Permit •
‘ CITY OF TIGARD PLUMBING PERMIT
• • COMMUNITY DEVELOPMENT Permit# PLM2012 -00265
Date Issued 09/12/2012
TIGARD 13125 SW Hall Blvd , Tigard OR 97223 503 718 2439 Parcel 2S102CD01900
Jurisdiction Tigard
Site address 9855 SW GARRETT ST
Project Jensen Subdivision FREWING'S ORCHARD TRACTS Lot 16
Project Description Connect existing house to sewer service See PF12012 -00030 for public portion
Contractor A -1 SEWER CONTRACTORS Owner JENSEN, WILLIAM G & YOLANDA T
BRUNDIDGE & SONS INC 9855 SW GARRETT ST
2207 SE 135TH AVE TIGARD, OR 97223
PORTLAND, OR 97233
PHONE 503 - 255 -1910 PHONE
FAX 503 - 256 -2699
FEES
Quantity Description Date Amount
145 If Sewer Service 09/12/2012 $100 06
Specifics 1 12% State Surcharge - 09/12/2012 $12 01
Plumbing
Type of Use SF
Class of Work ALT
Type of Const
Occupancy Grp
Stories
Total $112 07
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 work is suspended for more the 180 days ATTENTION Oregon law requires you to follow the rules adopted by the Oregon
Utili otification C r Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090 You may obtain a copy of the rules
or erect questions to OUN. • . n. 503 232 1987 or 1 800 332 2344
I sued By / Permittee Signature A---- 2� \
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
p FOR OFFICE USE ONE
City of Tigard DateB ® . I. Permit No A l . 4/ ^ ,0,265
1111 V 13125 SW Hall Blvd , Tigard,OR 97223 Plan Review
C Phone 503 718 2439 Fax 503 598 1960 Date/By Other Permit No
T I G n R D Inspection Line 503 639 4175 Date Ready/By inns RI See Page 2 for
Internet www tigard - gov Notified/Method Supplemental Information
TYPE OF WORK FEE* SCHEDULE
❑ New construction ❑ Demolition For special information use check /ist
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 (1) bath 312 70
Er I- and 2- family dwelling ❑ Commercial/Industrial SFR (2) bath 437 78 'Cr
building SFR (3) bath 500 32
❑ Accessory g ❑Multi -family
Each additional bath/kitchen 25 02
❑ Master builder ❑ Other Fire spnnkler ( sq ft ) Page 2 NI
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address l $ S 5 5 � /' -f t S -r- Catch basin or area dram 18 76
5 v°i ire Drywell, leach line, or trench drain 18 76
City /State /ZIP � t f
°)A IL Footing drain (no linear ft ) Page 2 n,
Suite/bldg /apt no I Project name Manufactured home utilities 50 03
Cross street/directions to job site Manholes 18 76
Rain drain connector 18 76
Sanitary sewer (no linear ft 1' 6 ) Page 2 /00.
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 31 27
DESCRIPTION OF WORK Backwater valve 12 51
/� Clothes washer 25 02
(, ovl nee 'f 1, O u�S P 1-D ptti ) I i G $e 'e'r Dishwasher 25 02
Drinking fountain 25 02
�
1 Ejectors /sump 25 02
/u PROPERTY OWNER I 0 TENANT Expansion tank 12 51
Name -- Te/v. e Fixture /sewer cap 25 02
Address Floor drain/floor sink/hub 25 02
Garbage disposal 25 02
City /State /ZIP Hose bib 25 02
Phone ( ) Fax ( ) Ice maker 12 51
❑ APPLICANT ❑ CONTACT PERSON Interceptor /grease trap 25 02
�c �' Medical gas (value $ ) Page 2
Business name , ti 0 ( t 6(6) c -�- 5 d 5 vv . —
Contact name Primer 12 51
/�ey\ 6., t Roof drain (commercial) 12 51
Address 22_0 7 5 6 )-3 (- <- Sink/basin/lavatory 25 02
f
City/State /Z1P 0y- 1t t Ia.,/ ot 6 72, 3 2, / Solar units (potable water) 62 54
Phone ( ) Fax ( ) Tub /shower /shower pan 12 51
2 Urinal 25 02
E -mail e hO I - 1 cGW CD,-1 -,L1, 5. Cowx
CONTRACTOR Water closet 25 02
1 C Water heater 37 52
Business name ` cj �y,^ u y � Water pipmg/DWV 56 29
Address a 7.0 7 l� 13 ft, /,4, Other 25 02
City /State /ZIP / 11 ( 4 4 - D) , ' 7 z 3 3 Subtotal 40. Cho
Phone (5'0 I) 2 S S 1 "I 1 V Fax ( p z) Z S 6 - z ' 1 Minimum permit fee $72 50 .--
CCB Lic / ( 1 " 7 7 Z-_ . /25//3 Plumbing Lic no 24 = 77 � P Plan review (25% of permit fee)
'/f JA Y State surcharge (12% of permit fee) / a.0/
Authonzed signature TOTAL PERMIT FEE / j,..._ 0 7
Pnnt name L e ►,.., 6.14., Wh o i ; j _ Date 7 — 2 _ /".4. This permit application expires if a permit is not obtained within 180 days
after it has been accepted as complete.
*Fee methodology set by Tn -County Budding Industry Service Board
1 \ Budding \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 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
Q ty. Fee (ea) Total each additional $100 00 or fraction thereof, to
Other Inspections or Fees 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 ", 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
4 "e, Pr evious Capped Added Existing
' engineer
Baptistry/Font ❑ New exterior plumbing site utilities for any complex structure
Bath - Tub /Shower as defined in OAR918- 780 -0040
- Jacuzzi/Whirlpool
Car Wash -Each Stall ❑ Medical gas and vacuum systems for health care facilities
Dave 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 meet the qualifications above
-4"
Car Wash Drain
Garbage - Domestic
Disposal - Commercial
Industrial Comments regarding fixture work:
Ice Mach /Refrig 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 - Clothes
Water Extractor plumbing permit can be issued.
Water Closet - Toilet
Urinal - -
Other Fixtures
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Recommendations (if any)
It is the purchaser's obligation to clearly mark underground utilities and underground irrigation systems
A- Affordable Septic Service is NOT responsible for unmarked utilities and /or irrigation systems
Signature / /,/ Date. t.— � , E
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All Claims MUST be accompanied by this bill o
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Rc No G 739302,117