Permit CITY OF TIGARD PLUMBING PERMIT
1111
COMMUNITY DEVELOPMENT Permit #: PLM2012 -00068
13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 03/27/2012
T I G AR 9 Parcel: 2S102DCO3000
Jurisdiction: Tigard
Site address: 13918 SW BRAYDON CT
Project: McDonald Woods, Lot 3 Subdivision: MCDONALD WOODS Lot: 3
Project Description: Backflow for irrigation.
Contractor: TERRA -SOL LANDSCAPING Owner: GERTZ CONSTRUCTION CO INC
21685 SW HEDGES DR 19200 SW 46TH AVE
TUALATIN, OR 97062 TUALATIN, OR 97062
PHONE: 503 - 691 -6105 PHONE:
FAX:
FEES
• Quantity Description Date Amount
1 ea Backflow Preventer 03/27/2012 $31.27
Specifics: 1 12% State Surcharge - 03/27/2012 $8.70
Plumbing
Type of Use SF 41 ea Minimum Fee Adjustment - 03/27/2012 $41.23
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 . Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will re if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires folio the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 95 01 -0090. ou may obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: Permittee Signature: �.
IJ
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 com etion,the project.
Approved plans are required on the job site at the time of each inspec ion.
Plumbing Permit Application
9
Building Fixtures 0 FOR OFFICE USE ONl.l
City of Tigard �'� � ' Received ���
111 ta 13125 SW Hall Blvd., Tigard,'•(; 'W'
Date/13 ��/ Permit No.: N'rp )I -
C Plan Review ehyi
Phone 503.718.2439 Fax: 5 i ' 98.19�� S�0 r• � Date/By: Other Permit No.: C 7 � ,/ p <�
Inspection Line: 503.639.4175 ��` , c� G
T I G A R D 4 1 �� Date Ready/By:
.7 Gil See Page 2 for
Internet: www.tigard
O` C , ` v Notified/Method: 7 7 . tJ Supplemental Information
TYPE OF WORK W# FEE* SCHEDULE
Si • w construction ❑ t \' ition For s eclat in ormalion use checklist
Description Qty. Ea. Total
• Addition/alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (1) bath 312.70
.A I- and 2- family dwelling ❑ Commercial/industrial SFR (2) bath 437.78
• Accessory building ❑ Multi- family SFR (3) bath 500.32
Each additional bath/kitchen 25.02
• Master builder ❑ Other: Fire sprinkler (_ sq. ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
ob site address: 13 9 t z 5i, b 0 iy Ci - Catch basin or area drain 18.76
City/State /ZIP: e , _) Drywell, leach line, or trench drain 18.76
(V Footing drain (no. linear ft.: _) Page 2
. uite/bldg. /apt. no.: I Project name: Manufactured home utilities 50.03
ross 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.: Page 2
Water service (no. linear ft.: ) Page 2
Subdivision: I Lot no.: Fixture or item:
Tax map /parcel no.: Backflow preventer 1 31.27 3 /47
DESCRIPTION OF WORK Backwater valve 12.51
�^� Clothes washer 25.02
I P L' � �-`I �\, AL GQ.9 Dishwasher 25.02
Drinking fountain 25.02
Ejectors /sump 25.02
❑ PROPERTY OWNER I ❑ TENANT Expansion tank ' 12.51
Name: V e.. vr-,- Fixture /sewer cap 25.02.
C �°'� 0-6-A.4 0-6-A.4 N Floor drain/floor sink/hub 25.02
Address:
Garbage disposal 25.02
City/State /ZIP: Hose bib 25.02
Phone: ) &a - Cy v Fax: ( ) ' Ice maker 12.51
❑ APPLICANT ❑ CONTACT PERSON Interceptor /grease trap 25.02
Business name: Medical gas (value: $ ) Page 2
Primer 12.51
Contact name:
Roof drain (commercial) 12.51
Address: Sink/basin/lavatory 25.02
City/State /ZIP: Solar units (potable water) 62.54
Phone: ( ) Fax: : ( ) Tub /shower /shower pan 12.51
E -mail: Urinal 25.02
CONTRACT II R Water closet 25.02
Water heater 37.52
Business nam . cm, . .p.,„. _ ., , c) • - t► / Water piping/DWV 56.29
Address: ✓ " n 12S Other: 25.02
elf .• - O (, . Subtotal 'j i )_•
Phone: 5 Got I , 1 dIV Fax: ( ) Minimum permit fee: $72.50 7A'
CCB Lic.: 5c) r1 Plumbing Lie. no.: Plan review (25% of permit fee)
State surcharge (12% of permit fee) 'c)
Authorized • 'nature: ' _
�a TOTAL PERMIT FEE (CI , 3C7
► , I Date;
®� This p ermit a expires if a permit is not obtained within 180 days
after it has been accepted as complete.
'Tee methodology set by Tri- County Building Industry Service Board.
•
I:\ Building \Permits\PLMU- PermitApp.d 0 1/09 440- 4616T(10/02/COM/WEB)
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' 50.03 0 to 2,000 $121.90
Footing 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 Systems:
Water Service - each additional 100' 37.52
Valuation: Permit Fee:
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
Other Inspections or Fees Qty. Fee (ea) Total each additional $100.00 or fraction thereof, to
and including $10,000.00.
Inspection of existing plumbing or for $10,001.00 to $25,000.00 $148.50 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 thereof, to
(minimum charge - 1/2 hour) and including $25,000.00.
Inspections outside of normal business 90.00/hr $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 * . Plan Review for Plumbing Installations
Quantity by Fixture Type Plan review is required for any of the following.
Fixture Type for Replace/ Please check all that apply.
Work Performed: Capped Added Relocate
Baptistry/Font ❑ Any new commercial building with water service 2" and
Bath: Tub /Shower greater, except systems designed and stamped by licensed
- Jacuzzi/Whirlpool engineer.
Car Wash: Each S • ❑ New exterior plumbing site utilities for any complex structure
Drive Stall all as defined in OAR918- 780 -0040.
Cuspidor/Water Aspirator ❑ Medical gas and vacuum systems for health care facilities.
Dishwasher: Commercial ❑ Any multipurpose fire sprinkler system.
Domestic ❑ Any complex structure as defined in OAR918 -780 -0040.
Drinking Fountain
Eye Wash Submit 2 sets of plans with any of the above.
Floor Drain/sink: - 2"
Isometric or Riser Diagram
4„ ❑ Isometric or riser diagram is required for new buildings
-Car Wash Drain that meet the qualifications above.
Garbage - Domestic non -food
Disposal: - Domestic food related
- Commercial food related
- Industrial food related
Ice Mach./Refrig. Drains Comments regarding fixture work:
Oil Separator (Gas Station)
Rec. Vehicle Dump Station
Shower: -Gang
-Stall
Sink: -LavBar non -food related
- Bradley
- Com/Serv/Util food related
- Service *Note: If the fixture work under this permit results in an
Swimming Pool Filter increase of sewer EDUs, a sewer permit will be issued and
Washer - Clothes fees assessed for the sewer increase must be paid before the
Water Extractor p
WaterCloset Toilet plumbing permit can be issued.
Urinal '
Other Fixtures:
I:\Building\Permits\PLMF- PermitApp.doc 08/04/2011 2