Permit O?" CITY OF TIGARD
PLUMBING PERMIT
Too
. •;'; COMMUNITY DEVELOPMENT Permit #: PLM2009 -00176
a ry +r ''` , 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 08/05/2009
T1GR.D g Parcel: 1S134BC00300
Jurisdiction: Tigard
Site address: 12210 SW SCHOLLS FERRY RD
Subdivision: Lot: 0
Project: Coffee Rush
Project Description: Installing 140' of sanitary sewer to service manufactured structure. Water service done under
separate permit.
Owner: FEES
FW OR- GREENWAY TOWN CENTER LLC Quantity Description Date Amount
PO BOX 790830
SAN ANTONIO, TX 78279 140 If Sewer Service 08/04/2009 $101.40
1 12% State Surcharge - 08/04/2009 $18.77
PHONE: Plumbing
Contractor:
FLYING H CONSTRUCTION CO
PO BOX 2533
WILSONVILLE, OR 97070
PHONE: 503 - 678 -4224
FAX:
Type of Use: CMS
Class of Work: OTR Type of Const:
Occupancy Grp:
Stories:
Total $120.17
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 obtain a copy of the rules
or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By: � `ol ��
` Ay , Permittee Signature:
l 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.
. ' , - I* nbi g Permit Application M l�' ( 7
SUE t „ : trr� .FOR 'OFFICE US O
Site Utilities 4 ! 1 � , : .: t .,., ,...., :
CI of T• and � Received q Permit No.: J C,+� �/� -7
IN a 13125 SW Hall Blvd., Tigard, OR I�j fl 0 2 2009 Date/By: 7 R (4 / p i N L// / fici� / f0
DPlan ate Rev y lS/ iew
M . Phone: 503.639.4171 Fax: 503.598.1960 �h Other Permit No.: 9�0
B
Inspection Line: 503.639.4175 CITY TIGnRD Y OF TIGARD Date Read /B Y RI Pa S e 2 for
. Internet: www.tigard- or.gov
BUILDING DIVI - • Notified/Method: f 7! Supplemental Information
.TYPE OF WORK /' ,,,,/. FEE *,:SCHEDULE '. .
❑ New construction ❑Demo ' ' . / Description For special information use checklist
J Qty. 1 Ea. 1 Total
❑ Addition/alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION .. SFR (I) bath 249.20
❑ 1- and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 350.00
❑ Accessory building 1:1 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: p ! 'C -44t - f % Catch basin or area drain 16.60
City/State /ZIP: - 1 1 64\ -- P--IN . 642_ ,1 - 7 'L'y? Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: 1 Project name: /- 6,E4 g_.4 Footing drain (no. linear ft.: _) Page 2
Manufactured home utilities 110.00
Cross street/directions to job site:
-
Manholes 16.60
Rain drain connector 16.60
Sanitary sewer (no. linear ft.: I4d) Page 2 /Of • ill
Storm sewer (no. linear ft.: tilk) Page 2
Subdivision: Lot no.: Water service (no. linear ft. , - Page 2
Tax map /parcel no.: / L f 3 (16 0 .� O 3 Q Fixture or item
Absorption valve 16.60
. DESCRIPTION OF WORK . ; Backflow preventer Page 2
YVtN6 k AJ 111 14. 5 1...1 ) ( (A)g 04-4+t} L-Ot & i 11 ft-12J) Backwater valve 16.60
To 11-7-47 S-w cc-II-DLLs- Fy r--ii tN - 116 -P- f C-evMTt - Clothes washer 16.60
E'v� -, iS t-o6 • PA S) 4 A 1" t'AfnE'u"f ,A.IA o'1 t Lt y"7` W ��2 lL~ Dishwasher 16.60
fob'- t\V €'- /J ' -O 1 tiV
Drinking fountain 16.60
Q'■ROPERTY OWNER ` I ' ❑ TENANT
Ejectors /sump 16.60
Name: Gam Nivitvy i O--Aw t N-t9 4 _. 1
c� ,Z EC,�C�L�, �- Expansion tank 16.60
Address: 6 ,1, VV b 'J , 12 -01�, Sv(TE i Fixture /sewer cap 16.60
City /State /ZIP: C1=i- O tM€c.(a0, - OP- q1 O 3C Floor drain /floor sink/hub 16.60
Phone: (4 3 j) 603 - 41 D V Fax: ( ) Garbage disposal 16.60
