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Permit CITY OF TIGARD PLUMBING PERMIT 11111 ' COMMUNITY DEVELOPMENT Permit #: PLM2011 -00333 TIGARD 13125 SW Hall Blvd , Tigard OR 97223 503.718 2439 Date Issued: 11/03/2011 Parcel: 25111 BA02200 Jurisdiction: Tigard Site address: 9925 SW VIEW TER Project: BOONE Subdivision: INGEBRAND HEIGHTS Lot: 7 Project Description: 40 ft. of water service. Electrical permit may be required if house grounding is affected Contractor: PIPELINE PLUMBING Owner: BOONE, JOHN D & DONNA M REVOC TR 333 S STATE ST, STE V -108 BY BOONE, JOHN D & DONNA M TRS LAKE OSWEGO, OR 97034 9925 SW VIEW TER TIGARD, OR 97224 PHONE: 503 - 624 -1906 PHONE. FAX: 503 - 624 -1926 FEES Quantity Description Date Amount 1 If Water Service 11/03/2011 $62.54 Specifics: 1 12% State Surcharge - 11/03/2011 $8 70 Plumbing Type of Use: SF 10 ea Minimum Fee Adjustment - 11/03/2011 $9 96 Plumbing 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 Utility Notification Center Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090 You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332 2344. 1 Issued By: Permittee Signature: Call 503.639.4175 by 7:00 a.m. for the next available inspection date. 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. Jun 03 00 11:49p p.1 I Plumbing Permit Application Build' Fixtures , 4s l t )K (ll i 1 <".F _ 15i t)ti = 13125 SW Hall Tigard Tigard OR 972 �. \\ 11 / 7 5,77-- Permit No.: f L f i1 J 1l „(u .n Plan Review Phone: 503.639.4171 Fax: 503.598.1960 _. •. % Qt y: Other PermitNo.. Inspection Liner 503.639.4175 'o' ' e' t1 ' I i, G : \ 1111 �� S) e R Y�Y= ...... See Page 2 for Internet www.tigard- or.gov {� `�� NotiGedlMGbad Supplementallaformation TYPE OF WORK C 3. - 4� �� - FEE* SCHEDULE ❑ New construction ❑ Demo MT For special infomiati m use checklist Description I OW. I Ea Tonal Hrkddition/altcrationireplacement ❑ Other. New 1- 2 - family dwellings (includes 100 It for each utility connection) CATEGORY OF CONSTRUCTION SFR (I) bath 249.20 1d 2- family dwelling 0 Commercial industrial SFR (2) bath 350.00 ❑ Accessory building 0 Multi- family SFR (3) bath 399.00 Each additional bath/kitchen 45.00 ❑ Master builder 0 Other Fire sprinkler ( sq. ft) Page 2 JOB SITE INFORMATION AND LOCATION Site utilities Job site address: C/ el ) 5 .S( V i � 1v.- �_ Catch basin or area drain 16.60 City/State/ZIP: 1-{ c� 0 f ( el --- ay > 0> leach line, or trench drain 16.60 Suite/bidgJapt. no.: Project name: Footing drain (no. linear ft.: -_, Page 2 Cross street/directions to job site: Manufactured home utilities ] 10,00 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 IL: ) ( Page 2 Fixture or item Tax map/parcel no.: Absorption valve 16.60 DESCRIPTION OF WORK _ Barrow preventer Page 2 1 ". -.k. -Q } C"-t- 0 i ,v i .. rL-1 -- ,..10 " - Backwater valve 16.60 T E m fra hill t i.Q 1 -0.0- - Clothes washer 16.60 Dishwasher 16.60 • Drinking fountain 16.60 ❑ PROPER Y OWNER ❑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 ❑ CONTACT PERSON Hose bib 16.60 Ice maker 16.60 1 Business name: r! ) •, 1 '1 . `.- � () (� ?��C Interceptor /grease trap 16.60 Contact name: L. iL A ( ,i,t.. 1---t Medical gas (value: $ ) Page 2 Address: 337 ,. • 4- : , Li . -� , - c 1 ‘ ..t ,C , Primer 16.60 City/State/ZIP: Roof drain (commercial) 16 60 Phone: (f T 3 ) (n •t�` FIC ax:: (� ) (-4 -� Cj - Sink/basitJlavaiory 16.60 Tub/shower /shover pan 16.60 16.60 16.60 E-mail: Urinal CONTRACTOR Water closet usiness name: Water heater 16.60 2 -... :; (3i ' ' Address. Other. City / State/ZIP: Subtotal ^- - Minimum permit fee: $72.50 Phone: ( ) Fax: ( ) Residential bacldlow minimum permit fee: $36.25 CCB Lie.: • - • " , (2, : Plumbing Lie. no.: n) ©I t/ Plan review (25% of permit fee) % Authorized si State surcharge (12%ofpermit fcc) E , _ TOTAL PERMIT FEE 1 I . Print name: / ,..0/1„,, 7(- Date: / ') 3' 2 If This permit application expires if a permit is not obtained within 180 days after it has been accepted as. complete. Jun 03 00 11:50p p.2 • 'ermit Application - City of Tigard L )plemental Information Jule: Residential Fire Suppression Systems: ilities Qty. Fee (ea) Total Square Footage: Permit Fee: rain - l'` 100' 55.00 0 to 2,000 $115.00 , drain - each additional 100' 46.40 2 001 to 3,600 5160.00 3,601 to 7,200 $220.00 r - 1st 100' 55.00 7,201 and greater $309.00 ✓er - each additional 100' 46.40 iater 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 Stone & Rain Drain - each additional 100' 46.40 55,001.00 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. I 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 Backtlow Prevention Device I each additional $100.00 or fraction thereof, to (minimum permit fee $3625) 27.55 and including $25,000.00. Rain Drain, single family dwelling 6525 $25,001.00 to $50,000.00 $37950 for the first $25,000.00 and $1.45 for Inspection of existing plumbing or each additional $100.00 or fraction thereof, to $7 including 00 o t e first $ .00. specially requested inspections - per hour 72.50 550 and up $742.00 for the first $50,000.00 and $120 for Subtotal: 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 Quanti by (Fixture) Work Performed greater, except systems designed and stamped by licensed Fixture Type: Reptece engineer. Previous Capped aimed Karst' iajt ❑ New exterior plumbing site utilities for any complex structure Baptistry/Font as defined in OAR918- 780 -0040. Bath - Tub/Shower 0 Medical gas and vacuum systems for health care facilities. - 7acw2i/Whirlpool ❑ Any multipurpose fire sprinkler system. • Car Wash -Each Stall ❑ Any complex structure as defined in OAR9I8- 780 -0040. - Drive Thru Cuspidor/Water Aspirator Submit 2 sets of plans with any of the above. Dishwasher - Commercial -Domestic Isometric or Riser Diagram Drinking Fountain tagra 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 - lndratrial ice Mach./Refrig. Drains Oil Separator (Gas Station) Rec. Vehicle Dump Station Shower -Gang -Stall - sink -Bar/Lavatory ey *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-