Permit CITY OF TIGARD PLUMBING PERMIT
1 MI C COMMUNITY DEVELOPMENT Permit #: PLM2013 -00176
TIGARD 13125 SW Hall Blvd , Tigard OR 97223 503.718.2439 Date Issued: 06/06/2013
Parcel: 2S102AC01101
Jurisdiction: Tigard
Site address: 12562 SW MAIN ST 100
Project: Max's Brew Pub Subdivision: BURNHAM TRACT Lot: 1
Project Description: Installation of backflow preventer for irrigation system
Contractor: TERRA -SOL LANDSCAPING Owner: 12562 MAIN ST LLC
21685 SW HEDGES DR BY GEORGE DIAMOND
TUALATIN, OR 97062 2839 SW 2ND AVE
PORTLAND, OR 97201
PHONE: 503 - 691 -6105 PHONE:
FAX
FEES
Quantity Description Date Amount
1 ea Backflow Preventer 06/06/2013 $31 27
Specifics: 1 12% State Surcharge - 06/06/2013 $8 70
Plumbing
Type of Use: COM 41 ea Minimum Fee Adjustment - 06/06/2013 $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 Cod te r• e of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans This permit will expire if w.rk is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION. Oregon law requires you to foll.w the rules adopted by the Oregon
Utility ification er Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 :01-0090 You may obtain a copy of the rules
or ' ect questions to OUN b - � � t 03.232.1987 or 1 800.332 2344
e
Iss d By: , 44 /(//
■ I Permittee Signature: i
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 o he project.
Approved plans are required on the job site at the time of each inspec ion.
Plumbin Permit A licatio
Building Fixtures
City of Tigard JUN 0 g Rved //�
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u 13125 SW Hall Blvd., Tigard,OR 97223 Plan Review
C Phone: 503.718.2439 Fax: 503.1 OFTIGApD Date/By • Other Permit No.
Inspection Line: 503.639.4175 B�DINGDIVISI Date Read B Jurist El See Pa e 2 for
Internet: www.ti
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g g Ol r Notified/Method: Supplemental Information
TYPE OF WORK FEE* SCHEDULE
❑ New construction ❑ Demolition For special information use checklist
Description I Qty. I Ea. I Total
Addition/alteration/replacement ❑ Other: New I- 2- family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (1) bath 312.70
❑ 1- and 2- family dwelling ,'m
Comercial/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: J 2 y Co MOM <> _ Catch basin or area drain 18.76
City /State /ZIP: 1} Drywell, l line, or trench drain 18.76
t /(. t Footing dra (no. linear ft.: _) Page 2
Suite bldg. /apt. no.: Project name: Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
Rain drain connector 18.76
Sanitary sewer (no. linear ft.: ) Page 2
Storm sewer (no. linear ft.: ) Page 2
Water • _ . linear ft. ) Page 2
Subdivision: Lot no.: Ix ure or t .
Tax map /parcel no.: Backllow prevent I 31.27 3/.27
DESCRIPTION OF WORK Backwate ve 12.51
;6 ti ;�� ^ Clothes washer 25.02
�C./� � Dishwasher 25.02
Dnnking fountain 25.02
Ejectors/sump 25.02
❑ PROPERTY OWNER I TENANT Expansion tank 12.51
Oft Name: u ek) . S J j wu Fixture /sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address: -
Garbage disposal 25.02
City /State /ZIP: Hose bib 25.02
Phone: (507) "330 -14090 Fax: ( ) Ice maker 12.51
APPLICANT ❑ CONTACT PERSON Interceptor /grease trap 25.02
Business name: (�ZQ� _ 4 0 , ��C .1,,,� Medical gas (value $ ) Page 2
Contact name: o � \ t 0 S 5 co 1,4 ' _\ 0 Primer 12.51
-{ Roof drain (commercial) 12.51
-
Address: VLJ `-C V(l� IS - c177 Q ( Z, Sink/basin/lavatory 25.02
d/i f,
City/State/ZIP: o % Y(\ m MO,Arl (1& Solar units (potable water) 62.54
Phone: 0) 109 I - (p ( O I Fax: : ( ) Tub /shower /shower pan 12.51
E -mail: 7 ( iP Sot, I A4,...\D es G 4v,\., , cbiLi Urinal 25.02
CONTRACTOR Water closet 25.02
Water heater 37.52
Business name: �/1�
L i Water piping/DWV 56.29
Address: ! Other 25.02
City/State /ZIP: Subtotal
Phone: ( ) Fax: ( ) Minimum permit fee: $72.50 7o1_S--6
CCB Lie.: /0 l of A Plumbing Lic. no.: Plan review (25% of permit fee) -
State surcharge (12% of permit fee) q. 70
Authorized signature: ' . • ■ ` TOTAL PERMIT FEE €g"( .
Print name \ , • «\ eA VNIVeIi✓. Date: i 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\Pl.MU- Perrnitpp..• .: 09 440-4616T(I0 /02/COM/WFB)
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 Inspections or Fees Qty. Fee (ea) Total each additional $100.00 or fraction thereof, to
P 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
❑ Any new commercial building with • . ter service 2" and
Baptistry/Font greater, except systems designed .. d stamped by licensed
Bath: - Tub /Shower
- Jacuzzi/Whirlpool engineer.
Car Wash: Each Stall ❑ New exterior plumbing site ilities for any complex structure
Drive Thru as defined in OAR918 -7: t -0040.
Cuspidor/Water Aspirator ❑ Medical gas and vacu systems for health care facilities.
Dishwasher. Commercial 0 Any multipurpos re sprinkler system.
- Domestic �] A Any com e • 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
❑ 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 -Lay/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
WaterCloset - Toilet plumbing permit can be issued.
Urinal
Other Fixtures:
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