Permit CITY OF TIGARD PLUMBING PERMIT
�. • • COMMUNITY DEVELOPMENT Permit #: PLM2009 -00251
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 09/11/2009
Parcel: 1S126BC01700
Jurisdiction: Tigard
Site address: 9050 SW WASHINGTON SQUARE RD
Subdivision: Lot: 0
Project: Georgetown Manor
Project Description: Replace 500' of sewer line.
Owner: FEES
JANZEN, TIMOTHY P & RACHEL A & Quantity Description Date Amount
DOUGLAS, BRUCE D & DEBORAH L &,
REINHART, STEVEN E ET AL, 7831 SE LAKE 500 If Sewer Service 09/11/2009 $240.60
PHONE. 1 12% State Surcharge - 09/11/2009 $28.87
Plumbing
Contractor:
PRO DRAIN & ROOTER SERVICE, INC
3300 NW 185TH AVE #213
PORTLAND, OR 97229
PHONE: 503 -533 -0430
FAX: 503 - 715 -4989
Type of Use: MF
Class of Work: ALT Type of Const:
Occupancy Grp:
Stories:
Total $269.47
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 questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By:
�[ �/ �J Perrnittee Signature: / /Ln /"
e 4 /
Call 503.639.4175 by 7:00 a.m. for an inspection that business day. <7
/9L ! mil/
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.
Sep 11 09 02:51p Pro Drain 503 533 -9376 p.1
1.
- Plumbing Permit Application
Building Fixtures FOR OFFICE USE ONL1
RECEIVED R eceivai
IN City of Tigard Date/By: iv 0 ' ' Permit No A 00 02 . /
. 13125 SW Hall Blvd.. Tigard, OR 9722 Plan Review
Phone: 503 639 4171 Fax: 503.598.19 P 1 1 2009 Date/By: Other Permit No.:
T 1 GAR D Inspection Line: 503.639.4175 Date Ready /By Ions El See Page 2 for
Internet www.tigard- or.gov CITY OF TIGARD Notified/Mcthod. 77t Supplemental Information
TYPE OF wB LDING DIVISIO FEE* SCHEDULE
❑ New construction ❑ Demolition For special information use checklist
Description I Qty. ] Ea. I Total
' ►, Addition /alteration/replacement El Other: New 1- 2- family dwellings (includes 100 II. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (1) bath 249.20
❑ I- and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 350 00
ID Accessory building ON Multi - family SFR (3) bath 399 00
Each additional bath/kitchen 45 00
El Master builder ❑ Other:
Fire sprinkler ( sq. ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities
Job site address: 1 _ _amps ia‘• • a , \ , Catch basin or area drain 16.60
IIIME EMEt - Z D2 7 Drywell, leach line, or trench drain 16.60
Suite. bldg. /apt. no.: Project name Pooling drain (no. linear ft.: ) Page 2
�'' • . sari - � a al Manufactured home utilities 1 10.00
Cross street/directions to job site: _ w
Manholes I 16.60
Rain drain connector 16.60
Sanitary sewer (no. linear ft..ri CO) 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/parcet no.:
Absorption valve 16.60
DESCRIPTION OF WORK Backflow preventer Page 2
• - ` - I AP.• ii1 al ' it ii, ,1 _ g Backwater valve 16.60
• 1 'ID Clothes washer 16.60
Dishwasher 16.60
El PROPERTY OWNER I ❑ TENANT Drinking fountain 16 60
Ejectors/sump 1660
Name: Expansion tank 16.60
Address: Fixture /sewer cap 1660
City /State /ZIP: Floor drain/floor sinkrhub 1 16.60
Phone: ( ) Fax: ( ) Garbage disposal 16.60
❑ APPLICANT 1:1 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: Pnmer 16.60
City /State/ZIP: Roof drain (commercial) 16.60
Phone { ) Fax:: ( ) Sink/basin/lavatory 16.60
Tublshower,'showcr pan 16.60
E -mail: Urinal 16.60
CONTRACTOR Water closet 16.60
Business nap • ,(-1 dr 1.16 *ll . , ' • Water heater 16.60
Address: `�3(O A l$C A � I Other. .
�✓ ` Subtotal
City /State//ZI'. ' . a • • •
Minimum permit fee: $72.50 .1,, ,
Phone: OimirellirMIIIIIMIEAILlY.d / Residential backflow minimum permit fee. $36.25_ r
I • Plumbing Lie. no.: • _ I ♦ Plan review (25% of permit fee)
Authorized signature: ' I Stale surcharge (12% of permit fee) aP,
L_ ; . l - TOTAL PERMIT FEE �4r? • 97
Print name: = . 411 , 1116‘ - Date: 9_ . U9 This permit application expires if a permit is not obtained within
180 days after it has been accepted as complete. �,�(/
*Fee methodology set by Tri- County Building Industry Service Board.
Sep 11 09 02:52p Pro Drain 503 533 -9376 p.2
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
1st 100' 55.00 3,601 to 7.200 5220.00
Sewer
��Q�3 C SJ�, 7,201 and greater $309.00
Sewer - each additional 100' .(4( :)q.' 46.40 1$5 160
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 SI.00 to $5,000 00 Minimum fee $72.50
Storm & Rain Drain - each additional 100' 46.40 S5,001 00 to $10,000.00 $72.50 for the first $5,000,00 and St.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 Wand $1 45 for
Inspection of existing plumbing or each additional $100.00 or fraction thereof. to
specially requested inspections - per hour 72.50 a and including the $50,000.00.
Subtotal: ) , (.03 $� $50,001.00 and up $742.00 for the First $50,000 00 and $1.20 for
•e 2 `! 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
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 OAR9I8 -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 U Isometric or riser diagram is required for new buildings
Floor Drain /sink - 2" that meet the qualifications above.
-3'
Car Wash Drain
Garbage -Domestic Comments regarding fixture work:
Disposal - Commercial
- industrial
lee Mach.lRefrig. 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
Unnal
Other Fixtures: