Permit CITY OF TIGARD PLUMBING PERMIT
': '' COMMUNITY DEVELOPMENT Permit #: PLM2011 -00335
TIGARD 13125 SW Hall Blvd , Tigard OR 97223 503 718 2439 Date Issued: 11/04/2011
Parcel: 2S 112 BD09200
Jurisdiction: Tigard
Site address: 14726 SW 78TH AVE
Project: Brittany Meadows, Lot 28 Subdivision: Lot:
Project Description: Installation of residential backflow preventer for irrigaton
Contractor: GREAT SCAPES INC Owner: HERONWOOD PROPERTIES
12473 SE CENTRAL PARK CT BY MORRIS R WESTLUND
PORTLAND, OR 97086 16615 MAPLE CIR
LAKE OSWEGO, OR 97034
PHONE: 503 - 784 -3869 PHONE
FAX:
FEES
Quantity Description Date Amount
1 ea Backflow Preventer 11/04/2011 $31.27
Specifics: 1 12% State Surcharge - 11/04/2011 $8 70
Plumbing
41 ea Minimum Fee Adjustment - 11/04/2011 $41.23
Type of Use: SF Plumbing
Class of Work: OTR
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 Notific. • • 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 direc •uestions to 'UNC ailing 503.232.1987 or 1.800.332.2344. //;
Issue. By: if „ ,/ G ��QQf/, ' r � '
� /� /���fff��� ---fff Permittee Signatur r� a
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.
Plumbing Permit Application
Building Fixtures FOR. OFFICE USE ONLY
City of Tigard Received I � ?
1 111 1 �� 13 125 SW Hal Blvd., Tigazd,OR 97223 Date/By a �� ( Permit No. • , �ll W336
Plan Review
Phone 503 718 2439 Fax: 503.598.1960 DateBy: Other Permit No. •
:T16 AR D Inspection Line 503 639.4175 Date Ready/By Ions I H See Page 2 for
Internet. www.tigard- or.gov Notified/Method. Supplemental Information
TYPE OF WORK FEE* SCHEDULE
New construction ❑ Demolition For special information use checklist.
Description I Qty I Ea I Total
❑ Addition/alteration/replacement ❑ Other: New 1 - 2 - family dwellings (includes 100 ft for each utility connection)
CATEGORY OF CONSTRUCTION SFR (1) bath 312.70
1- and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 437.78
SFR (3) bath 500.32
❑ Accessory building ❑ Multi - family
Each additional bath/kitchen 25 02
❑ Master builder ❑ Other: Fire sprinkler ( sq. ft) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: t 4 (<J 9 J 1 ( Catch basin or area drain 18 76
/
Vff Drywell, leach line, or trench drain 18.76
City /State /ZIP: G
t Footing drain (no linear ft • ) Page 2
Suite/bldg. /apt. no.: 1 Project name: Manufactured home utilities 50.03
Cross street/directions to job site: • Manholes 18 76
Rain drain connector 18.76
Sanitary sewer (no. linear ft ) Page 2
Storm sewer (no. linear ft . ) Page 2
r Water service (no linear If • ) Page 2
Subdivision: W,G'( Y J'1flv� Lot no.: , " � Fixture or item:
Tax map /parcel no.: l Backflow preventer ✓ e 31.27
DESCRIPTION OF WORK Backwater valve 91 12 51
�j� Clothes washer 25 02
'3�LIA- w c ' �' Dishwasher 25.02
Drinking fountain 25 02
Ejectors /sump 25 02
❑ PROPERTY OWNER I ❑ TENANT Expansion tank 12 51
Name: Fixture /sewer cap 25 02
Floor drain/floor sink/hub 25.02
Address:
Garbage disposal 25.02
City /State /ZIP: Hose bib 25.02
Phone: ( ) Fax: ( ) Ice maker 12.51
❑ APPLICANT ❑ CONTACT PERSON Interceptor /grease trap 25.02
Business name:
Medical gas (valu• $ ) Page 2
Primer 12.51
Contact name:
Roof drain (commercial) 12.51
Address: Sink/basin/lavatory 25.02
City /State /ZIP: Solar units (potable water) 62.54
Phone: ( ) Fax: : ( ) Tub /shower /shower pan 12.51
E -mail: Urinal 25 02
CONTRACTOR Water closet 25.02
n A � Water heater 37 52
Business name: G E K l LACW S Water piping/DWV 56 29
Address: v 17 w C 7\I 4 - 1. 124.46. �i. Other: 25 02
City /State /ZIP: V / b
c ' Y, Subtotal
Phone: (5- 7 O— la Fax: (Gl(,9 /01 - D 0 G O l Minimum permit fee: $72.50 7:L
