Permit q CITY OF TIGARD PLUMBING PERMIT
is • COMMUNITY DEVELOPMENT Permit #: PLM2013 -00240
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 07/15/2013
Parcel: 2S103DD00418
Jurisdiction: Tigard
Site address: 10725 SW FAIRHAVEN WAY
Project: Harrison Subdivision: FAIRHAVEN COURT Lot: 15
Project Description: Replace less than 100' of water service and install residential backflow preventer for irrigation system. House
grounding already exists.
Contractor: HALF MOON PLUMBING Owner: HARRISON, CALEB R & MARTI A
11720 SW SUMMERCREST DR 10725 FAIRHAVEN WAY
TIGARD, OR 97223 TIGARD, OR 97223
PHONE: 503 - 579 -2271 PHONE: 503-670-4602
FAX:
FEES
Quantity Description Date Amount
100 If Water Service 07/15/2013 $62.54
Specifics: 1 ea Backflow Preventer 07/15/2013 $31.27
1 12% State Surcharge 07/15/2013 $11.26
Type of Use: SF Plumbing
Class of Work: ALT
Type of Const:
Occupancy Grp:
Stories:
•
Total $105.07
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 ification Cen - . Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. You may obtain a copy of the rules
or ' ect questions to OUNC b alli s 503.232.1987 or 1.800.332.2344.
I ued By: / r 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 of the project.
Approved plans are required on the job site at the time of each inspection.
/'
Plumbing Permit Applicati ∎ 1
Building Fixtures '1+ CEIVED
City of Tigard I I I -- 1 5 2013 Received 1-
`y Date/By: 7 / 5 • /5 1 llh Permit No.: algoi17 D
-
9 13125 SW Hall Blvd., Tigard, OR 97 23 "�'/ z "
Plan Review
Phone: 503.718.2439 Fax: 503. f` bFTIGARD Other Permit No.:
D ateBy:
T I G A R p Inspection Line: 503.639 Date Ready/By: Juris: El See Page 2 for
Internet: www.tigard - or.gov BUILDING DIVISION Notified/Method: Supplemental Information
TYPE OF WORK FEE* SCHEDULE
For special information use checklist
❑ New construction ❑ Demolition
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 (I) bath 312.70
® I- and 2-family dwelling SFR (2) bath 437.78
y g ❑ Commercial/industrial
❑ Accessory building ❑ Multi - family SFR (3) bath 500.32
Each additional bath/kitchen 25.02
❑ Master builder ❑ Other:
Fire sprinkler ( sq. ft.) Page 2
JOB SITE INFORMATION AND LOCATION 4 Site utilities:
Job site address: 10725 S.W. Fairhaven Way Catch basin or area drain 18.76
Drywell, leach line, or trench drain 18.76
City /State /ZIP: Tigard, Or. 97223 -3824
Footing drain (no. linear ft.: ) Page 2
Suite/bldg. /apt. no.: n/a I Project name: n/a Manufactured home utilities 50.03
- Cross - street /directions job - site: Fairhaven street,south - one lot on right - - - -- - - Manholes 18.76
side of street. Rain drain connector 18.76
Sanitary sewer (no. linear ft.: ) Page 2
Storm sewer (no. linear ft.: ) Page 2
Water service (no. linear ft.: /DD ) Page 2 10 `,9. 0
Subdivision: n/a Lot no.: Fixture or item:
Tax map /parcel no.: Backflow preventer L 31.27 �3 2, X27
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 25.02
Dishwasher 25.02
• Drinking fountain 25.02
Ejectors /sump 25.02
® PROPERTY OWNER ❑ TENANT Expansion tank 12.51
Name: Caleb & Marti Harrison Fixture /sewer cap 25.02
Address: 10725 S.W. Fairhaven Way
Floor drain/floor sink/hub 25.02
Garbage disposal 25.02
City/State /ZIP: Tigard, Or. 97223 -3824 Hose bib 25.02
Phone: (503)670 -4602 Fax: ( ) Ice maker 12.51
0 APPLICANT ® CONTACT PERSON Interceptor /grease trap 25.02
Business name: Medical gas (value: $ ) Page 2
Contact name:
Primer 12.51
Roof drain (commercial) 12.51
Address:
Sink/basin/lavatory 25.02
City /State /ZIP: Solar units (potable water) 62.54
Phone: ( ) F :: ( ) Tub /shower /shower pan 12.51
E -mail: Urinal 25.02
. CONTRACTOR . - -
Water closet 25.02
Water heater 37.52
Business name: t. . . • •• .. - . - ' •�. 2 li /. / Water piping/DWV 56.29
Address: ( -'24e5 c i' Q�^�er C._4 .I■ , Other: 25.02
City /State /ZIP: ' Q� �Zz Subtotal 93. 87
Phone: 603) '"'r" - •^� 2 2. f Fax: ( ) 1 �� Minimum permit fee: $72.50
It '
CCB Lic.: (Qt + tun
. Plbin ,� . no.: � ( l l.'-+ % Plan review (25% of permit fee)
Authorized signature: r� State surcharge (12% of permit fee) / / . o o
' -." , � �_ I TOTAL PERMIT FEE 1 n S o7
Print name: ---r r Date: This permit application expires if a permit is not obtained within ISO days
`∎ �" A after it has been accepted as complete.
*Fee methodology set by Tri- County Building Industry Service Board.
1:\ BuildingWennits \PLM1J- PemutApp.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' j 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
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 - 172 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/ d for review is required an of the following.
Performed: Capped Added Relocate q any 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 OAR918- 780 -0040.
Eye Wash
Floor Drain sink 2" Submit 2 sets of plans with any of the above.
-3"
-4"
Car Wash Drain Isometric or Riser Diagram
Garbage - Domestic -non -food ❑ Isometric or riser diagram is required for new buildings
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
Washer - Clothes *Note: If the fixture work under this permit results in an
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:
h ttp: / /www. tigard- or.gov /city_hal l/departments /cd/docs/PLMF -Perm itApedoc