Permit t _ q
CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit #: PLM2009-00150
1 3125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 06/15/2009
'TIGARD Parcel: 1S135CA00600
Jurisdiction:
Site address: 11200 SW GREENBURG RD OFC
Subdivision: Lot: 0
Project: Autumn Oaks Apartments
Project Description: Install plumbing for new pool house, (1) 3" floor sink, (1) 2" floor drain and (1) shower head.
Owner: FEES
AUTUMN OAKS PROPERTIES LLC Quantity Description Date Amount
6036 SW MADISON CT
PORTLAND, OR 97221 2 ea Floor Drain /Floor Sink/Hub 06/15/2009 $33.20
1 ea Tub /Shower /Shower Pan 06/15/2009 $16.60
PHONE. 1 12% State Surcharge - 06/15/2009 $12.58
Plumbing
Contractor: 10 If Water Service 06/15/2009 $55.00
SHANNON CONTRACTING LLC
2065 NW MILLER RD #415
PORTLAND, OR 97229
PHONE: 503 - 913 -1339
FAX: 503 - 690 -5868
Type of Use: MF
Class of Work: ALT Type of Const:
Occupancy Grp:
Stories:
Total $117.38
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 adopt-.' •y the • e•.
Utility Noti - • enter. Those rules are set forth in OAR 952- 001 -0010 through OAR 952 - 001 -0100. You may obtai a copy
or di - questions to • NC b ing $3.246.6699 or 1.800.332.2344.
I sued By: / , i Permittee Signature: ,%.°4
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
Building Fixtures ,'; FOR OFFICE. SE ONLti: : . -
ill City of Tigard Received / /Cb Permit t / /0 /�
v 13125 S W Hall Blvd., Tigard, OR 97223 Date/By: C i (/ T , �! w( vv "�✓
Plan Review n
.• Phone: 503.639.4171 Fax' 503.598.1960 Other Permit No�i
Date/13y. ■
Inspection Line: 503.639.4175 D ate Read B
. TIGARD Ready /By: �^ Supplemental Information
® See Page 2 for
Internet: www.tigard - or.gov Notified/Method:
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❑ New construction ❑ Demolition For special information use checklist
Description I Qty. I Ea. I Total
❑ Addition /alteration/replacement ❑ Other: New I- 2- family dwellings (includes 100 ft. for each utility connection)
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° V CATEGORY O CONSTRUC ON ` s 4 T M ^'`' SFR 1 bath 249.20
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❑ 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:
Fires sprinkler s ft. Page 2
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Job site address: / %� Catch basin or area drain 16.60
City /State /ZIP: W 3FF:( / N NJ P"�2C: " as \ �T 7 Z/7 Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. nor. Project name: CI
Footing drain (no. linear ft.: ) Page 2
Manufactured home utilities 110.00
Cross street /directions to job site:
Manholes 16.60
/ t. -�
_ %`i t.).„, L c• "- / a , ii.t, Rain drain connector 16.60
Sanitary sewer (no. linear ft.. ) Page 2
Storm sewer (no. linear ft.: ,) Page 2
- Subdivision: I Lot no.:
Water service (no. linear ft.: JD') Page 2 #55. 6
/ 6) L c ^ CO U00 Fixture or item
Tax map /parcel no.: ( [ ,J t�/T l,/ 16.60
• ... <° .; ro- °r, .» N , F ..;. .,. , ;:- ,. Absorption valve
fit: x 4 : ;; ;,: ::.. .r. ,a, + ;r° �,.,:.
,, k:' .,.,: ,,,� ,: t ESCRTP>TXON QF W4oRK , r 1 .,,>
t'�� t?s.v'� �:^��x � ��:,- »rz <.�s��tavm, c:::r , . -. ., o»_ w : ..: .....:. .. a.a a C 0 preventer .n �� ,; ° ,�s� "�rX�: Y��.._� �� , i,: =,�� :. B kfl w pr Page 2
Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
kz. ° - :sue ° caws s � : ,=;- � , ,,,:.., = ..r etas:. , 7., Drinking fountain 16.60
:g PR®ERTrY OV11 Imr� 1sa : g
.� -. � , ., ����� r "�.:k... .,: ;�I�.�.� � ,�. .'�, �'....,,^nTgEN�NT��- .,`s�� ,: .
