Permit 7 CITY OF TIGARD PLUMBING PERMIT
'° COMMUNITY DEVELOPMENT Permit #: PLM2012 -00001
T1GARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 01/03/2012
Parcel: 1S134DA01902
Jurisdiction: Tigard
Site address: 10775 SW NORTH DAKOTA ST
Project: Wiemer Subdivision: NORTHERN PINE Lot: 6
Project Description: Replace 40' of water line.
Contractor: CASCADE MECHANICAL SYSTEMS INC Owner: WIEMER, TED
PO BOX 399 10775 SW NORTH DAKOTA ST
ESTACADA, OR 97023 TIGARD, OR 97223
P
PHONE: 503 - 968 -7042
PHONE: 503 - 630 -4492
FAX: 503 - 630 -5510
FEES
Quantity Description Date Amount
40 If Water Service 01/03/2012 $62.54
Specifics: 1 12% State Surcharge - 01/03/2012 $8.70
Plumbing
Type of Use SF 10 ea Minimum Fee Adjustment - 01/03/2012 $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 0 C by calling 503.232.1987 or 1.800.332.2344.
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.
Jan, 3. 2012 3:19PM No.6454 P. 1
Plumbing Permit A 1 ,._.
Building Fixtures ' FOR OFFICE USE ONLY
City f Tigard JAN 0 3 2012 Reeeived
II tY g �/d it No-- •
13125 SW Hall Blvd., Tigard, OR 97223 sal 3 � �'�� L °2 --/0 1 O Phone: 503.718.2439 Fax: 503.598.1960 By: glherPermitNo.;
CITY OF TIGA II Date/sy:
r1tl,�l(p inspection Line: 503.639 BUILDING DIU1Sf11 atettea ,rye 1 13 see Page 2for
Internet: w wv.tigard- or.gov otiGe&Method: &i Supptemeatal Information
.' ., n ' rY YP `r . rrt 4. 4 ' X G x ,SX��'' � / . 'f�,t5iy�, �.r
��, .R•.� T ' �;7�,.r3;r, �3� >'.. R � �� �,.' r . i�:k ,.:t' ?r -�i „�N ,7�.�.'1�'��•2
❑ New construction ❑ Demolition For speciallnfornrnllarr use checklist.
Description I Qty. I Ea. I Total
12r Additionfalteration /replacement ❑ Other: New 1- 2- farnlly dwellings (includes 100 R. for each utility connection)
:, O#110p t Y• 7,i iP tri ∎ ::$5 a�. x ,. .tY,,, SFR (1) bath 31230
eri- 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: -
:•,� ', .kr _,,c..,,x :,.;, ., .�w .yY.. ° x �, Fire sprinkler( sq. ft.) Paget
; .. Jt7B.; SST, , i1YFO Rk 1�T X 91: 1 D� K„� , + r I : ,; site utilillest
� 1 t C J
Job site address: l !! n Ur Catch basin or area drain 18.76
't ~ Drywall, leach line, or trench drain 18.76
City/State/ZIP: i t c a OR (31 F dra r
ootmg in (no. knee R._ ) Page 2
Suite/bldg./apt. no.: l 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.: T.) Page 2 • 'Water service (no, linear (I,: Page 2 4j4., 5
Subdivision: I Lot no.: Fixture or Item:
Tax map /parcel no.: Backflow preventer 31.27
: r . >; �, Backwater valve 12.51
5' , .;' DESCRIPTI� a����` c°� °3�' ';�? ac � - ---
-
r � � Clothes washer 25.02
• $ I A& . 1 A Dishwasher 25.02
Drinking fountain 25,07
,y D�jectors/surnp 25.02
. PROPI;RTY-•O CZ .. .(� }:i,,,{ I:�>S^y ny' O $" ' 1 x V Expansion tank 12.51
Fixture /sewer cap 25.02
Name;
'� 1 . a - - �� Floor drain/floor sinldhub 25.02
Address: 0 ' •: a� M'
Garbage disposal 25.02
City /State/ZIP: 1 a� ` Cot T2-2-3. Hose bib i 2
Phone: ( - . ax: ( ) Ice maker 12,51
040,X; P ANT '; g :.: r:..., Interceptor/grease trap 25.02
Business name: Medical gas (value; S ) Page 2
Primer 12.51
Contact name:
Roof drain (commercial) 12.51
Address: Sink/basin/lavatory 25.02
City /State /ZIP: Solar units (potable wafer) 62.54
Phone: ( ) Fox:: ( ) Tub /shower /shower an 12.51
mail: Urinal _ 25.02
COIV TRACTOR ; .. Water closet 25.02
''`;' Water heater 37.52
Business name: ° c 1. k.-. r . Water piping/DWV 56.29
Address: ( 1? _ 269 Other: 25.02
City/State/ZIP: F .5 , A 9702 - 3 Subtotal
r Minimum permit fee: $72.50 7z
dons; ( # _ Z Fax: °( --� /(�
4' CCB Y ie.: 17t0 I ./ / 1.,"0 Plumbing Lic. no.: 2 '• 3 2.4 pa, Plan review (25% of permit fee) __ '
State surcharge (12% of permit fee) § 7
Authorized signature: � TOTAL PERMIT FEE 1 pg.
