The URL can be used to link to this page

Permit CITY OF TIGARD PLUMBING PERMIT . • COMMUNITY DEVELOPMENT Permit #: PLM2009 -00105 T t GAR L7 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 05/01/2009 Parcel: 2S112AD00900 Jurisdiction: Tigard Site address: 14800 SW SEQUOIA PKWY Subdivision: Lot: 0 Project: Home Depot Project Description: Install backflow. Owner: FEES HD DEVELOPMENT OF MARYLAND, INC Quantity Description Date Amount BY HOME DEPOT USA, INC, PROPERTY TAX 1 ea Backflow Prevention - 05/01/2009 $46.40 DEPT #4002, PO BOX 105842 COM PHONE: 1 12% State Surcharge - 05/01/2009 $8.70 Plumbing Contractor: 26 ea Minimum Fee Adjustment 05/01/2009 $26.10 AMERICAN RESIDENTIAL SERVICES LLC - Plumbing P.O. BOX 2830 CLACKAMAS, OR 97015 PHONE: 503 - 235 -8784 FAX: 503 -491 -2932 Type of Use: COM 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 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 -0100. You may obtain a copy of the rules Issued By: Permutes Signature: 0 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. ' qPP - 30 - 2004 14:45 03S7(02- P.001 ..Plumbing Permit Application Building Fixtures RECEIVED FOR OFFICE USE, ONLY 71 City of Tigard Bl vd ReeC6 PIYY►?bm •43k45 t '' 2 9 2009 oar �,a, - a 9 - e Perron No.: + 13125 Su' Hall at d T .. igard. OR 972 Pfan ReLte� i s • • Phone: 501.639.4171 Fax: 503.598 (kae13■ Other Perron No • r . r �, rt t .� Inspection Line: 503.639.4175 Date Reed -8 � - Internet: vcww.ti and -or. o v C ITY OF TIGARD Not ) et ►�lEa S u See Je Page 2 for 6 g 'Mhod IST1 S lemental information - TYPE OF multi r • FEE* SC EDI;LE ❑ New construction ❑ Demolition For special information useehecklist Description I Qt)' 1 Ea. J Total _ Addition/altcrationireplaccment ❑ Other; New I- 2-family dwellings (includes 100 11. for each utility connections CATEGORY OF CONSTRUCTION SFR t 1 r bath 249.20 ❑ 1- and 2- family dwelling PI: Commercialfintlustrial SFR (21 bath 350.00 ❑ Accessory building CI Muhi•fumil} SFR 131 bath 399.00 - El Master builder ❑Other: Each additional bath/kitchen 45.00 Fire sprinkler ( sq. R.) Page 2 JOB SITE INFORMATION AND LOCATION Site utilities - Job site address: �' ,, -- II L / dr ��, SUV �/ 1 j�� •�II arch basin or area drain 16.60 City /State!L1P: - Kin . wP .q ?:__ Ornwell. leach line. or trench drain 111111 16.60 Suite/bldgJapt. no.: Project name: )aiil � Footing drain (no, linear 2: _) P age ` Cross street/directions to job site: Manufut:tured home utilities 1 10.00 Manholes 16,60 Rain drain connector 16.60 Sanitary sewer (no. linear ll.: _) - Page 2 Storm sewer (no. linear h,: _ ) Page 2 Subdivision: Lot no.: Water service (no. linear fl.: _ -__) Page 2 Tar map /parcel no.: Fixture or item Absorption valve 1 + 16.60 /�f� DESCRIPTION OF WORK Backftow preventer Page 2 "'�" i � ii `ia Backwater valve 16.60 i 4", Clothes washer 16.60 Dishwasher 16.60 lit PROPERTY OWNER • 0 TENANT Drinking fountain 16.60 1=11117 ,1 / / _ Ejectors/sump pani n oink 16.60 16.60 t� • Fixture/sewer Expansion lu �� 1 'corny /r / 1� e /sewer cap 16,60 City /State/ZIP: / �1� Floor drain/floor sink/hub 16.60 - i� i ' ' Ga a disposal Phone: ( / �� T Fs : ( ) P 16.60 - A APPLICANT Q CONTACT PERSON Hose ke 16.60 Business name; ARS dba JACK HOWL Ice maker 