Permit - r
CITY OF TIGARD PLUMBING PERMIT
DEVELOPMENT SERVICES PERMIT #: PLM2006 -00473
• DATE ISSUED: 10/12/2006
13125 SW Hall Blvd., Tigard, OR 97223 503 -639 -4171
PARCEL: 25111 BA -12200
SITE ADDRESS: 09641 SW MOUNTAIN VIEW LN ZONING: R
SUBDIVISION: TEMPLETON HEIGHTS LOT: 002 JURISDICTION: TIG
Project Description: Backflow preventer for irrigation.
CLASS OF WORK: OTR GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS: 1
OCCUPANCY GRP: R3 FLOOR DRAINS; TRAPS:
STORIES: WATER HEATERS: CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES:
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Owner: FEES
MASTERPIECE CONSTRUCTION INC
13849 SW MISTLETOE DR Description Date Amount
TIGARD, OR 97224 [PLUMB] Permit Fee 10/12/200E $36.25
[TAX] 8% State Surcha 10/12/200E $2.90
Phone : 503- 750 -5549 Total $39.15
Contractor:
FOWLER PLUMBING INC
3254 BARNETT ST
FOREST GROVE, OR 97116 REQUIRED ITEMS AND REPORTS
Contact # : PRI 503- 998 -3623
Reg #: LIC 161855
PLM 34 -444PB
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable laws. 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 than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 0001 -0010 through OAR 952 - 0001 -0100. You may obtain copies of
these rules or direct questions to OUNC by calling 503 - 246 -6699 or 1- 800 - 332 -2344.
Issued By: L%2�l(�l Permittee Signature: .%Q
,
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 projec .
Approved plans are required on the job site at the time of each inspection.
Plumbing Permit Application
\' Building Fixtures t' - -F� - ) 8�C'7, lOR OFFICE L'S[: ONLY
ved
City of Tigard Recei
IN >r�e oil* Permit No.11 7/J)b ., 3
n 13125 SW Hall Blvd., Tigard�'bi 971223~; 2 ) 0 6 Plan Review '•• JJ
U Phone: 503.639.4171 Fax: 503.598.1960 D Other Permit No.:
r I G n It 17 Inspection Line: 503.639.41q ' y'v° c ; `r , A�:) Dale ReadyBy. J u r i s t - T . See Page 2 for
Internet: www.tigard or.ger,;: ,„ :.6/2 D vici m 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 249.20
land 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
0 Fire sprinkler ( sq. ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities
Job site address: G L// S (/ t 14/140144, h2 y(f Catch basin or area drain 16.60
City / State/ZIP: -v Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: I Project name: Footing drain (no. linear ft: ) Page 2
Manufactured home utilities 110.00
Cross street/directions to job site: Manholes 16.60
- 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.: ) Page 2
Fixture or item
Tax map /parcel no.:
Absorption valve 16.60
DESCRIPTION OF WORK Back flow preventer Page 2
Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
❑ PROPERTY OWNER I ❑ TENANT Drinking fountain 16.60
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
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: ( ) I Fax: : ( ) Sink/basin/lavatory 16.60
Tub /shower/shower pan 16.60
E-mail Urinal 16.60
1 CONTRACTOR Water closet 16.60
•
Business name: �• " j( 6 7� ' "` V i1. b i 1,4k Water heater 16.60
Address: 3 614, c Other:
City / State/ZIP: I - V �C iT Tr--(1(-A, d g- I • Subtotal .
Minimum permit fee: $72.50 a i
• Phone: �) Ti g- ,. ? 3 Fax: ( ) Residential backflow minimum permit fee: $36.25 ✓FJ , p t5
613)
CCB Lic.: /i ( ) (ir Plumbing Lic. no.: qq L i 14 f 6 Plan review (25% of permit fee)
State surcharge (8% of permit fee) 47, 0
Authorized signature: `
TOTAL PERMIT FEE 3. 5
iii
Print nam 1 • W ' 4 I Datc: j(}1`L_I. 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.
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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' 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
Valuation: Permit Fee:
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
Q ty. Fee (ea) Total additional $100.00 or fraction thereof; to and
Fixture or Item 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
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
Quantity by (Fixture) Work Performed greater, except systems designed and stamped by licensed
Fixture Type: Replace engineer.
Previous Capped Added Existing ❑ 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 Submit 2 sets of plans with any of the above.
Cuspidor/Water Aspirator
Dishwasher - Commercial Isometric or Riser Ri Diagram
- Domestic g
• Drinking Fountain ❑ Isometric or riser diagram is required for new buildings
Eye Wash that meet the qualifications above.
Floor Drain /sink - 2"
-3"
- 4"
Car Wash Drain Comments regarding fixture work:
Garbage - Domestic
• Disposal -Commercial
- Industrial
Ice Mach./Refrig. Drains
Oil Separator (Gas Station)
Rec. Vehicle Dump Station
Shower -Gang
-Stall
• Sink - Bar/Lavatory *Note: If the fixture work under this permit results in an
- Bradley increase of sewer EDUs, a sewer permit will be issued and
- Commercial fees assessed for the sewer increase must be paid before the
- Service plumbing permit can be issued.
Swimming Pool Filter
Washer - Clothes
Water Extractor
• Water Closet - Toilet
Urinal
Other Fixtures:
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