Permit n CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit #: PLM2012 -00354
T IGARD' 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 12/05/2012
Parcel: 2S 112 BD07200
Jurisdiction: Tigard
Site address: 14747 SW 79TH AVE
Project: Brittany Meadows Subdivision: BRITTANY MEADOWS Lot: 8
Project Description: Run approximately 100' of storm line and install (1) catch basin at rear of lots 8, 3 and 2.
Contractor: RENNER TRUCKING & EXCAVATING INC Owner: BRITTANY MEADOWS LLC
228 SW WALNUT ST BY WESTLUND, MORRIS R
HILLSBORO, OR 97123 16615 MAPLE CIR
LAKE OSWEGO, OR 97034
PHONE: 503 - 793 -1172 PHONE:
FAX: 503 - 846 -1354
FEES
Quantity Description Date Amount
1 ea Catch Basin or Area Drain 12/05/2012 $18.76
Specifics: 100 If Storm and Rain Drain 12/05/2012 $62.54
1 12% State Surcharge - 12/05/2012 $9.76
Type of Use: SF Plumbing
Class of Work: ALT
Type of Const:
Occupancy Grp:
Stories:
•
Total $91.06
Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. .ecialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expir if work no started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires yo . follow e rule adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952- 001 -0010 through OAR 952 -01 S S =0. You may obtain a copy of the rules
or direct stions to C by call' 03 232.1987 or 1.800.332.2344.
Issued Permittee Signature-1`110
Call 503.639.4175 by 7:00 a.m. for the next available in pection 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
Site Utilities ' I OR m.1 IcE ''USE ONL
IIEC - P' Received pry
City of Tigard ,i P No.:
Date/By: /A S / �11.?cI/a�rS 3 s
. 13125 SW Hall Blvd., Tigard, OR 97223 2012 Plan Review
F ®; Phone: 503.718.2439 Fax: 503.598.1960 DEC ®5 Date/13y: Other Permit No.:
Inspection Line: 503.639.4175 CITY //��[[ ��//�� ��pQ�� Date Ready/By: Juris ®S ee Page 2 for
TIGA - - CIT OFTIGAR1) Y Y g
Internet: www.tigard-or.gov 'WING DIVISION Notified/Method: Supplemental Information
TYPE OF WORIJ ILUIVISION FEE* SCHEDULE
❑ New construction ❑ Demolition For special information use checklist.
Description I Qty. I Ea. I Total
❑ Addition/alteration/replacement ❑ Other: New 1 - 2 - family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (1) bath 312.70
❑ I- 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:
'' Catch basin or area drain 1 18.76 /3,70
Job site address: pi 71{1 5w 75 EVE
City/State /ZIP: SCE Drywell, leach line, or trench drain 18.76
Rao / 02. 97ZZL/ Footing drain (no. linear ft.: ) Page 2
Suite/bldg. /apt. no.: Project name: 51 Mcvorx Manufactured home utilities 50.03
Cross street/directions to job site: g j 1 71 1+, Manholes 18.76
/ Rain drain connector 18.76
Sanitary sewer (no. linear ft.: ) Page 2
- ,Storm sewer (no. linear ft.: I04 Page 2 to .5
Water service (no. linear ft.: ) Page 2
Subdivision: v72, j - 401( / &RAO 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
&'A/ PO 4.7,- t - Dishwasher 25.02
Drinking fountain 25.02
Ejectors /sump 25.02
. . 0 PROPERTY OWNER I ❑ TENANT Expansion tank 12.51
Name: Fixture /sewer cap 25.02
?)P JS I' Floor drain/floor sink/hub 25.02
Address: / 6,/ 5 m A� L� .
!!�� Garbage disposal 25.02
City /State /ZIP: A 976.r/ Hose bib 25.02
Phone: (5 ) 7 9/ / V/ Fax: ( ) Ice maker 12.51
® APPLICANT (l CONTACT PERSON Interceptor /grease trap 25.02
p4cafi>c, £, � Q M ES Medical gas (value: $ ) Page 2
Business name:
Primer 12.51
Contact name: /44.44N (OFfw ( (commercial) Roof drain commercial 12.51
Address: 7V /0 5 - 4 , ) v e r<4 s/ 2D at /33 Sink/basin/lavatory 25.02
City /State /ZIP: Pv/L7 /O j t)2, 177,-z-3 Solar units (potable water) 62.54
Phone: (E) 6 ejY 6523 Fax: : ( ) Tub /shower /shower pan 12.51
E -mail: 4 / A Tt�MOOIcP_ e J crnag C -Cl►er1 Urinal 25.02
CONTRACTOR Water closet - 25.02
Water heater 37.52
Business name: Voi,44.4. t -v^g'j, • . Water piping/DWV 56.29
Address: u$ SW (�.) G► Other: 25.02
Cit /State /ZIP: 1a, :b�.o 6'(L 1,2227 Subtotal '/ . 50
l
Phone: (5' 3 ) ,,/1p - `s L Fax: ( ) atr� - 63 s1 Minimum permit fee: $72.50 _
CCB Lic.: 16 Plumbing Lic. no.: 6 146 Plan review (25% of permit fee)
State surcharge (12% of permit fee) 9.74,
Authorized signature: 9.- /(1 I TOTAL PERMIT FEE I ` Oee
Print name:
5 .44 t , ( ,.ouw Date: 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.
i \ 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 - 1' 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 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 * .
Quantity by Fixture Type Plan Review for Plumbing Installations
Fixture Type for Replace/ Plan review is any required for of the following. Performed: Capped Added Relocate q y g
Baptistry/Font Please check all that apply.
Bath Tub /Shower ❑ Any new commercial building with water service 2" and
Jacuzzi/Whirlpool greater, except systems designed and stamped by licensed
Car Wash -Each Stall engineer.
-Drive Thru ❑ New exterior plumbing site utilities for any complex structure
Cuspidor/Water Aspirator as defined in OAR918- 780 -0040.
Dishwasher - Commercial ❑ Medical gas and vacuum systems for health care facilities.
- Domestic ❑ Any multipurpose fire sprinkler system.
Drinking Fountain ❑ Any complex structure as defined in OAR9 I 8-780-0040.
Eye Wash
Floor Drain/sink - 2" Submit 2 sets of plans with any of the above.
4 " Isometric or Riser Diagram
Car Wash Drain ❑ Isometric or riser diagram is required for new buildings
Garbage - Domestic - non - food g q g
Disposal - Domestic - food related that meet the qualifications above.
•
- Commercial -food related
- Industrial -food related
Ice Mach./Refrig. Drains
Oil Separator (Gas Station) Comments regarding fixture work:
Rec. Vehicle Dump Station
Shower -Gang
-Stall
Sink/Lay - Non -food related
- Bradley
- Commercial- food related
- Service
Swimming Pool Filter *Note: If the fixture work under this permit results in an
Washer - Clothes
Water Extractor increase of sewer EDUs, a sewer permit will be issued and
Water Closet Toilet fees assessed for the sewer increase must be paid before the
Urinal plumbing permit can be issued.
Other Fixtures:
I: \Building\Permits\PLMU- PermitApp.doc 2
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