' ' ❑ APPLICANT . •-' , `: -[CONTACT. PERSON , Hose bib 16.60
Ice maker 1 16.60
Business name:
�� Interceptor /grease trap ' 16.60
Contact name:„ ()� - l ------ Medical gas (value: $ ) t A Page 2
Address: Primer IF ,' 16.60
/
City /State /ZIP: Roof drain (commerc ` 16.60
' j Sink/basin/lavator 16.60
Phone: ( � 9 7U ` "I 7 (Q Fax:: ( )
Tub /shower /shower a \ 16.60
E -mail: Urinal vv • 16.60
CONTRACOR._ ..__
U
;�.�.,.__ -_.�- � _... Water closet , i 16.60
Business name: f"ty0)6 AI t J5T2u.�pd Water heater 1 16.60
Address: Other:
i City /State /ZIP: 2 '/ Subtotal �� • 7
, /
�l- rl�lvo - - D 9 -.- Minimum permit fee: $72.50
�
Pi one: (ti p3) 9, rj - / g to Fax: (� j) Residential backflow minimum permit fee: $36.25
I CCB Lic.: / 1 4,99 al /y/fD Plumbing Lic. no.: 3 --344f 0 4 Plan review (25% of permit fee) - F =} rg07
State surcharge (12% of permit fee) ( .-7 7
AnlhoriLad signature: �� 7/1 /l� TOTAL PERMIT FEE j 1 7
Print name: N it-LI l R-1 SS EL Date: 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:\Building \Permits \PLMU- PermitApp.doc 12/27/06 440- 4616T(10 /02 /COM/WEB) 11 l / 3, 7 � I�
. � R/
Plumbing Permit Application - City of Tigard ° ' - mil
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site Utilities Qty. Fee (ea) Total Square Footage: Permit Fee:
Footing drain - 1s' 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 - 1st 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
Fixture or Item Qty. Fee (ea) Total additional $100.00 or fraction thereof, to and
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
Subtotal: $50 and up $742.00 for the first $50,000.00 and $1.20 for
each additional $100.00 or fraction thereof.
Commercial Fixture Work: Plan Review for Plumbing Installations
Are you capping, adding or replacing fixtures? If "yes", Plan review is required for any of the following.
please indicate work performed by fixture. Failure to Please check all that apply.
accurately report fixtures could result in increased sewer fees * . ❑ Any new commercial building with water service 2" and
Quantity by (Fixture) Work Performed greater, except systems designed and stamped by licensed
Fixture Type: Replace engineer.
Previous Capped Added Existing ❑ New exterior plumbing site utilities for any complex structure
Baptistry/Font as defined in OAR918- 780 -0040.
Bath - Tub /Shower ❑ Medical gas and vacuum systems for health care facilities.
- Jacuzzi/Whirlpool ❑ Any multipurpose fire sprinkler system.
Car Wash -Each Stall ❑ Any complex structure as defined in OAR918- 780 -0040.
-Drive Thru
Cuspidor /Water Aspirator Submit 2 sets of plans with any of the above.
Dishwasher - Commercial
- Domestic
Drinking Fountain Isometric or Riser Diagram
Eye Wash ❑ Isometric or riser diagram is required for new buildings
Floor Drain/sink - 2" _ hl. that meet the qualifications above.
-3" _
- 4"
Car Wash Drain
Garbage -Domestic Comments regarding fixture work:
Disposal -Commercial (� /
- Industrial 1' V1
Ice Mach. /Refrig. Drains c »s' t [.o0Q /Jk S
Oil Separator (Gas Station)
Rec. Vehicle Dump Station 1 3 - (!.r -IP 6t A)k
Shower -Gang t MA 0, , tJii,
• -Stall
Sink - Bar/Lavatory / 1 HO P `tt N J
. - Bradley *Note: If the fixture work under this permit results in an
- Commercial 3 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 \PLMU - PermitApp.doc 2