Permit CITY OF TIGARD PLUMBING PERMIT
t ; COMMUNITY DEVELOPMENT
Permit #: PLM2009 -00216
' 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 04/29/2010
T1GA RD Parcel: 2S102BA00400
Jurisdiction: TIG
Site address: 9780 SW TIGARD ST
Subdivision: Lot:
Project: PIPELINE PLUMBING
Project Description: Install 300' of sanitary sewer and sewage ejector pump.
Owner: FEES
PIPELINE PLUMBING Quantity Description Date Amount
ADAM AND LORI FAREN, 9780 SW TIGARD ST
TIGARD, OR 97223 300 If Sewer Service 04/29/2010 $147.80
1 ea Ejectors /Sump 04/29/2010 $16.60
PHONE: 1 12% State Surcharge - 04/29/2010 $19.73
Plumbing
Contractor:
PIPELINE PLUMBING
333 S STATE ST, STE. V -108
LAKE OSWEGO, OR 97034
PHONE: 503 - 624 -1906
FAX: 503 - 624 -1926
Type of Use: COM
Class of Work: ALT Type of Const:
Occupancy Grp:
Stories:
Total $184.13
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 -0100. You may obt 'n a copy of the rules
or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By: Permittee Signature:
Call 503.639.4175 by 7:00 a.m. for an Inspection that business day.
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.
Accumulative Sewer Tally Parcel # 2S102BA00400
Tenant Name: Pipeline Plumbing This SWR# 2009 -00080
Site Address: 9780 Tigard St This PLM# 2009 -00216
Fixture Value Previous Previous Credits Capped Fixture Fixture New New
# value capped off value added added total total
count off #s count # value #s values
Baptisery /Font 4 0 0 0 0 0
Bath - Tub /Shower 4 0 0 0 0 0
- Jacuzzi /Whirlpool 4 0 0 0 0 0
Car Wash - Each Stall 6 0 0 0 0 0
- Drive through 16 0 0 0 0 0
Cuspidor /Water Aspirator 1 0 0 0 0 0
Dishwasher - Commercial 4 0 0 0 0 0
- Domestic 2 0 0 0 0 0
Drinking Fountain 1 0 0 0 0 0
Eye Wash 1 0 0 0 0 0
Floor Drain /Sink - 2 inch 2 0 0 0 0 0
- 3 inch 5 0 0 0 0 0
- 4 inch 6 0 0 0 0 0
- Car Wash Drn 6 0 0 0 0 0
Garbage Disposal
- Domestic (to 3/4 HP) 16 0 0 0 0 0
- Commercial (to 5 HP) 32 0 0 0 0 0
- Industrial (over 5 HP) 42 0 0 0 0 0
Ice Machine /Refrigerator Drain 1 0 0 0 0 0
Oil Sep (Gas Station) 6 0 0 0 0 0
Rec. Vehicle Dump station 16 0 0 0 0 0
Shower - Gang (per head) 1 0 0 0 0 0
- Stall 2 0 0 0 0 0
Sink - Bar /Lavatory 2 0 0 2 4 2 4
- Bradley 5 0 0 0 0 0
- Commercial 3 0 0 0 0 0
- Service 3 0 0 1 3 1 3
Swimming Pool Filter 1 0 0 0 0 0
Washer - Clothes 6 0 0 2 12 2 12
Water Extractor 6 0 0 0 0 0
Water Closet - Toilet 6 0 0 0 0 0
Urinal 6 0 0 0 0 0
Previous EDU Count 0 0
Capped EDU Credit 0
TOTALS 0 0 0 0 5 19 5 19
Current Fixture Value 19 divided by 16 = 1.2 Current EDU 1 EDU = $ 3,600
Previous Fixture Value 0 divided by 16 = 0.0 Previous EDU
Change 19 divided by 16 = 1.2 over (under) $ 4,320.00
Enter EDU Change Here 1.2
Notes: Connect existing structure to sewer service.
Authorized Name /Signature: Debbie Adamski ci Date: 8/11/2009
Building Division
Note: The property owner shall retain the ORIGINAL sewer tally record. If credits exist, this document will serve as a voucher which must be
submitted to the City of Tigard Building Division to redeem credits towards future system development charges.