16.60 Rescue R ooter interceptor /grease trap 16.60 Contact name: JOYCE DENNIS Medical gas (value: $ 1 - Page 2 Address: P.O. BOX 2830 Primer 16.60 • City /State/ZIP: CLACKAMAS, OR 97015 Roof drain (commercial) 16.60 Phone: (503) 2,35 -8784 I Fax: ; (503) 491 -2932 Sink/basiriltataton 16.60 Tub /showcr /showcr pan _ 16.60 E -mail; JOYCE @JACKHO K.COM Urinal 16.60 CONTRACTOR water closet 16.60 Business name: ARS dba .JACK HORN: /Rescue Rooter Water heater 16.60 Address: P.O. BOX 2830 Other: City /State/ZIP: CLACKAMAS, OR 97015 Subtotal Minimum permit Ice: $72.50 '�� Phone: (503) 235 -8784 Fax: (503) 491 -2932 Residential backflow minimum .ermit fee: $36.25 L. CCB Lie,: 127325 Plan review (25 %ofpermitfee) Igh Authorized signature: re, le Slate surcharge (12% of permit fee) • TOTAL PERMIT FEE 8i. Print name: A /FA , ` ./� 4 V This permit application expires if a permit Is ant obtaltled within 180 dens after it has been accepted as complete. "Fee methodology set by Tri- County Building industy Service Hoard. rlrtuildina:PermitsTLhQ•P. Please FAX BACK to: 03- 491 -2932 . -30 -2004 14: 46 P.002 Plumbing Permit Application - City of Tigard Page 2 - Supplemental Information Fee Schedule: Residential Fire Suppression Systems: Site Utilities Qty. Fee (ee Total Square Footage: Permit Fee: Footing drain - I" 100' 55 00 0 to 2.000 SI 15.00 Footing drain - each additional I On• 46.30 2.001 to 3.600 $16090 3.601 to 7.200 $220.00 Sewer • • 1st 11)0 S -` 00 _ 7.201 and greater $3o0 (q) Sewer - each additional 100' 46.40 - WaterSenicc - 1st 100' 55.00 - Medical Gas Systems: Water Service • each additional 100' .36.40 Valuation: Permit Fee: Storm & Rain Dram - 1st 1t)0' 55.00 ` $1,00 to $5.000 .00 Minimum fix $72 SO Storm & Rain Drain - each additional 100" 46.40 $5.001.00 to S10.000.00 $72.50 for the first $5.000.00 and $1.5'_ for each additional $100.00 or fraction thereof. to and ^ Qty. Fee (ea) Total Fixture or Item including $1.0.000.00. Commercial Back Flow Prevention Device 46.40 r' , / $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 pcmtit tee $36.25) 27.55 and including $25.000.00 Rain Drain. single family dwelling 65.25 $25001.00 to $50.000.00 $379.50 for the first $25.01)0.00 and $1,45 for Inspection of existing plumbing or each additional $100.00 or haction thereof to 1 and including $50.000.00. specially requested inspections - per hour 72.50 550.001.00 and up $742.00 for the first $50.000.00 and $1.20 for Subtotal: each additional $100.00 nr (}action 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 t3apustry/Font as defined in OAR918- 780 - 00.10. Bath -Tub /Shower ❑ Medical gas and vacuum systems for health care facilities. - Jacuzzi/Whirlpool ❑ Any multipurpose Eire sprinkler system. Car Wash -Each Stull ❑ 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 Isometric or Riser Diagram Drin F ountain) r. Eve Isometric or riser diagram is required for new buildings Floor Drain/sink - 2" that meet the qualifications above. - 3" -4 •' Car Wash Drain Garbage - Domestic Comments regarding fixture work: Disposal - Commercial - - Industrial — Ice MachfRefrig. Drains Oil Separator (Gus 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. tBui lding.Pensits'PLM•PermitApp.doc 17!:7'96 •