Permit CITY OF TIGARD PLUMBING PERMIT
1111 11- 2 COMMUNITY DEVELOPMENT Permit #: PLM2013 -00008
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 01/08/2013
Parcel: 2S102AB00300
Jurisdiction: Tigard
Site address: 12175 SW LINCOLN AVE
Project: Lincoln Subdivision:RTH TIGARDVILLE ADDITION, AMENC Lot: 63
Project Description: Backflow for landscape irrigation.
Contractor: STEVENSON & ASSOCIATES INC Owner: LINCOLN HOUSE LLC
PO BOX 23398 12175 SW LINCOLN AVE
TIGARD, OR 97281 TIGARD, OR 97223
PHONE: 971 - 228 -8431 PHONE:
FAX: 971 - 228 -8436
FEES
Quantity Description Date Amount
1 ea Backflow Preventer 01/08/2013 $31.27
Specifics: 1 12% State Surcharge - 01/08/2013 $8.70
Plumbing
Type of Use: SF 41 ea Minimum Fee Adjustment - 01/08/2013 $41.23
Class of Work: OTR
Plumbing
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 -4 a • 1 You may obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
i
Issued By: ta i _ i Permittee Signature:
Call 503.639.4175 by 7:00 a.m. for the next available inspe ' ion .
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
R ECEIVE Site Utilities OR OI :I:�CE USE
` City of Ti and Received
g JAN 0 8 2013 Date/By: / p /2 4,, Permit No.kir/a9 /3 ZV I)°,
n 13125 SW Hall Blvd., Tigard, OR 97223
Plan Revie
Phone: 503.718.2439 Fax: 503.598. 1 960 Other Permit No.:
T I Cis R D Inspection Line: 503.639.4175 CITY Q OF M TIGARD late/ ,' Date Ready/By: 1 Fa See Page 2 for
Internet: www.tigard or.gov BUILDING DIVISIO. Notified/Method: J ( Supplemental Information
!' •' 'TYPE OF WORK ° 0 FEE* ,SCHEDULE
❑ New construction ❑ Demolition For special information use checklist
Description I Qty. I Ea. I Total
❑ Addition/alteration/replacement le Other: New I- 2- family dwellings (includes 100 ft. for each utility connection)
.CATEGORY OF CONSTRUCTION SFR (1) bath 312.70
rg 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:
Job site address: 12- I - ? - 5 - r-, tN L. /N G O t_ N /fVe Catch basin or area drain 18.76
City /State /ZIP: T LG. -L' / o �- 17- 2-81:3
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: Manholes 18.76
t:_ /Ai c. / e. syyn i n C�2 t C" Rain drain connector 18.76
e. 2 0 S Sanitary sewer (no. linear ft.: ) Page 2 .
Storm sewer (no. linear ft.: ) Page 2
Water service (no. linear ft.: ) Page 2
Subdivision: I Lot no.: Fixture or item: 7?-
Tax map /parcel no.: BackOo preventer / 31.27 ;( --
DESCRIPTION OF WORK, 0 Backwater valve 12.51
" Clothes washer 25.02
/ Al S""PrZ-r -e 7 D /Yr"-X- F-1 -O^) F 12- 1 IL l 6 /YTl av Dishwasher 25.02
c-2,c 5 C OAJNC ?( C' /2 02 /N 0 O)c Drinking fountain 25.02
/VJt. 7 7c) /!Z ereg «7' Ejectors /sump 25.02
' ROPERTY OWNER ❑ TENANT Expansion tank 12.51
Name: G /Ne0 bdl!S L� Fl oo r drain / fcap 25.02
Floor drain/floor sink/hub 25.02
Address: /e; 7_5" Se-3 /--/ /./ c_404_ "/ -Az-v1- Garbage disposal 25.02
City /State /ZIP: 7 4 -�Q 2)2 9 7 a c2 Hose bib 25.02
Phone: ( ) Fax: ( ) Ice maker 12.51
. - APPLICANT .' . ., ❑ CONTACT PERSON Interceptor /grease trap 25.02 .
Business name:
Medical gas (value: $ ) Page 2
Contact name: Stevenson 8 Associates, Inc. Primer 12.51
Landscapers Nalorolly Roof drain (commercial) 12.51
Address: ' P.O. Box 23398 Sink/basin/lavatory 25.02
City /State /ZIP: Tigard, OR 97281 Solar units (potable water) 62.54
Phone: ( Cri.1 )216., got,( 3 Fax: : (ill )7,l -pi 4 1 • Tub /shower /shower pan 12.51
E -mail: Urinal 25.02
CONTRACTOR Water closet 25.02
Water heater 37.52
Business name: Water piping/DWV 56.29
Stevensun & Associates, Inc.
Address: 25.02
Landscapers Naturally Other: ,
Cit /State /ZIP: PO. Box 23398 Subtotal 3/
Tigard, OR 97281 Minimum permit fee: $72.50 7-1 W
Phone: qv ) ZZ$ - 04 3 1 Fax: E9 ? )7z.6. _et, .6'
CCB Lie:: 5 5D -L ) _AP( Plumbing Lic. no.: Plan review (25 %ofperrnit fee)
3/3 i //� TOTAL PERMIT FEE State surcharge (12% of permit fee) j " ?
Authorized signature: e /, 2 0
Print name: I Date: /215/0.- This application expires if a permit is not obtained within 180 days �!
s perm app
after it has been accepted as complete.
L C - e frze / 7J Sp/ •Fee methodology set by Tri- County Building Industry Service Board.
I:\ Building \Permits\PLMU - Permit App.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
Storm & Rain Drain - 1st 100' 62.54 Valuation: Permit Fee:
$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 Inspections or Fees Qty. Fee (ea) Total each additional $100.00 or fraction thereof, to
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/lu $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/
Work Performed: Capped Added Relocate Plan review is required for any of the following.
Baptistry/Font Please check all that apply.
Bath - Tub /Shower ❑ Any new commercial building with water service 2" and
Jacuai/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 OAR918- 780 -0040.
Eye Wash
Floor Drain/sink - 2" Submit 2 sets of plans with any of the above.
-3"
Isometric or Riser Diagram
Car Wash Drain ❑ Isometric or riser s
diagram is required for new buildings - 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/Lav - 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:
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