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Permit
CITY OF TIGARD PLUMBING PERMIT I N 0 • COMMUNITY DEVELOPMENT Permit #: PLM2009 -00192 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 07/16/2009 Parcel: 2S110DC00700 Jurisdiction: Tigard Site address: 11205 SW SUMMERFIELD DR Subdivision: Lot: 0 Project: Summerfield Golf Cart Storage Project Description: Installation of 40' of storm service. Owner: FEES TIGARD RETIREMENT RESIDENCE LLC Quantity Description Date Amount 600 UNIVERSITY ST STE 2215 SEATTLE, WA 98101 40 If Storm and Rain Drain 07/16/2009 $55.00 PHONE: 1 12% State Surcharge - 07/16/2009 $8.70 Plumbing 18 ea Minimum Fee Adjustment - 07/16/2009 $17.50 Contractor: Plumbing ACTIVE PLUMBING LLC 330 W FAIRFIELD ST GLADSTONE, OR 97027 PHONE: 503 - 722 -5310 FAX: • Type of Use: COM Class of Work: ALT Type of Const: Occupancy Grp: Stories: • Total $81.20 Required Items and Reports (Conditions) This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain a copy of the rules or direct questio. • OUNC by calling 503.246.6699 or 1.800.332.2344. Issued :y: / / Permittee Signature: Call 503.639.4175 by 7:00 a.m. for an inspection that business day. This permit card shall be kept in a conspicuous place on the job site until completion of the project. Approved plans are required on the job site at the time of each inspection. • Plumbing Permit Application 'Building Fixtures RECEIVED - City of Tigard Date Received By: � g /� d9 / N!C Permit ---, V 13125 SW Hall Blvd., Tigard, OR 97223g -A 1 6 2009 Phone: 503.639.4171 Fax 503.598.19 V 2009 Plan Review Date/By: Other Permit No.: T I GA R D Inspection Line: 503.639 Date Ready/By: 1 See Page 2 for Internet: www.tigard or.gov CITY OFTIGARD Notified/Method: S upplemental Information TYPE OF w$k}ILD1Nli DIVISION 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 (I) bath 249.20 ❑ 1- and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 350.00 Accessory building SFR (3) bath 399.00 El ry g ❑ Multi - family 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: I f a,6 5 � SU /AA. (NA'ev-4 .e IA C' R Catch basin or area drain 16.60 City /State /ZIP: g t2 avpt © ., J'az3 Drywell, leach line, or trench drain 16.60 Suite/bldg. /apt. no.: JJ I Project name: t 5 V � y,.e r - r i p( lot (tjp(ecoxf Footing drain (no. linear ft.: _) Page 2 sk ( Manufactured home utilities 110.00 Cross street/directions to job site: Manholes 16.60 Rain drain connector 16.60 Sanitary sewer (no. linear ft.: ) Page 2 Storm sewer (no. linear ft.:1'()) Page 2 Subdivision: Lot no.: Water service (no. linear ft.: ) Page 2 Fixture or item Tax map /parcel no.: - Absorption valve 16.60 -f- ry� DESCRIPTION OF WORK Backflow preventer Page 2 �YII� I l to p 1C S -( D r -'_ 6/ LL t - . Backwater valve 16.60 Clothes washer 16.60 Dishwasher 16.60 ❑ PROPERTY OWNER I ❑ TENANT Drinking fountain 16.60 � Ejectors /sump 16.60 Name: l l A �r +�t - w .1 5 io ie( J/( Expansion tank 16.60 Address: f W CAN:,Vercli -tv/ S•' f S zz`') Fixture /sewer cap 16.60 City /State /ZIP: S -.- -1. r vuk get o l 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 Address: Primer 16.60 City /State /ZIP: Roof drain (commercial) 16.60 Phone: ( ) Fax:: ( ) Sink/basin/lavatory 16.60 Tub /shower /shower pan 16.60 E -mail: Urinal 16.60 CONTRACTOR Water closet 16.60 Business name: A cf cruse pl, v.,,LI\t5 Water heater 16.60 Address: 3 36 W • Fairc--1`k IA Other: City /State /ZIP: & frac f -S'c. OK gio -a-T Subtota Minimum permit fee: $72.50 Phone: ($ ) G'27- 6 Fax: ( ) Residential backflow minimum permit fee: $36.25 - 7,9"✓✓✓ CCB Lic.: /66,36 Z Plumbing Lic. no.: P/3 66( Plan review (25% of permit fee) State surcharge (12% of permit fee) t ' .7 v Authorized signature: TOTAL PERMIT FEE g' , 2-0 Print name: Ivi k . /�ah, t "1 `/ Date: . 7 -- / p - 01 This permit application expires if a permit is not obtained within ' I 180 days after it has been accepted as complete. *Fee methodology set by Tri -County Building Industry Service Board. 1. \Building\Permits\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 or fraction 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 $50,000.00 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 QuantitYby (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" -4" 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