The URL can be used to link to this page

Permit CITY OF TIGARD PLUMBING PERMIT a COMMUNITY DEVELOPMENT Permit# PLM2012 -00275 Date Issued 09/19/2012 T I G AR E) 13125 SW Hall Blvd , Tigard OR 97223 503 718 2439 Parcel 1 S 134CA00513 Jurisdiction Tigard Site address 11150 SW 119TH AVE Project Alholm Subdivision PANORAMA NO 2 Lot 24 Project Description Replace 30' sewer Contractor T C EXCAVATING INC Owner GARRISON TRUST, THE PO BOX 1733 BY JUDY ALHOLM SANDY, OR 97055 2848 DOVER ST LONGVIEW, WA 98632 PHONE 503 - 407 -0503 PHONE FAX FEES Quantity Description Date Amount 30 If Sewer Service 09/19/2012 $62 54 Specifics 1 12% State Surcharge - 09/19/2012 $8 70 Plumbing Type of Use SF 10 ea Minimum Fee Adjustment - 09/19/2012 $9 96 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 (� 7 Permittee Signature 0/4 '!"1 v 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 Building Fixtures FoR OFFICE USE ONLY R City of Tigard P No a 131 SW Hall Blvd , Tigard, OR 97223 Date/By Q' Q �� P �� 'O �� NI C Phone 503 718 2439 Fax 503 598 1960 Plan Review Date/By Other Permit No I' I C. n R D Inspection Line 503 639 4175 Date Ready/By Jun See Page 2 for Internet www tigard -or gov Notified/Method Ii IP Supplemental Information TYPE OF WORK FEE* SCHEDULE ID New construction El Demolition For special information use check list Description I Qty I Ea I Total ddition/alteration/replacement ❑ Other New 1 - 2- family dwellings (includes 100 ft for each utility connection) CATEGORY OF CONSTRUCTION SFR (1) bath 312 70 and 2- family dwelling ❑Commercial /tndustnal SFR (2) bath 437 78 - SFR (3) bath 500 32 ❑ Accessory building ❑ Multi- family Each additional bath/kitchen 25 02 ❑ Master builder ❑ Other Fire sprinkler ( sq ft) Page 2 JOB SITE INFORMATION AND LOCATION Site utilities: Job site address 1 ) ) 50 .... W 1 1 f i' 1 Catch basin or area drain I I 18 76 I City /State /ZIP Drywell, leach line, or trench drain 18 76 ) . f. e4., A Footing drain (no linear ft ) Page 2 Suite/bldg /apt no 7 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 J Page 2 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 F-12d Clothes washer 25 02 Ot ` �Q/Kl& Dishwasher I 25 02 I Drinking fountain 25 02 Ejectors/sump 25 02 ❑ PROPERTY OWNER I ❑ TENANT Expansion tank 12 51 Name Fixture /sewer cap 25 02 Floor drain/floor sulk/hub 25 02 Address 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 Business name `7 FIX CC.Av Medical gas (value $ ) Page 2 ■ �` Primer 12 51 Contact name Roof dram (commercial) 12 51 Address -P 0 Qt ? (42-7 I Sink/basin/lavatory 25 02 City /State /ZIP i_ s -/—ace �. r.. Q — 2p Z .. Solar units (potable water) 62 54 Phone (5o 4477 _ n S o . 5 Fax ( ) Tub /shower /shower pan 12 51 Urinal 25 02 E -mail ' f -(,,cixc.0.4)(4." © Qt I � 6.0 ,p �\ Water closet 25 02 CONTRA - Water heater 37 52 Business name Water piping/DWV 56 29 Address Other 25 02 City/State /ZIP Subtotal Phone ( ) 3((I, f((4 Fax ( ) Minimum permit fee $72 50 CCB Lic ( , --- e:7 V.( E_ Plumbing Lic no Plan review (25% of permit fee) State surcharge (12% of permit fee) Authonzedsignatur /, � TOTAL PERMIT FEE I $/, eZD Pnnt name t n Date CI --1 9 _ i This permit application expires if a permit is not obtained within 180 days / l l ' " after it has been accepted as complete *Fee methodology set by Tn- County Building Industry Service Board I \BuddingWerrmts\PLMU- PenmiApp 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 - I" 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 Other Inspections or Fees Qty. Fee (ea) Total and hnc uding $10,000 00 additional fraction thereof, to 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 ", please indicate work performed by fixture. Failure to accurately report fixtures could result in increased sewer fees * . Plan Review for Plumbing Installations Quantity by Fixture Type Plan review is required for any of the following Fixture Type for Replace/ Please check all that apply Work Performed: Capped Added Relocate Baptistry/Font El Any new commercial building with water service 2" and Bath Tub /Shower greater, except systems designed and stamped by licensed - Jacuzzi/Whirlpool engineer Car Wash Each Stall ❑ New exterior plumbing site utilities for any complex structure Dave Stall as defined in OAR918- 780 -0040 E1 Cuspidor/Water Aspirator Medical gas and vacuum systems for health care facilities Dishwasher Commercial 1:1 Any multipurpose fire sprinkler system Domestic ❑ Any complex structure as defined in OAR918 -780 -0040 Drinking Fountain Eye Wash Submit 2 sets of plans with any of the above. Floor Drain/sink - 2" 3 " Isometric or Riser Diagram 4 " ❑ Isometric or riser diagram is required for new buildings - Car Wash Drain Garbage Domestic non - food that meet the qualifications above Disposal - Domestic food related - Commercial food related - Industrial food related Ice Mach/Refrig Drains Comments regarding fixture work: Oil Separator (Gas Station) Rec Vehicle Dump Station Shower -Gang -Stall Sink - Lav/Bar non -food related - Bradley — - Com/Serv/Util food related - Service *Note: If the fixture work under this permit results in an Swimming Pool Filler increase of sewer EDUs, a sewer permit will be issued and Washer - Clothes fees assessed for the sewer increase must be paid before the Water Extractor p WaterCloset Toilet plumbing permit can be issued. Urinal Other Fixtures I \Building\Permits\PLMF- PermitApp doc 08/04/2011 2