Permit CITY OF TIGARD PLUMBING PERMIT
2 - COMMUNITY DEVELOPMENT Permit #: PLM2012 -00149
13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 06/04/2012
TIGARD Parcel: 2S 110BA 10400
Jurisdiction: Tigard
Site address: 14204 SW 119TH PL
Project: Treehill Partition, Lot 1 Subdivision: 2010 -004 PARTITION PLAT Lot: 1
Project Description: Residential irrigation backflow.
Contractor: EDWARD MULLEN PLUMBING Owner: FOUR D CONSTRUCTION
1601 SE RIVER RD P.O. BOX 1577
HILLSBORO, OR 97123 BEAVERTON, OR 97075
PHONE: 503 - 720 -7445
HONE: 503 - 640 -0113
FAX: 503 - 640 -4483
FEES
Quantity Description Date Amount
1 ea Backflow Preventer 06/04/2012 $31.27
Specifics: 1 12% State Surcharge - 06/04/2012 $8.70
Plumbing
Type of Use: SF 41 ea Minimum Fee Adjustment - 06/04/2012 $41.23
Plumbing
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 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 OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: ,� / Permittee Signature: -- _AO ��/ III
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.
Plumbing Permit Application
RECEIVE OFFICE, liSI: ONLY
City of Tigard Received
Date/By: �y //
y , ! Permit No./DZ./L.162042 - D / y9
l i a 13125 SW Hall Blvd., Tigard,OR 97223 , lUN 0 4 2012 Plan Review 1
C . Phone: 503.718.2439 Fax: 503.598.1960 Date/By: Other Permit N sTo� // ea /13-..g Inspection Line: 503.639.4175 a te Rea /B r� ® See Pa e 2 mtalln for •
T I G A It D Internet: www.tigard-or.gov C' OF �1'1\I y g
tfie S
TYPE OF WORK BU1LDI O DIVISION FEE* SCHEDULE
P f 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 437.78 connection)
CATEGORY OF CONSTRUCTION SFR (1) bath 312.70
VI- and 2- family dwelling ❑ Commercial/industrial SFR (2) bath
SFR (3) bath 500.32
❑ Accessory building ❑ Multi - family
Each additional bath/kitchen 25.02
❑ Master builder ❑ Other: Fire sprinkler L_ sq. ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: 1 y; Oki &C.%) - , I ct l' L_ Catch basin or area drain I I 18.76
Drywell, leach line, or trench drain 18.76
City/State /ZIP: 71 (o w-rD Qg_ 9 22,014 Footing drain (no. linear ft.: _) Page 2
Suite/bldg. /apt. no.: I Project name: Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
1 1 9 14 9 / l� 14 ���� Rain drain connector I 18.76 I
1 x Sanitary sewer (no. linear ft.: Page 2
Storm sewer (no. linear ft.: Page 2
Water service (no. linear ft.: ) Page 2
Subdivision: --g_ EE µ I Lt_ I Lot no.: Fixture or item:
Tax map /parcel no.: Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 25.02
i_FINOSL> ' kr 13 AC.. LO UD PE e1Jr1..>iCere- Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
PROPERTY OWNER I ❑ TENANT Expansion tank 12.51
ctt V (
1
Name: {Ou� D (t S re-.1 - _ Fixture /sewer cap 25.02
1�� Floor drain/floor sink/hub 25.02
Address: R. U . ,R 0( IS - 7
Garbage disposal 25.02
City/State /ZIP: . _A‘,/ 2 1t 3 �(2,,, 9 707 Hose bib 25.02
- 7 „ 2 . , _ - - 2 y y S Fax: ( So3) S96 ^ 1-75 I Ice maker 12.51
t/ APPLICANT ❑ CONTACT PERSON Interceptor /grease trap 25.02
Medical gas (value: $ ) Page 2
Business name: Fo Arte ^i) ee) I..) S 12.4kc7-tom -
Primer 12.51
Contact name: D Ay I PAR-PR) v- Roof drain (commercial) 12.51
Address: R () , P 1 5 ? -) B ( V cP- 701■.j Sink/basin/lavatory 25.02
City/State /ZIP: 0}Z 9 ? O 7S Solar units (potable water) 62.54
Phone: (5o3) 72. °- . 7 ‘.1-1S I Fax: : (Su j) 5 9 0 -OS S I Tub /shower /shower pan 12.51
E -mail: pa L i 12_ D C C - C' O. M S N , Urinal l 25.02
Water closet 25.02
CONTRACTOR
L Z.6•J9 Water heater 37.52
Business name: AAA LLtN Water piping/DWV 56.29
Address: /6 0 1 ._5 € R q.) t o RI Other: 25.02
City /State /ZIP: a 1 I S 19, , - CIWZ _ Subtotal
Phone: (51:3) 6 ix -_ 0// 3 Fax: S33) 6 c/t) -, y ys_3 Minimum permit fee: $72.50 7,2 „S(,
CCB Lic.: 9. 6 0 7 Plumbing Lic. no., -2 (,o pg Plan review (25% of permit fee)
State surcharge (12% of permit fee) ,F, '76
Authorized signature: e. TOTAL PERMIT FEE pi/ 21
Print name: cD wimp /We? / f C Date: - 14 _ i 7._ Ibis permit application expires if a permit is not obtained within 180 days
/y after it has been accepted as complete.
"Fee methodology set by Tri-County Building Industry Service Board.
I:\ Building \Permits\PLMU- PermitApp.doe 10/01/09 440- 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 lee:
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 10'7,200 $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 existirig'plumbing or for V $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 ", Plan Review for Plumbing Installations
please indicate work performed by fixture. Failure to Plan review is required for any of the following.
accurately report,fixtures could result in increased sewer fees * . Please check all that apply.
Quantity by (Fixture) Work Performed . ❑ Any new commercial- building:with water service 2" and
'Fixture Type: Replace greater, except systems 'designed and stamped by licensed •
Previous Capped Added Existing engineer.
Baptistry/Font
Tub /S ❑ New exterior plumbing site utilities for any complex structure
Bath - hower
Tub/S ower rlpool as defined in OAR918- 780 -0040.
Car Wash Each Stall ❑ Medical gas and vacuum systems for health care facilities.
-Drive Stall ❑ Any multipurpose fire sprinkler system..
Cuspidor/Water Aspirator ❑ Any complex structure as defined in OAR918 -780 -0040.
Dishwasher - Commercial
Domestic Submit 2 sets of plans with any of the above.
Drinking Fountain •
Eye Wash Isometric or Riser Diagram
Floor Drain/sink - 2" ❑ Isometric, or riser diagram is required for new buildings
that meetthe`qualifications above."' -�•
Car Wash Drain , • '
Garbage - Domestic . , ,
Disposal - Commercial
- Industrial • Comments regarding fixture work:
'Ice MachiRefrig. Drains •
Oil Separator (Gas'Station)
_ Rec. Vehicle Dump Station • '
Shower -Gang • . • .
-Stall
Sink - Bar/Lavatory -, _ • - ' • -
- Bradley •
- Commercial , • *Note: If the fixture work under this permit results in an '
- Service increase of sewer EDUs, a sewer permit will be issued and
Swimming Pool Filter • fees assessed for the sewer increase must be paid before the
Washer r Extractor plumbing permit can be issued.
. Water Extractor � p g p
' Water Closet - Toilet
• Urinal _
Other Fixtures:
I:\ Building \Permits\PLM- PermitApp.doc 2