Permit CITY OF TIGARD
PLUMBING PERMIT
_: COMMUNITY DEVELOPMENT Permit #: PLM2009 -00215
TiGAItD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 09/02/2009
Parcel: 1 S135BC01100
Jurisdiction: Tigard
Site address: 11101 SW GREENBURG RD
Subdivision: Lot: 0
Project: Greenburg Building
Project Description: Replace 300' of existing water service & overhead water service.
Owner: FEES
ROBINSON FAMILY TRUST Quantity Description Date Amount
PO BOX 91305
PORTLAND, OR 97291 300 If Water Service 09/02/2009 $147.80
1 Plan Review 09/02/2009 $36.95
PHONE: 1 12% State Surcharge - 09/02/2009 $17.74
Plumbing
Contractor:
WESTERN PLUMBING
9460 SW TIGARD, AVE STE 101
TIGARD, OR 97223
PHONE: 503 - 639 -5296
FAX: 503 - 684 -9015
Type of Use: COM
Class of Work: ALT Type of Const:
Occupancy Grp:
Stories:
Total $202.49
Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility N. • . . - - -r. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain a copy of the rules
or di •ct questions to OU .y c:l)ng 503.246.6699 or 1.800.332.2344.
Iss.ed 101E% Permittee g tan ure:
Call 503.639.4175 by 7:00 a.m. for an inspection thath - -ss day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Plumbing Permit Applicatini6, FOR OFFICE USE ONLY
n City of Tigard k I A �, DE!iew ? , / Permit No.: 13125 SW Hall Blvd., Tigard, OR 7 P Phone: 503.639.4171 Fax: 503.59$ 1960 Date/By: 1` - 7 ' Other Permit No.:
Inspection Line: 503.639 rrtt U 7 2009
TI GARD Date e Ready /By: ! J ® See Page 2 for
Internet: www.tigard- or.gov 8 pp
yy, Date Read /By: oq Su lemental Information
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❑ New construction ■ Demolitiot�`'IUN For special information use checklist
Description I Qty. I Ea. I Total
VI,Addition/alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
' ATEG.a x cif, O. S,, ..
�,, �;; � � 4� " � ��� <� SFR 1 bath 24
9.20
❑ 1- and 2- family dwelling Commercial /industrial SFR (2) bath 350.00
❑ Accessory building ❑ Multi- family SFR (3) bath 399.00
❑ Master builder Each additional bath/kitchen 45.00
❑ O ther:
e „ h a:a r•,yf,,s Fire sprinkler ( sq. ft.) Page 2
: * ,. OB` a SITE : FQR° _T IO. _ .' l tSC' . , w
i°'
- ° <' � ��. � -�< `1 � �� Site utilities
Job site address: 1 `` 0 l Si r p ,, n 13 ,,, t3 - pi Q)( Catch basin or area drain 16.60
City /State /ZIP: l - dl / (ts9X T Drywell; leach line, or trench drain 16.60
Suite /bldg. /apt. no.: P roje ct ctt name: C Yr tbwrG� b Lp, Footing drain (no. linear ft.: ) Page 2
� Manufactured home utilities 110.00
Cross street/directions to job ste: (J
Manholes 16.60
•
Rain drain connector 16.60
Sanitary sewer (no. linear ft.: ) Page 2
Storm sewer (no. linear ft.: ) Page 2
( Water service (no. linear ft.: ) 2' Page 2 / „
Subdivision: • Lot no.: n
Fixture or item
i Tax map /parcel no.:
gnat ,• r•`: r:�� y ; ,. .y : s = ` *_ tt ,,. , . Absorption valve 16.60
- „„„ „ P1I . ON Olt
.,' U ,,, ' ..:. Z O M
• � - , ,��> ..rr;`: :.�;�r;aa ��s. - z�,axsrs�.rs;,- ,, . -��� ,= ^ <�:.�„ s, a �- . :.��.y
°��?or� •
�' =:`.. - -.: Backflowprev enter Page 2
Backwater valve 16.60
U ' ry i 1 VCaa O5a- Clothes washer 16.60
Dishwasher 16.60
M: " ' =r ,. < , , rR„ ,, r , :•,: = ,, r , , €e. Drinking fountain 16.60
`` r r, ,PIiI)P- RT"Y 01'4!NEI2 , i s ` N T;$EN,APIT -r .
r'�°" -',x �«�-- ,mss..; >m�:...3z �•3vsz, e::.;cxffifi .:�.•- c'4'.:tn;::..," '-w.2..4�'�+''�Mtw' .:et'%iAt°Y`s•..
