Permit - CITY OF TIGARD PLUMBING PERMIT
INCOMMUNITY DEVELOPMENT Permit#: PLM2012-00311
,-�„�-* Date Issued: 10/25/2012
T1CrARD! 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439
Parcel: 2S110CB07600
x:.
Jurisdiction: Tigard
Site address: 14998 SW AUGUSTA TER
Project: Ruecker Subdivision: MOUNTAIN VIEW ESTATES Lot: 1
Project Description: Irrigation backflow device.
Contractor: SOUTHWEST LANDSCAPE LLC Owner: RUECKER, DONALD CRAIG& BEVERLY
8900 SW BURNHAM ST E-108 13828 SW FANNO CREEK DR,#2
TIGARD, OR 97223 TIGARD, OR 97223
PHONE: 503-620-0149 PHONE.
FAX: 503-620-0590
FEES
Quantity Description Date Amount
1 ea Backflow Preventer 10/25/2012 $31.27
Specifics: 1 12%State Surcharge- 10/25/2012 $8.70
Plumbing
Type of Use SF 41 ea Minimum Fee Adjustment- 10/25/2012 $41.23
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: /dIvq/ / '!Permittee Signature: pG/c/9-770 _ //
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.
10/25/2012 11:45 FAX 0001/003
Plumbing PerniiiARpikgRiECEIVED FOR OFFICE USE ONLY
amend emutNop�y air-D03
City of Tigard r 5 qq _0ate/Br (61/25//2--
n 13125 SW Hall Blvd.,Tigard,Olt'97223 T �{ 20�L Plan Review
tither PermitNy�!1s����Q�a/Q
a _ Phone: 503.639.4171 Fax: 503.598.1960 narrJBy.
TI GARD Inspection Line: 503.639.4175 CITY OF TIGARD Date R,mdy/By: r
Internee www.tigard-or.gov Notified/Method: 17
Supplemental
Y. .. : e z1717 ..1.'. , - .. E* SCHEDULEid:
i
❑Demolition Porn' dal in ornio6on checklist
❑PIcw construction _ Description y Ea. Total
❑Addition/alteration/replacement ❑Other New 1-2-family dwellings(includes 100 it for each utility connection)
COiOnRUGTIQN. :`:- g."l:.;::=` ':'`.�:-:;:': SFR(1)bath 249 20
350.00
bath 3
b
2) a 5
❑ 1-and 2-family dwelling ❑Commercial/industrial SFR( 350
SFR(3)bath
❑Accessary building ❑Multi-family — - 45.00
Each additional batl/kitchent
❑Master builder ❑Other. Fite sprinkler(_^sq.ft) Page 2
...,....:: : s p: v; :,i . ,'.,:. E.,, .-.,.,,..,,, .. . .,.
- , �...'JOB_`STTE�:INFOliMATIONAND�LQCATION,ii;;„ :..;'•: ':...,-........r. .. site utilities
r -�.CCa • Catch basin or area drain • 16.60
_
Job site address: ...;\ID � - � . �'� -
�� / — Dr/well,leach line,or trench drain 16.60
City/SlatdZIP-� ('�, (`� Page 2
Footing drain(no_linear ft.:^) g
$uiteJbldgJapt.no.: — J Project name:`� Manufactured home utilities 110.00
Cross street/directions to job sift: Manholes 16.60
_ Rain drain connector 16.60
Sanitary sewer(no.linear ft.:_) Page 2
Storm sewer(no.linear R.: Page 2
-
/Lot no.: Water service(no.linear R:^). Page 2
Subdivision: _ -- Fixture or item
Tax map/parcel no.: _ Absorption valve 16.60 1
c -
Baktlowprevcntrs — Page
:. :.,-..... : Bacicwatr7 valve L6.60
�—W. (\ C;t r 1C-"' . c. 16.60
Clothes washer __
- Dishwasher 16.60
16.60
-
Dtinkmg o
.....:......: .
16.60
Name_ i tcEC&( i/i - Expansion tank 16.60
Address: 4�T7
^ A_ ,6-- Fixturclscwercap 16.60
Floor drain/floor sink/hub . 16.60
City/State/ZIP: _ _ —
Garbage disposal 16,60
_ _
Phone:( ) Fax:( ) Hose bib _ 16.60
.,.....El';'.,APPLICANT/:.
