcel: 2S111AB01201
Jurisdiction: Tigard
Site address: 9225 SW ELROSE CT
Subdivision: Lot: 0
Project: Andrade
Project Description: Connect existing house to sewer service. Septic tank is to be pumped and filled. Reimbursement
District #36 fee paid.
Owner: FEES
ANDRADE, JORGE SR & Quantity Description Date Amount
ANDRADE, BALDEMAR, 9225 SW ELROSE CT
TIGARD, OR 97224 100 If Sewer Service 08/03/2009 $55.00
PHONE: 1 12% State Surcharge - 08/03/2009 $8.70
Plumbing
18 ea Minimum Fee Adjustment - 08/03/2009 $17.50
Contractor: Plumbing
A AFFORDABLE SEPTIC SERVICE
PO BOX 1130
WILSONVILLE, OR 97070
PHONE: 503 - 969 -9548
FAX: 503- 570 -0779
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp:
Stories:
Total $81.20
Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utilit . • enter. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain a copy of the rules
o :irect questions to • A 1 C by ..fling 503.246.6699 or 1.800.332.2344.
.sued By: • /i, , 1 Permittee Signature:
Call 503.639.4175 by 7:00 a.m. for an inspection that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
- Plumbing Permit Application
���D FOR OFFICE USE ONLY
of Tigard
R eceived � D q '„Jn
( //
14 Permit No.: / Gt /OYJ OP'
4 13125 SW Hall Blvd., Tigard, OR
vC ��9 Date/By: \� Date/By: � 7/ Plan Review !� _ n 4/
Phone: 503 639.4171 Fax. 503.598.19 1 _ Other Permit NcbOJG
Date
Inspection Line: 503.639.4175 p.
TIGARD Internet: www.tigard or.gov p ,A1 _ � A, ed /M et hod. y: Jy S CO
See Page 2 for
or sAvv Notified/Method. ! i f , Supplemental In
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' -� �� -'�. :�. ��TXPE OFre'4VQRK�' � °� FREE* SCHEDULES - � V ''' ,
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❑ New construction ❑ demolition For special information use checklist
Description Qty. I Ea. I Total
❑ Addition/alteration/replacement ❑ Other: New 1 - 2 - family dwellings (includes 100 ft. for each utility connection)
�- � La afteOR$ OF C N . CT wr W ..7 FA ' ;� SFR (1) ba th 249.20
Y 0 STAR = Y® SF
., v..KS, ,h...' �� - e`-_T .,�, ..�5a-st�xs.:-,-- s&T,a -, xa..,,f'w.�en'.;�•x >,is.`-�',. _.. fY :§ . , a �.�.:c' .�, b ..., 3i
❑ 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:
; »,J =:..:. ::.'_-..: F "..wr, :y:._ ::„ . m_..:N:; ,.: •, ..r.,- ., „r -, <; _> Fire sprinkler ( sq. ft.) Page 2
, .
; ",,, , ; :J O11 SITE I NORI V IA Y ., P1 AJ ) b LtOCA "ION � k ' Site utilities
Job site address: ( 1, 2 2 5� 2 E i r-z:2 _ Q. , Catch basin or area drain 16.60
City /State /ZIP: Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: Project name: ,n nd r a Cam- 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.: gg2D i Page 2 ✓S.00
• Storm sewer (no. linear ft.: ) Page 2
Subdivision: Lot no.: Water service (no. linear ft.: ) Page 2
Fixture or item
Tax map /parcel no.:
valve
..z� .�., ~�=i1 : `s � �, a s 'sr =:= ��.stts��,ar�mrxa:e.�. �; ,, �. �. .. �� � Absorption 16 0
.,, f,; ? va, for , tie g � , D1'SCRiPTTdN OF" WO�tK tg a ew , � r� Backflow preventer Page 2
C _ _rte r‘.12 � A-� ` �Q_ - Backwater valve 16.60
l -� ' ` ` Clothes washer 16.60
Dishwasher 16.60
ry •. .Wia r ^:.:::;>a, �;_�.;,l ° .. =rt< i aZ. N »x Drinking fountain 16.60
: #. ®%rPRORE1u;k44OWIVER ;°r.=• ; : ; i i irO:s oS4,7, :`TEI p fr ; + AQ4, '__:
�i�' i�.:`' ���°. sza». �Y�: kxi' �' ?w+ zs,% �4rsr+ ::.: w*c:u:h :- �.,.'a��::,..,.; a�.."� ^..�:*�;�� ' ��aro •wa�r.'..%'�1�,'_ >.'w.��-:". ^' = Nk '.s ..