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 \' •16.60
< -;,.,z. :e =. < <: .Hose bib
5 „_ -.. >, < .5 �� 16.60
:,;. )..A44,1,- n . 3 , LIG 1., ,�... . *, 4 ®;C"fl CTr °EFiRSw _
t 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: (- t .s._ Roof drain (commercial) 16.60
Phone: ( ) • Fax: : ( )
. Sink/basin/lavatory 16.60
Tub /shower /shower, pan = 16.60
E -mail: • ;,
i 1rival 16.60 •
;_: .,.. .,3 r iG DITEAtrTOR .a -.:.: "Y ..,_:.; , • •hl,
�,�w � �,�a�+��A�.� ._ -_ -_ ��- ,. , <s��.,, . . <_ Water closet 16.60
Business name: Western Plumbing, Inc. . . -Water heater 16.60
• Address: 9460 SW Tigard Avenue, Suite 101 , , + Other:
City/State /ZIP: Tigard, Oregon 97223
Subtotal
Minimum permit fee: $72.50
Phone: (503) 639 -5296 Fax: (503) 684 -9015 Residential backflow minimum permit fee: $36.25
CCB Lic.: 2439 Plumbing Lic. no.: 3429PB Plan review (25% of permit fee) � O
State surcharge (12% of permit fee) 1 (j
��
I
Authorized signature -1
sI. L : , .• _ . AR _ � TOTAL PERMIT FEE
Print name: Dana Jensen Date • ^'0 ' (x . 01 - 1 ('i This permit application expires if a permit is not obtained within
P� 1 180 days after it has been accepted as complete.
*Fee methodology set by Tri -County Building Industry Service Board.
I:\ BuildingWermits \PLM- PermitApp.doc 06/26/06 440- 4616T(10 /02/COM/WEB)
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
1 .,r t ,.ee ea i'�Ttiial p ° .
�S �etliti es ,._ Q y ( ., i ..:
� , �srt.S Tr s .^ . Awe' �` ^' .,.», r�e..� ��� �� F'r ..,�..s��+.:a�.�";� %;
Footing drain - 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
a7 u ><n Fne wee .• , W
Storm & Rain Drain - 1st 100' 55.00 " �.w_ <a„ ": °° _
_ $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
Faw e l)2' + m, :'z ,� "" ( ea " otal"' additional $100.00 or fraction thereof, to and
� � � ` %:: °� ` _. . "_� Qty "�' . ..H ,�,,:.
' a ��... .. ..,..,.., � <. a , P ;O;oK ".� ; -�:-c �.. 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: -
"- -a rA a 'reILSr F1'u 'bin
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
�.P A t ; W ii greater, except systems designed and stamped by licensed
� � ?r�� ,� � ;' T Quann` tity:" tiy_ {F P Y
Vie: * ,,. Eliep1i engineer.
., f, n < ' ,Pre "ious =mU,CaRpeda +W tl'ild'e1 :-F $ Ezi I ❑ Any new exterior plumbing site utilities.
Baptistry/Font ❑ Medical gas and vacuum systems for health care facilities.
Bath - Tub /Shower ❑ Any multipurpose fire sprinkler system.
Jacuzzi /Whirlpool ❑ Any complex structure as defined in OAR918- 780 -0040.
Car Wash -Each Stall
-Drive Thru
Cuspidor/Water Aspirator Submit 2 sets of plans with any of the above.
Dishwasher - Commercial
Domestic t j5 t S . 's � > ,.
=' Rise�Di"a ra =m kt , :
`;, rISO1Tletii 'lc»��4.r�.�_- .`..,��r. ��.. �', "�.�..,.,.�.,�..,
Drinking Fountain
Eye Wash ❑ Isometric or riser diagram is required for new buildings
that meet the ualifications above.
Floor Drain /sink - 2" 9
-3"
4 " Comments regarding fixture work:
Car Wash Drain
Garbage - Domestic
Disposal - Commercial
- Industrial •
Ice Mach./Refrig. Drains
Oil Separator (Gas Station)
•
Rec. Vehicle Dump Station
•
Shower -Gang
Stall *Note: If the fixture work under this permit results in an
Sink - Bar/Lavatory increase of sewer EDUs, a sewer permit will be issued and
- Bradley fees assessed for the sewer increase must be paid before the
- Commercial plumbing permit can be issued.
- Service
Swimming Pool Filter •
Washer - Clothes
Water Extractor •
Water Closet - Toilet
Urinal
Other Fixtures:
i.\auildin Permits \PLM- PermitApp.doc 09/22/06