Permit CITY OF TIGARD PLUMBING PERMIT
II 1 COMMUNITY DEVELOPMENT Permit #: PLM2009-00220
T I GARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 08/13/2009
Parcel: 1 S136AA01002
Jurisdiction: Tigard
Site address: 10270 SW 70TH AVE
Subdivision: Lot: 0
Project: Tusky
Project Description: Replace exterior water service and repipe entire house, approximately 200'.
Owner: FEES
TUSKY, JOSHUA & REYNA Quantity Description Date Amount
10270 SW 70TH AVE
TIGARD, OR 97223 30 If Water Service 08/13/2009 $55.00
101 da Misc Other Fee 08/13/2009 $101.40
PHONE: 1 12% State Surcharge = 08/13/2009 $18.77
Plumbing
Contractor:
BERRY PLUMBING & CONSTRUCTION
PO BOX 1364
FAIRVIEW, OR 97024
PHONE: 503 - 491 -8395
FAX:
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp:
Stories:
Total . $175.17
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
issua - , .r i wo • ' uspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utif Notification Cente . Thos- • e are s- forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain a copy of the rules
or direct questions to OUNC calli 1 • 6699 or 1.800.332.2344.
o fo
I By: L = ued B . � a- !!� �L L Permittee Signature:
`. �
CaII 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.
•
P'rambing Permit Application
FOR OFFICE USE ONI,Y
City of Tigard Date/By: S /5 o ' •i Permit No.: lial 4 i00„, >, 4 0
ill 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
C Phone: 503.639.4171 Fax: 503.598.1960 Date/By: Other Permit No.:
T I G A R D Inspection Line: 503.639.4175 Date Ready/By: • is:,.„, 1 ® See Page 2 for
Internet: www.tigard - or.gov Notified/Method: L jej Supplemental Information
TYPE OF WORK • FEE* SCHEDULE
❑ New construction ❑ Demolition For special information use checklist
Descri•tion • . Ea. Total
yk .... Addition/alteration/replacement ❑ Other: (includes t t -
CATEGORY OF CONSTRUCTION New 1- 2-family dwellings ■ 249.20 -
IIA ■ Commercial/industrial SFR (2) bath 350.00
SFR (3) bath ■ _ ■
Each additional bath/lcitchen •• tt
tt
■ Master builder ID Other:
Fire sprinkler ( sq. ft.) Page 2
JOB SITE INFORMATION AND LOCATION .
. Site utilities
City /State /ZIP: tT ` CypNY 9 e Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.:. Project name:
Footing • 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.: ) Page 2
Storm sewer (no. linear ft.: ) Page 2
Water service (no. linear ft.:34) / Page 2 �5 •
Subdivision:
Fixture or item
Tax map/parcel no.:
Absorption valve 16.60
DESCRIPTION Backflow preventer Page 2
• •
WI o.ASP \ s i p b,\ -I Clothes washer 16.60
Dishwasher 16.60
fountain
PROPERTY OWNER I ❑ TENANT Drinking ■ t
- n . 16.60
Name: �..� 4s64'� LU `S ( E' 03 "r:t.5ESx Expansion tank 16.60
Address: Fixture/sewer cap 16.60
City /State /ZIP: Flom drain/floor t
Phone: ( ) Fax: ( ) '' disposal " '
Hose bib 1
❑ APPLICANT ❑ CONTACT PERSON 6.60
Ice maker ••t
Business name:
Interceptor/grease trap 16.60
Contact name: Medical
Address: Primer 16.60
City /State /ZIP: Roof drain 16.60
.t
Phone: ( ) I Fax: : ( )
Tub/shower/shower pan .t
E -mail:
Urinal • •t
CONTRACTOR ,
Business name: `e *t A vi-- b A , • I Water heater 16.60
Address: � • v ' �_ r '0
.• City /State /ZIP: r \v' Q `g-- 0 Z ��►
Minimum permit fee: $72.50 5-6. i
Phone: r (23) • 8 M S Fax: ( ) Residential backflow minimum permit fee: $36.25
a 4° e,6 Plan review (25% of permit fee)
CCB Lic.: , N 2 i / Plumbing Lic. no.: I % %'. ;,;.: ��
State surcharge (12% of permit fee) ri 11 ;
Authorized signature: _ ._ r 7 1 1 TOTAL PERMIT FEE
Print name: 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.
I:\ Building \Permits\PLM- PermitApp.doc 12/27/06 440- 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' 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 _ $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
-Tub/Shower ❑ New exterior plumbing site utilities for any complex structure
Bath - b /Shower
Tub /S as defined in OAR918- 780 -0040.
-Jacuzzi/Whirlpool
Car Wash Each Stall ❑ Medical gas and vacuum systems for health care facilities.
- Drive Tan, ❑ 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
3 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 ermit results in an
- Bradley 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:
is \ Building \Permits\PLM- PermitApp.doc 12/27/06