CCB Lic.: Plan review (25% of permit fee)
' �Z� 1 Plum bing Lic. no.: State surcharge (12% of permit fee)
Authorized signature: l� TOTAL PERMIT FEE & . °i'
Print name: /1(, ' �+ Date: a 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
I \BuddmgWermits\PLMU- PermitApp doc 10/01/09 440- 4616T(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' 50 03 0 to 2,000 $121 90
Footing drain - each additional 100' 37.52 2,001 to 3,600 $169 69
3,601 to 7,200 $233 20
Sewer - 1st 100' 62 54 7,201 and greater $327 54
Sewer - each additional 100' 37.52
Water Service - 1st 100' 62 54 Medical Gas Systems:
Water Service - each additional 100' 37 52
Valuation: Permit Fee:
Storm & Rain Drain - 1st 100' 62 54 $1 00 to $5,000 00 Minimum fee $72.50
Storm & Rain Drain - each additional 100' 37.52 $5,001 00 to $10,000.00 $72 50 for the first $5,000 00 and $1 52 for
Q ty. Fee (ea) Total each additional $100 00 or fraction thereof, to
Other Inspections or Fees and including $10,000 00.
Inspection of existing plumbing or for $10,001 00 to $25,000.00 $148.50 for the first $10,000.00 and $1 54 for
which no fee is specifically indicated 90.00/hr each additional $100 00 or fraction thereof, to
(minimum charge — 1/2 hour) and including $25,000 00
inspections outside of normal business 90 00/hr $25,001.00 to $50,000 00 $379'.50 for the first $25,000 00 and $1 45 for
hours (minimum charge — 2 hours) each additional $100 00 or fraction thereof, to
Remspection Fees 90.00/hr and mcludin• $50,000.00.
Additional plan review for revisions 90.00/hr $50,001 00 and up $742 00 for the first $50,000.00 and $1.20 for
(minimum charge — 1/2 hour) each additional $100.00 or fraction thereof
Subtotal:
Commercial Fixture Work:
Are you capping, adding or replacing fixtures? If "yes ",
please indicate work performed by fixture. Failure to
accurately report fixtures could result in increased sewer fees * .
Quantity by Fixture Type Plan Review for Plumbing Installations
Fixture Type for Replace/ Plan review is required for any of the following. Performed: Capped Added Relocate 9 y g'
Baptistry/Font Please check all that apply.
Bath - Tub /Shower ❑ Any new commercial building with water service 2" and
- Jacuzzi/Whirlpool greater, except systems designed and stamped by licensed
Car Wash -Each Stall engineer.
-Drive Thru ❑ New exterior plumbing site utilities for any complex structure
Cuspidor /Water Aspirator as defined in OAR918- 780 -0040.
Dishwasher - Commercial ❑ Medical gas and vacuum systems for health care facilities.
- Domestic ❑ Any multipurpose fire sprinkler system.
Drinking Fountain ❑ Any complex structure as defined in OAR918- 780 -0040.
Eye Wash
Floor Drain /sink - 2" Submit 2 sets of plans with any of the above.
-3"
4 Isometric or Riser Diagram
Car Wash Dram ❑ Isometric or riser diagram is required for new buildings - Domestic - non - food
s
g q g
Disposal - Domestic - food related that meet the qualifications above.
- Commercial —food related
- Industrial -food related
ice Mach /Refrig Drains
Oil Separator (Gas Station) Comments regarding fixture work:
Rec Vehicle Dump Station
Shower -Gang
-Stall
Smk/Lav - Non -food related
- Bradley
- Commercial -food related
- Service
Swimming Pool Filter *Note: If the fixture work under this permit results in an
Washer - Clothes
Water Extractor increase of sewer EDUs, a sewer permit will be issued and
Water Closet - Toilet fees assessed for the sewer increase must be paid before the
Urinal . plumbing permit can be issued.
Other Fixtures
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