Print rlanle: CI t7(n,1b Date: / 13 l,. This permit application expires IC a permh Is not obtained within 180 a
I otter it has been accepted ns complete.
'Fee methodology set by Tri•Counly Building Industry Service Board.
CP4 420 I:1Builei U'ermitAPLUIU- PermiLApp.doc 10'01/09 440 -46 t6T(10;021COMM'Ln)
Jan. 3. 2012 3:19PM No. 6454 P. 2
Plumbing_Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: on
esidential Fire Suppression S tems:
Sl to rflll l s 2: '` ee (ea) • Total 1' � i otage: P ,:':.,;z e .: , •
Fooling drain - l 100' 50.03 0 to 2,000 512190
Fooling 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 S stems:
Water Service - each additional 100' 37.52 r .+ •c>c
X
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
....., �•'�"';•.f 4146 , ' lrse ";' S =' . . a t
each additional $100.00 or fraction thereof, to
,li�,±�r!FFYp. T S NI e
end including $10,000.00.
Inspection of existing plumbing or for $10,001,00 to $25,000.00 $ I48,50 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 hereof, to
(minimum charge -1/2 hour) and including $25,000.00.
Inspections outside of normal business 90.00/1u $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
Reinspection Fees 90.00/hr and including $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*.
Ouan(It by Fixture Type : t ' u . • flan ° - Xe''fQir'i��4jIlliaPf<1`<kti
1rlit k P for R`p1a°d Plan review is required for an of the following.
Performed: Copped Added Relocate check all that apply.
y g
Baptistry/Font
Bath Tub /Shower — ❑ My new commercial building with water service 2" and
Jacuzzi/Whirlpool greater, except systems designed and stamped by licensed
Car Wash -Each Stall engineer.
- Drive rhru ❑ New exterior plumbing site utilities for any complex structure
Cus ipdor/WaterAspirator as defined in OAR91S-780.0040-
Dishwasher - Commercial ❑ Medical gas and vacuum systems for health care facilities.
- Domestic ❑ My multipurpose fire sprinkler system.
Drinking Fountain ❑ Any complex structure as defined in OAR918- 780 -0040.
Wash ! -
Floor Drain/sink - 2" Submit 2 sets of plans with any of the above,
- 3"
Car Wash Drain ...:, ;'�SOII lC Or R19e , i; I'ayTl ...: ... .
Garbage - Domesti -non -food El Isometric or riser diagram is required for new buildings
Disposal - Domestic - food related that meet the qualifications above.
- Commercial -food related
- Industrial -food related
Ice MachiRefrig, Drains
Oil Separator (Gas Station) Comments regarding fixture work:
Rec. Vehicle Dump Station —
Shower -Gang ,
-Stall ,
Sink/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 p
Water Extractor increase of sewer FDIls, 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:
C:1 UsersUULIE \Documents\Forms\PLM1- PermitApp.doc 2