Ejectors /sump 16.60
Name: ajructi �� I LC ..
t' Expansion tank 16.60
Address: �7 . ^'
��,�(; ---7C,2) �l��;ftJ -� Fixture /sewer cap 16.60
City /State /ZIP: P ( - , O(2C / J Floor drain /floor sink/hub 16 60 35..2-o Phone: (3 ) ` 1 Fax: ( ) Garbage disposal 16.60
tm9: - �;:v.,Mw4,3t ;t.:as - -,'r 'r ».�- :. 1 r > r • r te ,, r ,, , v =-t;:,•o' ?• x: >.';.r:.+ a:.:� Hose bib
®API : LTCAN A . f .. @ONT�CT RERSON� 3 16.60
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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
•
Phone: ( ) Fax:: ( )
Sink/basin /lavatory 16.60
Tub /shower /shower pan l 16.60 /4 .
E -mail:
,r 5
. ':r:•. M'r =''r.; ,:, w. .. Urinal 16.60
�' : "- - iti ; tre .'° ' st w '....my,^, v c -� t,70. .1,, . ,� ° ;y; i
c: ?��.�.� c;.; v ,�; :tl:�°�av���;.C� ® -R- ; °�.t �.aa z.�",.:''i "�1. �„ ��,���.��:= �s;>`` Water closet 16.60
Business name:
'`' C;' Tid`' 1 r
�Lc Water heater 16.60
Address: r r f Other.
City /State /ZIP: PIv/- ( r..-N.1 f Subtotal
ll Minimum permit fee: $72.50 t
/O t go
Phone: ( _C
e�) / )- % ri / ax. ) Residential backflow minimum permit fee: $36.25 (f
CCB Lic.: /"i', L : j�l ` umbing Lic. no,: Plan review (25% of permit fee)
r , � J State surcharge (12% of permit fee) / f•5
Authorized signature: ,-„.,
>✓u 40 TOTAL PERMIT FEE rr 7 3g
Print name: ' Yt/i �411,j; •Vei- Date: / 7 - 6' ' This permit application expires if a permit is not obtained within
180 days after it has been accepted as complete.
*Fee methodologyysetky Tri- Counnty B ding Industry Service Board.
I•\ Building\Perm w
its\PLMF- PermitApp doc 12/27/06 440- 4616T(10 /02 /COMIWEB) Se_. - /12. ' ^ / .d _
.* 1I X 357• �
•
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
.x:a -. -* ::: " .x' . t 1,0"`4 ° sz 're F"
° . _ Ree4 1, T "t,
t �o
��� ..... ....��F
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' 46.40
%rl ":. +. �a : -. t „" tifirk u: xi�s�xtFermi 1 �e . rz j, r" �vav^-.> �.; ,s' >'.',a"..,r�.,.�::'t���^
u" s 4ew* � a';',11z4tela
Storm & Rain Drain - 1st 100' 55.00 $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
: triireo` ' "< 'n? * gv° :`,% =';E ." "" additional $100.00 or fraction thereof to and
F'1X t1re;;01' TiteI11 ::. a = s MtJ . , Wigan G Total
,.� ,. ^..... .. ^ ; a a .. ; + > sr y , ...:.....,x `: >a 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 $50,001 00 and up $742.00 for the first $50,000.00 and $1.20 for
Subtotal: each additional $100.00 or fraction thereof.
Commercial Fixture Work:PtanReie_w fo)rPlibzbg;rstallations '
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
greater, except systems designed and stamped by licensed
., ,' . :::.; r engineer.
=F'nrture Type ;; s �* � � ���.� r � � � Replace�:'.�, g
Fowl r4, ` ., a $ � 111 New exterior plumbing site utilities for any complex structure
�6�� 3q. , .. ����u4. �v5,<. � '>�'s�,r�t°�`��:§;�s�Previous�, � "Cappedn,..,.Addedu;, u
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 , ::. sOiI1CfI'1COITe?DIAgI Ill t%
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:
i. /Buildmg\ Permits\PLM- PermitApp, dac 12/27/06