Ejectors /sump 16.60
Name: ��r�¢ d� Expansion tank 16.60
Address: Fixture /sewer cap 16.60
City /State /ZIP: jAPC Floordrain /floorsink/hub 16.60
Phone: A. --1 ( Fax: ( ) Garbage disposal 16.60
W.; f:W'Ni:43GtiiV z >;;r _�:r.*�.�.. ;�. a ��- " "�.�..k�,- ;�s >�:- .s� . .�,,r�.�:,,, . � �<��m. Hose bib 16.60
,,. 1 1 C T .ii . '' i ` 7 .::: ®CO NN A CT ' ;PE RS ON . ,o
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
a" ; � . � * . t, -...,N A , v , � RAA OR _.A ;:L:, -; <. . :. „k. _; W ater closet 16.60
Business name: 4 - �4A - FD,2 /)A/� /et s f.p�r - vices Water heater 16.60
Address: / f/30 Other:
City /State /ZIP: 4 , 2, tS0, 9, 74 l �, 9 e2 70 Subtotal cc) d/ Minimum permit fee: $72.50 - A
Phone: (5-40) 6 82 _ / 729 Fax: (5223 ) 5 - 1 5) - ?7 ? Residential backflow minimum permit fee: $36.25 '
2 y,
CCB Lic.: Plumbin Lic no Plan review (25% of permit fee)
State surcharge (12% of permit fee) S. 70
/Authorized signatu =:: TOTAL PERMIT FEE �1 20
Print name: X je.6'1/9 S Date y j� 9 This permit application expires if a permit is not obtaine - within
180 days after it has been accepted as complete.
*Fee methodology set by Tri- County Building Industry Service Board
I Building \Permits\PLM- PermaApp.doc 12/27/06 440-461 6T( I 0 /02 /COM /WEB)
Plumbing Permit Application - City of Tigard
Page 2,- Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
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.. , Pit Q f = Fe ( , TUt81: a t a
Site iTt><1><t><es _ Square Footage x " ermx Fee :',;t!
gin
n__ .v.��w...., w. � .�, ��_�.�.�,��<�_,._. _�,��:�:�; ..- ,. ._
.a,,. _. _ ;.:3k
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' 46.4. > r. s M
46.40 ., _ a;� ��; �
5 Valuation; r a
Storm & Rain Drain - 1st 100' 55.00° c.
$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
� �= r ` tu:re,_O ` °. Fe ea additional $100.00 or fraction thereof, to and
<F>1r ItxClll r � ...... ' z.. Q :� ......t
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",
,
Y adding P g >,., PlW:ncMWSAoT RIRM,, <ng Ins alga z ns � >
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.
' i uan;`tft Qtiy (Fi7ftuie `r is erfdrmed" =' y ❑ Any new commercial building with water service 2" and
4fiiititi hype sp -^d. °'- ..- a t � `� �Reptac i greater, except systems designed and stamped by licensed
„
t„, a lttiti Pce'vious ' -t3appeI �Adt�ed a „,.'Extatii } engineer.
Baptistry/Font
Bath - Tub /Shower El New exterior plumbing site utilities for any complex structure
as defined in OAR918 780 - 0040.
- Jacuzzi/Whirlpool
Each Stall
C] Medical gas and vacuum systems for health care facilities.
Car Wash
E t o l ❑ 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
Eye Wash 'ISOmetrlcOrRiserD °I'atm`r
Floor Drain /sink - 2" ❑ Isometric or riser diagram is required for new buildings
that meet the qualifications above.
-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 *Note: If the fixture work under this permit results in an
- Bradley
- 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 \Bu6ding\Permits\PLM- PermitApp doc 12/27/06
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