Permit CITY OF TIGARD PLUMBING PERMIT
1 g . COMMUNITY DEVELOPMENT Permit#: PLM2015 00333
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 09/30/2015
Parcel: 2S114BC04800
Jurisdiction: Tigard
Site address: 10417 SW BONANZA WAY
Project: Ahlbrecht Subdivision: RIVERVIEW ESTATES NO.2 Lot: 85
Project Description: Irrigation backflow device.
Contractor: A L&J LANDSCAPE INC Owner: AHLBRECHT,ANTONY G&CHRISTINE
22995 SW MOUNTAIN CREEK RD 10417 SW BONANZA WAY
SHERWOOD, OR 97140 TIGARD,OR 97224
PHONE: 503-680-6337 PHONE:
FAX: 503-746-7652
FEES
Quantity Description Date Amount
1 ea Backflow Preventer 09/30/2015 $31.27
Specifics: 1 12%State Surcharge- 09/30/2015 $8.70
Plumbing
Type of Use SF 41 ea Minimum Fee Adjustment- 09/30/2015 $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 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. Yo .'obtain a copy of the rules
or direct questions t • NC by calling 503.232.1987 or 1.800.332.2344.
Issued By: `II Permittee Signature: ' 7::;/€:.. .- Y
Call 503.639.4175 by 7:00 a.m.for the ne. ..le inspection date.
This permit card shall be kept in a conspicuous place .• e job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Plumbing Permit Application
Building Fixtures RECEIVED FOR OFFICE USE ONL1
City of Tigard [p Q Received Q Permit No.
oSfV4 23 U 2015 Date/By: yje/�s" " �°G/`l�0/S v33
13125 SW Hall Blvd.,Tigard, 72
' Plan Review
Phone: 503.718.2439 Fax: 5 Other Permit No.:
Inspection Line: 503.639.4011 T OFIGARD Date/By:
I I t A R D Internet: www.ti and-ormi ILDING DIVISION Date Ready/By: )uric: Supplemental See Pent 2 Information
g Notified/Method: Supplemental Information
TYPE OF WORK FEE* SCHEDULE
El
construction ❑ Demolition For special information use checklist.
Description Qty. I Ea. Total
❑Addition/alteration/replacement p! ether: New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF C O NSTRUCTION - SFR(l)bath 312.70
r ❑ComI-and 2-family d'.s elling
mercial industrial SFR(2)bath 437.78
❑ Accessory building
12 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 Site utilities:
Job site address: /0 y,/ 7 . ,C/ 1,0444 za u/a,/ Catch basin or area drain 18.76
City/State/ZIP: 7---,.,,,,,,„:i L� Drywell,leach line,or trench drain 18.76
Q �2- 9 701 a y Footing drain(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 service(no.linear ft.: I Page 2
Subdivision: I Lot no.: Fixture or item:
Tax map/parcel no.: CBackflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
/ Clothes washer 25.02
//1 b /k//,0 v/ 01: 4a L4 1/O U/ 163-evf 11 ter (d Dishwasher 25.02
j y)---j 3 q /...oA1 5 215 l e j(/� Drinking fountain 25.02
Ejectors/sump 25.02
❑ PROPERTY OWNER I ❑ TENANT Expansion tank 12.51
/7 G- A ,/ (Li. Fixture/sewer cap 25.02
Name: �
Floor drain/floor sink/hub 25.02
Address: /6,1.//7 y� /7dn 2 G `,,y Garbage disposal 25.02
City/State/ZIP: Gju Y(1 O R_ / 7Q a " Hose bib 25.02
Phone:( ) Fax:( ) Ice maker 12.51
❑ APPLICANT ❑ CONTACT PERSON Interceptor/grease trap 25.02
Business name: A L rf , j 4 j Lq,pe /j)G Medical gas(value:$ ) Page 2
l �t Primer 12.51
Contact name: J ec5 -} G% L. €o N
Roof drain(commercial) 12.51
Address: dza q45 Sw M0v4/ in C j--et L 71 d Sink/basin/lavatory 25.02
City/State/ZIP: C y -a 0 / 0 Solar units(potable water) 62.54
Phone:(503,) 6.So- 63 3 7 Fax::( ) Tub/shower/shower pan 12.51
E-mail: .3 e/ros 6�6 xna / . C O fr' Urinal 25.02
Water closet 25.02
CO OR
Water heater 37.52
Business name: Water piping/DWV 56.29
Address: Other: 25.02
City/State/ZIP: Subtotal
Phone:( ) Fax:( ) Minimum permit fee: $72.50 Z2.5-6
Plan review (25%of permit fee)
CCB Lic.: a 0 /J _ Plumbing Lic.no.: State surcharge(12%of permit fee) j.76
Authorized signature:
'� / / TOTAL PERMIT FEE 7. aZi
Print name: ' ''` / N Date: This permit application expires if a permit is not obtained within 180 days
W`� �^ % 30 /S 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- I IOU 50.03 0 to 2,1100 $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 55,000.00 Minimum fee$72.50
Stonn&Rain Drain-each additional Ion' 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 525,000.00.
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/lu 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
Baptise r„nt
El Any new commercial building with water service 2"and
greater,except systems designed and stamped by licensed
Bath: -Tub/Shower
-Jacuzzi/Whirlpool engineer.
I=1 Car Wash: Each Stall New exterior plumbing site utilities for any complex structure
Drive Thll 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 El 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
❑ 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
Water Closet-Toilet plumbing permit can be issued.
Urinal _
Other Fixtures:
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