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Permit
CITY OF TIGARD BUILDING PERMIT COMMUNITY DEVELOPMENT Permit #: PLM2009 -00046 TI G AR D 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 03/02/2009 Parcel: 2S102CD02802 Jurisdiction: Tigard Site address: 9865 SW OMARA ST Subdivision: Lot: 0 Project: McDonald Project Description: Owner: FEES MCDONALD, TERRY UDIANE L Description Date Amount 9865 SW OMARA Water Heater 03/02/2009 $16.60 TIGARD, OR 97223 12% State Surcharge - Plumbing 03/02/2009 $8.70 PHONE: 503- 639 -3573 Minimum Fee Adjustment - Plumbing 03/02/2009 $55.90 Contractor: PHONE: FAX: Specifics: Type of Use: Class of Work: Dwelling Units: Stories: Height: ft Bedrooms: Bathrooms: Value: $0 Floor Areas: Total Area: Accessory Struct: Basement: Carport: Covered Porch: Deck: Garage: Mezzanine: Total $81.20 Required: Required Items and Reports (Conditions) Fire Sprinkler: Parapet: Fire Alarm: Protected Corridors: Smoke Detectors: Manual Pull Stations: Accessible Parking: 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 throug OAR 952 - 001 -0100. You may obtain a copy of the rules or direct questions to OUNC by calli • • 50 46.6699 or 1.800.3 ' 44. By: \ , I Permittee Signature: Issued B '� � � J ♦ . AP I lk g � �_ �1 C Ada Call 503.639.4176 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 ApplicationRECFIVE Buiildibg Fixtures MAR 0 2 2 009 Received FOR OFFICE USE ONLY City of Tigard ed Date/By: d 3 • • O^. `-1 Permit No.: ° 9 avAr a 13125 SW Hall Blvd., Tigard, OR 9722 0 Phone: 503.639.4171 Fax: 503.598 OF TIG ARD Date/By: Review k DING OF Other Permit No.: TI GARD Inspection Line: 503.639.4175 tf DIVISIO Date ReadyBy: s: See Page 2 for Internet: www.tigard - or.gov Notified/Method: Supplemental Info 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 0 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: Fire sprinkler ( sq. ft.) Page 2 JOB SITE INFORMATION AND LOCATION Site utilities Job site address: . , dp . r 1 L l ' Catch basin or area drain 16.60 City/State /ZIP: 11G A2 i ( fa t �Z2 Drywell, leach line, or trench drain 16.60 Suite/bldg. /apt. no.: I Project name: _ l Footing drain (no. linear ft.: _) Page 2 Manufactured home utilities 110.00 Cross street/directions to job site: � Q, 1 Manholes 16.60 1, A ■ a ,( . & • & k V . f 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 LESS DESCRIPTION OF WORK [ Backflow preventer Page 2 ._ LESS L. a -. V\ (tit r• Backwater valve 16.60 -_ = - - __ L jf\T J 3 (t , ' FoQ ( - o t Clothes washer 16.60 Dishwasher 16.60 ❑ PROPERTY OWNER I ❑ TENANT Drinking fountain 16.60 L ,� ^ Ex pan s ion 16.60 Name: r Y Expansion tank 16.60 Address: ( 0� SOO ©IY\ ( Fixture /sewer cap 16.60 City/State /ZIP: ( �3 , 1•�5_( RA O f2. 2 ' Floor drain/floor sink/hub 16.60 Phone: ) ! G r ( ) F ax: 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 Sink/basin/lavatory 16.60 Phone: ( ) I Fax: ( ) Tub /shower /shower pan 16.60 E -mail: Urinal 16.60 CONTRACTOR Water closet 16.60 Business name: Water heater I 16.60 Address: • Other: City /State /ZIP: Subtotal Ito .60 Minimum permit fee: $72.50 -7 Phone: ( ) Fax: ( ) Residential backflow minimum permit fee: $36.25 12. CCB Lic.: P tubing Lic. no.: Plan review (25% of permit fee) - % State surcharge (12% of permit fee) 8.7 0 Authorized si gn x � - 1 t � ature: f _ ' / TOTAL PERMIT FEE Si. 20 Print name: Date. 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: \Building'Permits\PLMF- PermitApp.doc 12/27/06 44046I6T(l0 /02/COM/WEB) Plumbing Permit Application - City of Tigard Page 2 - Supplemental Information -14 Fee Schedule: Residential Fire Suppression Systems: Site Utilities Qty. Fee (ea) Total Square Footage: Permit Fee: Footing drain - IA 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 Storm & Rain Drain - 1st 100' 55.00 Valuation: Permit Fee: $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 Fixture or Item Qty. Fee (ea) Total additional $100.00 or fraction thereof, to and 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 and including $50,000.00. specially requested inspections - per hour 72.50 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. Commercial 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 ❑ New exterior plumbing site utilities for any complex structure 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 Isometric or Riser Diagram Eye Wash ❑ Isometric or riser diagram is required for new buildings Floor Drain/sink - 2" that meet the qualifications above. -3" 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:\Building\Permits\PLM- PermitApp.doc 12/27/06