Permit CITY OF TIGARD PLUMBING PERMIT
111 11 : COMMUNITY DEVELOPMENT Permit #: PLM2012 -00356
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 12/05/2012
Parcel: 2S102CD02603
Jurisdiction: Tigard
Site address: 9605 SW HILLVIEW CT
Project: Modlin Subdivision: TWALITY HILL Lot: 3
Project Description: Install reverse plumbing and 30' of sanitary sewer line to connect to plumbing.
Contractor: TITAN PLUMBING CO LLC Owner: MODLIN, PATRICIA M
PO BOX 746 1600 MARSHALL CIRCLE
NEWBERG, OR 97132 DUPONT, WA 98327
PHONE: 253- 964 -6147
HONE: 503 - 997 -9460
FAX:
FEES
Quantity Description Date Amount
30 If Sewer Service 12/05/2012 $62.54
Specifics: 1 ea Water Piping /DWV 12/05/2012 $56.29
1 12% State Surcharge - 12/05/2012 $14.26
Type of Use: SF Plumbing
Class of Work: ALT
Type of Const:
Occupancy Grp:
Stories:
Total $133.09
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: — Permittee Signature: W7
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 RECEIVED
Building Fixtures DEC 05 2012 FOR OFFICE USE ONLY
City of Ti and Received Permit No
U 131 SW Hall Blvd., Tigard,OR 97223 Date/By: �ol / /.Z ���.�D /� QO3s C
II Phone: 503.718.2439 Fax: 503.598.1 CITY OF TIGARD Plan Review Other Permit No.:
Inspection Line: 503.639.4175 �. 1ILDING DNISION
T I G A R D P Date Ready/By: orris: El See Page 2 for
Internet: www.tigard - or.gov Notified/Method: 71 Er""Supplemental Information
TYPE OF WORK FEE* SCHEDULE
❑ New construction ❑ Demolition For special information use checklist.
Description I Qty. I Ea. I Total
dditio eration/rep acement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (1) bath 312.70
1 1 1- and 2- family dwelling ❑ Commercial/industrial 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: q 6 ...CA/ 1.1, ifv tea , el. Catch basin or area drain 18.76
City /State /ZIP: 776,14/e 0 6 • 97.24 3 Drywell, leach line, or trench drain 18.76
/ • Footing drain (no. linear ft.: ) Page 2
Suite/bldg. /apt. no.: I Project name: Manufactured home utilities 50.03
Cross street/directions to job site: (3 vyi N A Manholes 18.76
Rain drain connector 18.76
Sanitary sewer (no. linear ft.:30) Page 2 ,P, 5y
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
Clothes washer 25.02
Dishwasher 25.02
Drinking fountain 25.02
Ejectors /sump 25.02
PROPERTY OWNER I ❑ TENANT Expansion tank 12.51
Name: p T21 tin M. MODL`if Fixture /sewer cap 25.02
Address: 1 / fro Co M s1(4cL 61 R 61' L C Garbage drain/floor sink/hub 25.02
/ Gage e disposal 25.02
City /State /ZIP: DLfi4Nr W N ?J ,g 7 Hose bib 25.02
Phone: (Al 3) 9 � Y -6 Lf ( Fax: ( ) Ice maker 12.51
❑ APPLICANT ❑ CONTACT PERSON Interceptor /grease trap 25.02
Business name: Medical gas (value: $ ) Page 2
Primer 12.51
Contact name:
Roof drain (commercial) 12.51
Address: Sink/basin/lavatory 25.02
City/State /ZIP: Solar units (potable water) 62.54
Phone: ( ) Fax: : ( ) Tub /shower /shower pan 12.51
E -mail: Urinal 25.02
CONTRACTOR Water closet 25.02
/ Water heater 37.52
Business name: -7=/ 7 A / t 1/3//vG--- P P � I� i/£/LSE
Water i in W V 56.29 s4 -.29
Address: / 0 a O)C 2 6 Other: Ale/A/6"--- 25.02
City /State /ZIP: ,A/&. XR. / j 7/3,2, Subtotal li k3
Phone: ( ) Fax: ( ) Minimum permit fee: $72.50
CCB Lic.: 8 , 57 , ,/ / // g /47 /007 _ Plan review (25% of permit fee)
�' Plumbin Lic. no.:
State surcharge (12% of permit fee) /y, a 4,
x Authorized signature: ��� p
firite_6,_ G� /161 TOTAL PERMIT FEE /33r [ Print name: /? o �Y /' / e /y�)(� N Date: This permit application expires if a permit is not obtained within 180 days
�) P��/ \ 4,9,13-4:2 after it has been accepted as complete.
*Fee methodology set by Tri -County Building Industry Service Board.
1: \Building\Permits\PLMU- PermitApp.doc 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 - l 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 42,S, 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 ec
Ins tions or Fees Qty. Fee (ea) Total each additional $100.00 or fraction thereof, to
Inspections and including $10,000.00.
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 ❑ Any new commercial building with water service 2" and
greater, except systems designed and stamped by licensed
Bath: - Tub /Shower
- Jacuzzi/Whirlpool engineer.
Car Wash: Each Stall ❑ New exterior plumbing site utilities for any complex structure
Drive tall as defined in OAR918- 780 -0040.
Cuspidor/Water Aspirator ❑ Medical gas and vacuum systems.for health care facilities.
Dishwasher: Commercial ❑ 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 Filter 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
Water Closet Toilet plumbing permit can be issued.
Urinal
Other Fixtures:
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