< ,CONTACT-.P
,.:. .:.. .._ .....r_::�•:.. ice 16,60
Business nam . - '*-' IWO. C.°!*I -Interceptor/grease trap 16.60
t
Contact name: _� C Va.— Medical gas(value:S ) Page 2
C --
Address: `jG[ -) -� � \--V\--..--. - 1V Primer
- 16.60
City/State/ZIP:--.--,.2.7.;c0fly f r�" p n Roof drain(commercial) 16.60
, Sinkibasin/lavatory 16.60
Phone: L S -
Tub/shower/shower pan 16.60 ,
E-mail: Urinal _ 16.60
. .. .... . :.....
Business 16.60
. — Water heater
name: Wt heter
Other.
Address: Subto
City/Statc/ZIP: O 091,1 Minimum permit f : $72,50
Fax:( ) •• , umpere ,.- - "t'
� l �fa.SC
Phone:( ) Plan review (25%of permit fee)
' B Lie.: • S/ " Plumbing Lic.no.: Srate surcharge o of permit fee) rr 70
I ►
Authorized signature: � SAL PERMIT FEE 6,_��
Date: This permit application expires if a permit is not obi ed within
Print tram_: 180 days after it has been accepted as complete.
1� 1
*Fcc methodology set by Tri-County Building Industry Service Board.
.._.,,.__,e�.:Ann..- A.,,,�a6n_6/oc pt 2) Ati.0- .6.ro%E>, 1 W aO
sci✓b ove--4"/
10/25/2012 11:45 FAX 0002/003
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Plumbing Permit Application - City of Tigard
Page 2-Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site Utilities - QtY FC(p5) ..Total- Square Footage Permit Fee
Footing drain-1"100' 55.00 Oto2000 $115.00
Footing drain-each additional 100' 46.40 2,001 to 3,600 SI60.00
3,601 to 7,200 S220.00
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
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 Fee(Ca) Total additional$100.00 or fraction thereof to and
ixturg(foe,Item 7 : . :
including S10,000.00.
Commercial Back Flow Prevention Device 46.40 $10,001.00 to 525,000.00 5148.50 for the first$10,000.00 and$154 for
Residential Baeldlow Prevention Device each additional$100.00 or fraction then:of,to
f minimum permit fee$3625) 27.55 and including 525.000.00.
'Rain Drain,single family dwelling 65.25 $25,00 1.00 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
550,001.00 and up $742.00 for the first$50,000.00 and$1_20 for
Subtotal:
each additional S100.00 or fraction thereof.
Fixture or :Igiillans"
,
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
'Onrty (Fitteire)Work Perforined greater,except systems designed anditampcd by licensed
Fixture'Type. ,".--
" Replace engineer.
'0'. 7 • •%;:;; : ..:Prevtriat1.:.:CcpWed.; 0 Any new exterior plumbing site utilities.
Baptistry/Font 0 Medical gas and vacuum systems for health care facilities.
Bath -Tub/Shower 0 Any multipurpose fire sprinkler system.
-Jacuzzi/Whirlpool 0 Any complex structure as defined in 0AR918-780-0040.
Car Wash -Each Stall
-Drive That Submit 2 sets of plans with any of the above.
Cuspidor/Water Aspirator
-
Dishwasher -Commercial 7 Isometric or Riser Diagram
Drinking Fountain - 0 ISOmetric or riser diagram is required for new buildings
Eye Wash that meet the qualifications above.
Floor Drain/sink -2"
-3-
Comments regarding fixture work:
Car Wash Drain
Garbage -Domestic
Disposal -Commercial
Ice MachJPefrig.Drains
Oil Separator(Gas Station)
Rec.Vehicle Dump Station
Shower -Gang *Note: If the fixture work under this permit results in an
-Stall • •
increase of sewer EDUs,a sewer permit will be issued and
Sink -Bar/Lavatory
fees assessed for the sewer increase must be paid before the
-Bradley
mmercial plumbing permit can be issued.
-Co
-Service
Swimming Pool Filter
Washer-Clothes
Water Extractor
Water Closet-Toilet
Urinal
Other Fixtures:
iMuildion1Pcrmits\PLM•PermitApp.doc ti9ra.t06
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