Permit CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit #: PLM2009-00193
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 07/20/2009
Parcel: 2S102BD03200
Jurisdiction: TIG
Site address: 13075 SW PACIFIC HWY
Subdivision: Lot:
Project: SPEC SPACE
Project Description: Installation of commercial backflow for irrigation system.
Owner: FEES
ESTATE OF SHULER, GARRY COUEY Quantity Description Date Amount
30790 NE FERNWOOD
NEWBERG, OR 97132 1 ea Backflow Prevention - 07/20/2009 $46.40
COM
PHONE: 1 12% State Surcharge - 07/20/2009 $8.70
Plumbing
26 ea Minimum Fee Adjustment - 07/20/2009 $26.10
Contractor: Plumbing
BRUNER PLUMBING
PO BOX 23985
TIGARD, OR 97281
PHONE: 503 - 484 -5105
FAX: 503- 624 -2173
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Type of Use: COM
Class of Work: OTR 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 'cation Ce : Those rules are set forth in OAR 952- 001 -0010 through OAR 952 - 001 -0100. You may obtain a copy of the rules
or d• ect questions to OUN c •y . • • • 503.246.6699 or 1.800.332.2344.
Iss ed By: Permittee Signature: ` I` . .'
ail 1.01. 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 USE ONLY
RECEIVED R eceived la/22209....a9/5 Q
City of Tigard 7 Permit No.:
1 3125 SW Hall Blvd Ti
Date/By: 7 6
., Tigard, OR 97223
q g
° ` 2009 Plan Review
Phone: 503.639.4171 , Fax: 5 98. Other Permit No.:
Inspection Line: 503.639.4175 Date/By:
TIGARD Date ReadyBy: ® See Page 2 for
Internet: www.tigard or.gorrry OF TIGARD Notified/Method: Supplemental Information
TYPEMLIMnIVISION FEE* SCHEDULE
❑ New construction ❑ Demolition • For special information use checklist.
Description I Qty. I Ea. I Total
.0 Addition/alteration /replacement ❑ Other: . New 1- 2- family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (1) bath 249.20
❑ 1- and 2- family dwelling Q 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: /3 07S 61 6.(7...f F C gut (, Catch basin or area drain 16.60
City/State /ZIP: Til Q I\ J Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. I Project name: �s Q.r,zr Footing drain (no. linear ft.: _) Page 2
Cross street/directions to job site: I Manufactured home utilities 110.00
12F 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 Backflow preventer Page 2
a 61_0( ( r' rt o e , 4- (ea- _ Backwater valve 16.60
J I Clothes washer 16:60
Dishwasher 16.60
❑ PROPERTY OWNER I ❑ TENANT Drinking fountain 16.60
Ejectors /sump 16.60
Name:, Expansion tank 16
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
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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: 6 t bi 3 /N Water heater 16.60
L ; i2�►ne../ h
Address: ,7 c _,, .3 2.3 el 8 s Other:
City /State /ZIP: -7-2-7'‘,„,,e o 2 Gt i? j Y( . 3 r y ) ' subtotal
/ Minimum permit fee: $72.50 -7Z ��
Phone: ($c61) (�Z Si cer 0 Fax: (503) (o2. y/ - 2.0 3 Residential backflow minimum permit fee: $36.25 f
CCB Lic.: si 8 3 7 Plumbing Lic. no.: Z6_ yys "e Plan review (25% of permit fee)
State surcharge (12% of permit fee) ca, 7D
Authorized signature: TOTAL PERMIT FEE gr . O ?)
Print name: hij go bl ej"--- Date: / 7 This permit application expires if a permit is not obtained within
180 days after it has been accepted as complete.
*Fee method set by Tri-County Building Industry Service Board.
I:\ Building \Pmnits\PLMF- PermitApp.doc 12/27/06 440- 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' . 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
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 orfraction thereof, to •
specially requested inspections - per hour 72.50 and including $50,000.00.
Subtotal: $50,001.00 and up $742.00 for the first $50 and $1.20 for
each additional $100.00 or fraction thereof.
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'Commercial Fixture Work: Plan Review for Plumbing Installations
Are you capping, adding or replacing futures? 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 *. ID 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
FloorDrain/sink _ -2" • . that meet- the'qualificationsabove. ' .
4"
Car Wash Drain '
Garbage -Domestic . • Comments regarding fixture w
- 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 . incr ease of sewer EDUs, a sewer permit will be issued and -
Service .. . fees assessed 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 •