Permit CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit #: PLM2009-00085
13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 04/13/2009
TIGARD g Parcel: 1S135DC06500
Jurisdiction: Tigard
Site address: 11.665rSW_92ND:AVE>
Subdivision: COURT Lot: 13
Project: Munoz
Project Description: Install residential backflow preventer for irrigation.
Owner: FEES
MUNOZ, JESUS & OLIVIA Quantity Description Date Amount
11665 SW 92ND AVE 1 ea Backflow Prevention - RES 04/13/2009 $27.55
TIGARD, OR 97223 1 12% State Surcharge - 04/13/2009 $4.35
PHONE:
Plumbing
9 ea Minimum Fee Adjustment 04/13/2009 $8.70
Contractor: - Plumbing
OWNER
PHONE:
FAX:
Type of Use: SF
Class of Work: OTR Type of Const:
Occupancy Grp:
Stories:
Total $40.60
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 itwork is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility otification Ce r. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain a . • • ' of the rules
Is ued By: / Permittee Signature: k -. 7
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 oft project.
Approved plans are required on the job site at the time of each inspection.
Plumbing Permit Application
Building Fixtures FOR'OFFICE USE ONLY
City of Tigard Date/By: ,Al c ( Permit No.: r( �' PS . • 11
v 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
= Phone 503 639.4171 Fax: 503.598.1960 Other Permit No.:
I Date/By:
TI GA RD Inspection Line: 503.639.4175 Date Ready /By: t s./1 ® See Page 2 for
Internet: www.tigard - or.gov Notified/Method: G Supplemental Information
TYPE.,OF WORK ' �. _ � ` FEE* SCIDULE`
El New construction ❑ Demolition For special information use checklist.
Description Qty. I Ea. Total
El Addition/alteration/replacement El Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
r , -- CATEGORY; OF CONSTRUCTION . - -, - SFR (l) bath 249.20
❑ 1- and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 350.00
El Accessory building El 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 6- S cA_) 9' z h . 4 V e Catch basin or area drain 16.60
City /State /ZIP: 71 . a y-d t Or- 4 j 7a0 3 Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: Project name: 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.: ) Page 2
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.:
. Absorption valve 16.60
A, �. DESCRIPTION `OF' WORK °' '' Backflow preventer / Page 2 09 7. 5
// � c - (,t.) ./- /42 /6 f�� Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
- Drinking fountain 16.60
❑,wPROPERTY" OWNER ° .1'.. ', . la TENANT:' .
MU ^ Ejectors /sump 16.60
M
Name: J € S U S U 1 1 0 Z Expansion tank 16.60
Address: 1166 Sul 9Z c) Ilu e Fixture /sewer cap 16.60
City /State /ZIP: / f Q ycL Or. 5 7 a 3 Floor drain /floor sink/hub 16.60
Phone: 503 ) 3 $ O - i S R y Fax: ( ) Garbage disposal 16.60
Hose bib 661
:.; ❑- ,.APPLICANT .. e - ' - ❑ .CONTACT :PERSON ; a
Ice maker 16.60
Business name: Interceptor /grease trap 16.60
Contact name: Medical gas (value: $ )
Address: Primer 16.60
City /State /ZIP: Roof drain (commercial) 16.60
Phone: ( ) Fax:: ( ) Sink/basin/lavatory 16.60
Tub /shower /shower pan 16.60
E -mail:
Urinal 16.60
CONTRACTO - • Water closet 16.60
Business name: () (A Water heater 16.60
Address: Other:
City /State /ZIP: Subtotal
Minimum permit fee: $72.50 �� jj a -
Phone: ( ) Fax: ( ) Residential backflow minimum permit fee: $36.25 °`
CCB Lic.: ' Plumbing Lic. no.:
Plan review (25% of permit fee) --Cr
State surcharge (12% of permit fee) '.
Authorized signature: /e a • TOTAL PERMIT FEE er/t94.(c0
Print name: J e U 5 //y Lc) rV o L Date: 9//3/01 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.
P\ Building\Permits\PLMF- 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:
r Site Utilities q . tt Qty: Fee (ea) Torah S ' g iiare Foota , Permit`Fee
Footing drain - l 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
Valuatiori: `t. 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
additional $100.00 or fraction thereof, to and
Fi%tlire,Or'Item', °" Qty:. - Fee,(ea)' , Total;
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
each additional $100.00 or fraction thereof, to
Inspection of existing plumbing or
and including $50,000.00.
specially requested inspections - per hour 72.50
Subtotal: $50,001.00 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 hnstallations°.: -i
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
Quaridtyby'(Fixture) Work Performed greater, except systems designed and stamped by licensed,
V Fizture: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 Isometrics OP`=Riser�Diagram,
Eye Wash ❑ Isometric or riser diagram is required for new buildings
Floor Drain /sink - 2" that meet the qualifications above.
-3"
-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
- Bradley *Note: If the fixture work under this permit results in an
- 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