Permit r
ill
-^ CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT PERMIT #: PLM2008 -00222
- TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 5/16/2008
PARCEL: 2 S 103AC -01300
SITE ADDRESS: 11245 SW FONNER ST ZONING: R -4.5
SUBDIVISION: LOT: JURISDICTION: TIG
PROJECT: OAK
Project Description: Connecting existing house to sewer. Septic tank to be pumped and filled.
CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: R3 FLOOR DRAINS; TRAPS:
STORIES: WATER HEATERS: CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES:
TUB /SHOWERS: SEWER LINE: 80 ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Owner:
FEES
RICK OAK
11245 SW FONNER ST Description Date Amount
TIGARD, OR 97223 [PLUMB] Permit Fee 5/16/2008 $72.50
[TAX] 12% State Surch 5/16/2008 $8.70
Phone : 503- 887 -1252 Total $81.20
Contractor:
OWNER
REQUIRED ITEMS AND REPORTS
Contact # : PRI
Reg #:
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable laws 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 than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 0001 -0010 through OAR 952 - 0001 -0100. You may obtain copies of
these rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By. /� ij� t / � Permittee Signature: ki _ p ,) !,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.
Plufnbila.g Permit Application .. I, �-- cJuo 79
Building Fixtures OCtINIBID FOR" OFFICE' USE, ONLY
City of Tigard Received Q Pennit No
il
a 13125 SW Hall Blvd , Tigard, OR 97223 �oOp 6 Date/By ` , �"- �`(� , _
P lan Review
Phone 503 639.4171 Fax 503 598 1%N( x Date/By. Other Permit No 0 i / _ -
T1 GA R D Inspection Line 503 639 4175 ,�IGP w ' Date Ready /By Juns ®See Pa 2 for
Internet www.tigard -or gov ` te
1r 0 D V ■ 1. ,. 0 i� Notified/Method Supplemental Information
:: -.TYPE.OF'WO 13SIN ", V . _ e ,. •FEE *`SCHEDULE -,
❑ New construction Demolition For special information use checklist.
Description Qty. I Ea I Total
[ ddition/alteration /replacement El Other: New 1- 2- family dwellings (includes 100 ft for each utility connection)
i ' ' CATEGORY OF CONSTRUCTION', SFR (I) bath 249 20
X l- and 2- family dwelling El Commercial /industrial SFR (2) bath 350.00
Accessory building ❑ Multi- family SFR (3) bath 399.00
Each additional bath/kitchen 45 00
❑ Master builder El Other:
Fire sprinkler ( sq ft) Page 2
- J911 SITE INFORMATION "AND' LOCATION' ` t Site utilities
Job site address: l 1.9.45 (J FZIY1 h C r Catch basin or area drain 16 60
City /State /ZIP: —7
/ i a t ,-4 O k 1 •-7 Z 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 /r .2, Page 2
of
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
' mo t\ \ - 6 ;- ' I
N -9::, - DESCRH'TION OF WORK , ', 4 `'" Backflow preventer Page 2
TIo r i rtc u_ c n i n P cc/ bc4A Zoa 4.7 4— Backwater valve 16 60
ill vi k; f-di eel — spC.M., 'f�"6C 44 A. .„ 1 „.. ) , lothes washer 16 60
C e inwi G Z� Dishwasher 1660
. , ,. Drinking fountain 16 60
❑ " PROPERTY OWNER ,'. ;, • 0 TENANT
R � k_
Ejectors/sump 16 60
Name: Expansion ansion tank 16 60
Address: r' ` G Fixture /sewer cap 16 60
City /State /ZIP: Floor drain /floor sink/hub 16 60
Phone: 603) I P R7 / 5,.. Fax: ( ) Garbage disposal 16.60
m,• - - Hose bib 16 60
e "APPLICANT: ° F .. r ❑ i CONTACT' PERSON - -
' - v " ''_ 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
- ' f• ' Water closet 16 60
Business name: ® VE: Water heater 16 60
Address: Other
City /State /ZIP: Subtotal
Minimum permit fee. $72 50
Phone: ( ) Fax: ( ) Residential backflow minimum permit fee. $36 25 7 ) , 0
CCB Lic.: Plumbing Lic. no.: Plan review (25% of permit fee)
State surcharge (12% of permit fee) 0 • 7d
Authorized signature o GO
TOTAL PERMIT FEE s/ ab
i
Print name: pvck, • , Date: 5 , ^Q 52 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 \Building\Permns\PLMF- PermitApp doe 12/27/06 440- 46I6T(10 /02 /COM/WEB)
S 60.'
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Situ Utilities ty• Q Fee (ea) Total . Square Footage: " Permit Fee:: •
Footing drain - 1s 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 &Ram Drain - 1st 100' 55 00 Valuation:" , ," Permit Fee:
$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
Q Fee (ea) Total - additional $100.00 or fraction thereof, to and
Fixtill'e or. Item, 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: _. ' 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 - °Isiimetric.ol' Riser Diagram •
Eye Wash ❑ Isometric or riser diagram is required for new buildings
Floor Drain/sink - 2" 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
Urinal
Other Fixtures
\Buildmg\Permits\PLM- PermitApp doc 12/27/06