I: \Building \Sewer Tally \SewerTallySheet- 3600.xls 06/25/08
Plumbing Permit Application .., 2, 1, •- •rrl'r
I ; FOR OFFICE USE ONLY
City of Tigard Received ���9 P No.: 1
� I DOp /
a Date
l
1,1
13125 SW Hall Blvd., Tigard; OR 972 2 Plan Review
_ Phon 503.639.4171 Fax: 503.56 Date /By: Other Permit No.aegeOr?. - ■80
Inspection Line: , 503.639.4175 ., "'` \,
TIGARD g an g ov .. , \' ri r i �._'3, Notified/Method: .1 l � M See Page 2 for
Internet: www.ti Supplemental Information
www.tigard-or.gov
OF WORK% ) s FEE* SCHEDULE
1'
❑ New construction ❑ Demolition For special information use checklist
Description Qty. 1 Ea. 1 Total
0 Addition/alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (1) bath 249.20
❑ I- and 2- family dwelling KJ Commercial /industrial SFR (2) bath 350.00
❑ Accessory building ❑ Multi - family SFR (3) bath 399.00
Each additional bath/kitchen 45.00
❑ Master builder ❑ Other:
Fire sprinkler ( sq. ft.) Page 2
JOB SITE INFORMATION AND LOCATION ' Site utilities
Job site address: '6� Ca tch basin or area d rain 16.60
�`j 7�b SW \ ‘,.,6_,..„A, -
City /State /ZIP: k � 1 'S� g12-Z Drywell, leach line, or trench dram 16.60
-
J _ ) Page 2
Suite/bldg./apt. no.: l Project name: � L t tJ� 1 1.�H�f Footing dram (no. linear ft.: .
Cross street /directions to job site: Manufactured home utilities 110.00
5t ���^ �� �`�^� Manholes 16.60
6 - Rain drain connector 16.60
Sanitary sewer (no. linear ft.: ;3et)) Page 2 /Z/7, $O
Storm sewer (no. linear ft.: ) Page 2
Subdivision: I Lot no.: Water service (no. linear ft.: ) Page 2
Fixture or item
Tax map /parcel no.: a 510 R 4 j �
Absorption valve 16.60
DESCRIPTION OF WORK Backflow preventer Page 2
n 47:■.\t Sz w . e t t. `, Q . I - � (lg .- 0$ ._ Backwater valve 16.60
3b(:) e 7 `� J r Clothes washer 16.60
schc� % o \ \
Dishwasher 16.60
❑ PROPERTY OWNER ❑ TENANT Drinking fountain 16.60
Ejectors /sump L 16.60 /U '60
Name: c6.04■ t LrX, _ems Expansion tank 16.60
Address: 0 5,1,1 - S{ , Fixture /sewer cap 16.60
City /State /ZIP: • � Floor drain / floor sink /hub 16.60
Ttt r a ti� z2 3 _
Phone: (SC3) (p'3 2,0( Fax: ( ) Garbage disposal 16.60
❑ APPLICANT ❑ CONTACT PERSON Hose bib 16.60
t�` Ice maker 16.60
Business name: P ( Qr' x t"U C 1 U✓VY\b\ v_, Interceptor /grease trap 16.60
Contact name: pa,A ^i\ ^ �C ,s ex� J Medical gas (value: $ ) Page 2
Address: 331 5 , s S k R 1 p Primer 16.60
L Roof drain (commercial) 16.60
City/State/ZIP:
La.\c_L Y-)5tr.5R 0 6O q l
Phone: 663 ) (oq., _ i b J Fax: : (5d3) 62 ` \9 Sink/basin/lavatory 16.60
Tub /shower /shower pan 16.60
E -mail: Urinal 16.60
CONTRACTOR Water closet 16.60
Business name: Q. 1 ‘4\4._ Pk u ,,j, Water heater 16.60
Address: S - e � g \I _ \0?� Other: t
3 "3 "3 .
