Permit CITY OF TIGARD PLUMBING PERMIT
s • COMMUNITY DEVELOPMENT Permit #: PLM2009 -00122
T I G AR D 13125 SW Hall Blvd., Tigard OR 97223 503.639 4171 Date Issued: 05/18/2009
Parcel: 1 S125DD06600
Jurisdiction: Tigard
Site address: 9580 SW VENTURA CT
Subdivision: Lot: 0
Project: Satalich
Project Description: Replace water heater and supply line to water heater.
Owner: FEES
SATALICH, ANDREW L & VERONICA L Quantity Description Date Amount
9580 SW VENTURA CT 100 If Water Service 05/18/2009 $55.00
PORTLAND, OR 97223 1 ea Water Heater 05/18/2009 $16.60
PHONE: 1 12% State Surcharge - 05/18/2009 $8.70
Plumbing
Contractor: 1 ea Minimum Fee Adjustment 05/18/2009 $0.90
SELLWOOD PLUMBING - Plumbing
PO BOX 82188
PORTLAND, OR 97282
PHONE: 503 - 239 -0009
FAX: 503 - 236 -1545
Type of Use: SF
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. Y ay obtain a copy of the rules
Issued By: 0
r is v� n ��A n _/� Permittee Signature:
Call 503.639.4175 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 Applicat orb;
FOR OFFICE: USE ONLY
City of Tigard MAY 18 2009 Received Pt
• 13125 SW Hall Blvd , Tigard, OR 97223
Date/By ) Permit �� • Ill, • at 2
0 Phone 503 639 4171 Fax 503 'd : la Review
� ` !� ®I TIGARD DateBy Other Permit No
TIGARD Inspection Line. 503 4175 BUILDING DIVISION Date Ready/By Jun ® See Page 2 for
Internet www tigard - gov Notified/Method C� Supplemental Information
TYPE OF WORK , FEE* SCHEDULE •
ID New construction ❑ Demolition For special information use checklist.
Description I Qty. I Ea Total
Addition/alteration/replacement ❑ Other. New 1- 2- family dwellings (includes 100 ft for each utility connection)
CATEGORY OF CONSTRUCTION SFR (1) bath 249 20
6°.,- and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 350 00
El Accessory building ❑ Multi- family SFR (3) bath 399.00
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 10 S 1 gio Z4- c r Catch basin or area drain 16 60
City /State /ZIP I ML 7 ?2 ? Drywell, leach line, or trench drain 16.60
Suite/bldg /apt no • P roj e ct name J Footing drain (no linear ft . ) Page 2
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 ) Page 2
Subdivision: Lot no. • Water service (no linear ft ) Page 2
Tax map /parcel no.:
Fixture or item
Absorption valve 16 60
DESCRIPTION OF WORK Backflow preventer Page 2
1 f pa I_*u.5 s t,t.1 U i Nes r n Backwater valve 16 60
Clothes washer 16 60
fo o wA I k� .
Dishwasher 16 60
PROPERTY OWNER ❑ TENANT Drinking fountain 16 60
• ' + Ejectors /sump 16 60
Name. �L?_20 /3 6 C A S ,pt f 1.1 c Expansion tank 16 60
Address of 5 8 Q [' 0 0 gj p, 6. Fixture /sewer cap 16 60
City /State /ZIP: '` 119. -0 1 17223 Floor drain /floor sink/hub 16 60
Phone ( ) Fax: ( ) Garbage disposal 16 60
p APPLICANT ❑ CONTACT PERSON Hose bib 16 60
Ice maker 16 60
Business name: g_.G(i) 1 14.44,44.17 P � Interceptor /grease trap 16 60
Contact name 1� £ V ()L � gas (
c.l Medical as value• $ ) Page 2
Address. pe Q 2r-y �,[[�y 8 7 1 ogi Primer 16 60
City /State /ZIP• . p r - j )( 2_ q 7282- Roof drain (commercial) 16 60
Phone (L 236i, _ p ppc Fax ( � 3 ) 23( - I S /C Smk/basin/lavatory 16.60
l Tub /shower /shower pan 16 60
E-mail.
Urinal 16 60
CONTRACTOR Water closet 16.60
Business name: S� Water heater / 16 60 f & - ( O
Address: p 0 . C7 ,( t Z( 8 g Other
City /State /ZIP: pp ct 7 ZEZ Subtotal j(p, (
1 Minimum permit fee: $72.50
Phone: ( 5 2. 4 . un Fax ( 2,) 23 b . 1 5.-I5 Residential backflow minimum permit fee $36 25 7 2 - °
CCB Lic. • S. 0 3 Plumbing Lie no : 24 77 3rd Plan review (25% of permit fee)
State surcharge (12% of permit fee)
Authorized signature: TOTAL PERMIT FEE V t . 2 0
Print name: l - , u ,) iA "s'� r J - Date •- ( b This permit application expires if a permit is not obtained within
V"" 180 days after it has been accepted as complete.
*Fee methodology set by Tri -County Building Industry Service Board
i \Budding\Permits\PLM- 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 - I" 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:
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
Bath - Tub/Shower ❑ New exterior plumbing site utilities for any complex structure
Tub /S i/Whirlpool as defined in OAR918- 780 -0040.
El Car Wash Each Stall Medical gas and vacuum systems for health care facilities.
Drive Thru ❑ 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 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 *Note: If the fixture work under this permit results in an
- Bradley un p
- 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
\Budding\Permits\PLM- PermitApp doc 12/27/06