Permit CITY OF TIGARD PLUMBING PERMIT
` ' COMMUNITY DEVELOPMENT Permit #: PLM2009 -00248
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 09/08/2009
Parcel: 1S125DA03200
Jurisdiction: Tigard
Site address: 6511 SW WALNUT TER
Subdivision: Lot: 0
Project: Sapp
Project Description: Replace 80' of sanitary sewer service.
Owner: FEES
SAPP, JAMES MICHAEL Quantity Description Date Amount
6210 SW DELKER RD
TUALATIN, OR 97062 80 If Sewer Service 09/08/2009 $55.00
PHONE: 1 12% State Surcharge - 09/08/2009 $8 70
Plumbing
18 ea Minimum Fee Adjustment - 09/08/2009 $17.50
Contractor: Plumbing
APOLLO DRAIN & ROOTER SERVICE
2208 NW BIRDSDALE #8
GRESHAM, OR 97030
PHONE: 503 - 239 -8801
FAX 503- 669 -9568
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 You may obtain a copy of the rules
or direct que o • u by c- ' , g 503.246 6699 or 1.800.332.2344
Issued y: • �� Permittee Signature: �N , /IC A . / J "
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 e FOR OFFICE USE ONLY
City of Tigard Date /By q / e 9 ,, Permit No hz1 9 �8
IN
q 13125 SW Hall Blvd , Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax• 503.598 1960 Date /By Other Permit No.
TIGARD Inspection Line 503.639.4175 Date Ready /By
"era, ®See Page 2 for
Internet: www.tigard - or gov Notified /Method Supplemental Information
TYPE OF WORK FEE* SCIIEDULE
❑ New construction ❑ Demolition For special information use check list.
Description I Qty. 1 Ea. I Total
1 ddition/alteration/replacement ❑ Other: New 1 - 2 - family dwellings (includes 100 ft for each utility connection)
CATEGORY OF CONSTRUCTION SFR (I) bath 249 20
I- and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 350.00
❑ Accessory building 1=I 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 u tilities
Job site address: (pc k ` 3cA3 l_/l_J� - --\-----EL Ca tch b asin or area drain 16 60
City /State /ZIP: \ � 4 OV� G�• '� a- Drywell, leach line, or trench drain 16 60
Suite/bldg. /apt. no.: Project name: Footing drain (no. linear ft • _) Page 2
(s7 - 7 i - 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: I Lot no.: Water service (no linear ft . _) Page 2
Fixture or item
Tax map /parcel no.:
Absorption valve 16 60
DESCRIPTION OF WORK Backlow preventer Page 2
/ '-C10 (a( ' .Q - _ • • in V 1 Aii d Backwater valve 16.60
'" Clothes washer 16.60
Dishwasher 16 60
PROPERTY OWNER I ❑ TENANT Drinking fountain 16.60
V 1/4. ► ` Ex tan k 16 60
16 60
Name: Y Expansion tank
Address: Fixture /sewer cap 16 60
City /State /ZIP: Floor drain /floor sink/hub 16 60
Phone: ( ) Fax: ( ) Garbage disposal 16 60
❑ APPLICANT ❑ CONTACT PERSON I lose 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
Sink/basin /lavatory 16 60
Phone: ( ) I Fax::( )
Tub /shower /s hower pan 16.60
E -mail:
Urinal 16.60
l CONT' - TOR t Water closet 16 60
Business name: , C/ Water heater 16 60
Address: _ MN - 6 A A M A ` � �y. Other. ■
City /State /ZIP: 1�S 6 0 � �N ` q - 7 0 3 Subtotal
v Minimum permit fee $72 50
Phone,) 3 4 :6b - 03 1 Fax: t, 4 ei et s---( _ Residential backflow minimum permit fee $36 25 ?2
CCB Lic.: Lc, Plumbing Lic. qs.:,l ( .. 3-, ic Plan review (25% of permit fee)
Authorized signature: _ r , t State surcharge (12% of permit fee) f7
g _ - = iif y, . TOTAL PERMIT FEE '/ ,�
Print nam:� i 1111 _ � � ' ^% r t ► a te: • _ O This permit application expires if a permit is not obtained within
— - 180 days after it has been accepted as complete.
*Fee methodology set by Tn-County Building Industry Service Board
I \Building \Permn$\PLMF- PermitApp doc 12/27/06 440- 4616T(10 /02 /COM/WEB)
- Plulnbing 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 s ' 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 - I st 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 - I st 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 $1 0,001.00 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
each additional $100 00 or fraction thereof, to
Inspection of existing plumbing or
and including $50,000 00
specially requested inspections - per hour 72.50
Subtotal: $50 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*. 1=I 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
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 OAR9 1 8-780-0040.
-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 he issued.
Washer - Clothes
Water Extractor
Water Closet - Toilet
Urinal
Other Fixtures
\Budding \Permns\PLM - PermitApp doc 12/27/06