City/State/ZIP: Subtotal
Cit
Y LC\ \C� b 5„ e c30 C X _ 9 70 �' \ Minimum permit fee: $72.50 ) / _, / (�
Phone: (( 3) 6Z 4 _ Iq .0 4 Fax: (5G3) (0 Li \9 244 Residential backflow minimum permit fee: $36.25 i -r ( o
CCB Lic.: t 5 g Ac., J Plumbing Lic. no.: 8'660 Plan review (25% of permit fee) $-
� �j l0 State surcharge (12% of permit fee) / 9 - 73
Authorized signature: I tJ q. / 3
TOTAL PERMIT FEE U I
Print name: ` e...- Ca/ Pn/‘._ Date- ) I I /0 9 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.
1 t Building ■Permits■PLM- PermitApp.doc 12/27/06 440- 4616T(I0 /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' 55.00 0 to 2,000 $115.00
Footing drain - each additional 100' 46.40 2,001 to 3,600 $160.00
3,601 to 7,200 $220.00
Sewer - 1st 100' 55.00 7,201 and greater $309.00
Sewer - each additional 100' 46.40
Water Service - Ist 100' 55.00 Medical Gas Systems:
Water Service - each additional 100' 46.40
Valuation: Permit Fee:
Storm &Rain Drain - 1st 100' 55.00 $1.00 to $5,000.00 Minimum fee $72.50
Storm & Rain Drain - each additional 100' 46.40 $5,001.00 to $10,000.00 $72.50 for the first $5,000.00 and $1.52 for each
Q ty. Fee (ea) Total additional $100.00 or fraction thereof, to and
Fixture or Item including $10,000.00.
Commercial Back Flow Prevention Device 46.40 $10,001.00 to $25,000.00 $148.50 for the first $10,000.00 and $1.54 for
Residential Backflow Prevention Device each additional $100.00 or fraction thereof, to
(minimum permit fee $36.25) 27.55 and including $25,000.00.
Rain Drain, single family dwelling 65.25 $25,001.00 to $50,000.00 $379.50 for the first $25,000.00 and $1.45 for
Inspection of existing plumbing or each additional $100.00 or fraction thereof, to
and including $50,000.00.
specially requested inspections - per hour 72.50 $50,001.00 and up $742.00 for the first $50,000.00 and $1.20 for
Subtotal: each additional $100.00 or fraction thereof.
Commercial Fixture Work:
Are you capping, adding or replacing fixtures? If "yes ", Plan Review for Plumbing Installations
please indicate work performed by fixture. Failure to Plan review is required for any of the following.
accurately report fixtures could result in increased sewer fees * . Please check all that apply.
Quantity by (Fixture) Work Performed ❑ Any new commercial building with water service 2" and
Fixture Type: Replace greater, except systems designed and stamped by licensed
Previous Capped Added Existing engineer.
Baptistry/Font
Bath - Tub /Shower El New exterior plumbing site utilities for any complex structure
Tub /Sh /Whirlpool as defined in OAR918- 780 -0040.
El Car Wash Each Stall Medical gas and vacuum systems for health care facilities.
Drive Thru CI Any multipurpose fire sprinkler system.
Cuspidor /Water Aspirator ❑ Any complex structure as defined in OAR918- 780 -0040.
Dishwasher - Commercial
Domestic Submit 2 sets of plans with any of the above.
Drinking Fountain
Eye Wash Isometric or Riser Diagram
Floor Drain /sink - 2" ❑ Isometric or riser diagram is required for new buildings
that meet the qualifications above.
-4"
Car Wash Drain
Garbage - Domestic Comments regarding fixture work:
Disposal - Commercial
- Industrial
Ice Mach./Refrig. Drains
Oil Separator (Gas Station)
Rec. Vehicle Dump Station
Shower -Gang
-Stall
Sink - Bar/Lavatory *Note: If the fixture work under this permit results in an
- Bradley uner p
- Commercial increase of sewer EDUs, a sewer permit will be issued and
- Service fees assessed for the sewer increase must be paid before the
Swimming Pool Filter plumbing permit can be issued.
Washer - Clothes
Water Extractor
Water Closet - Toilet
Urinal
Other Fixtures:
i:\ Building\Permits\PLM- PermitApp. doc 12/27/06