Permit III „,, CITY OF TIGARD PLUMBING PERMIT
: r = COMMUNITY DEVELOPMENT Permit #: PLM2011 -00199
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 06/28/2011
Parcel: 2S110CB08800
Jurisdiction: Tigard
Site address: 12446 SW ST ANDREWS LN
Project: Mountain View Estates Lot 13 Subdivision: MOUNTAIN VIEW ESTATES Lot: 13
Project Description: Backflow for irrigation.
Contractor: TERRA -SOL LANDSCAPING Owner: WESTLAKE HOMES INC
21685 SW HEDGES DR 17313 BLUE HERON RD
TUALATIN, OR 97062 LAKE OSWEGO, OR 97224
P
PHONE: 503 - 675 -0495
PHONE: 503 - 691 -6105
FAX:
FEES
Quantity Description Date Amount
1 ea Backflow Preventer 06/28/2011 $31.27
Specifics: 1 12% State Surcharge - 06/28/2011 $8.70
Plumbing
Type of Use SF 41 ea Minimum Fee Adjustment - 06/28/2011 $41.23
Plumbing
Class of Work: ALT
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 •- . Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if wt-rk is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires • d to •ol ow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 d01 -0090. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or ; • s .2344.
Issued By: .1.111111111 ee,Signature: Opp
Call 503.; • � '.• 75 by 7:00 a.m. for the next available inspec n date.
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.
Plumbing Permit Application
Building Fixtures � � , `� FOR OFFICE USE ONLY
City of Tigard � ti4 Received 'r /
14 a Date /By: / tI L• � �%1 Permit No.: I j' O �C�A
'. 13125 SW Hall Blvd., Tigar. %% 7223 t�, ' Plan Review
1 /
O Phone: 503.718.2439 Fax: ` ' .598. 0
Other Permit No.: �1,
T t G A R D Inspection Line: 503.639.4175 6� ��5 Date/By: mJ U - } ill Go
Ready/By: ® See Page 2 for
Internet: www.tigard - or.gov �� Notified/Method: r/r r Supplemental Information
TYPE OF WORK., \9 FEE* SCHEDULE
.rNew construction ❑ 13fiolition _ For special information use checklist
Description Qty. Ea. Total
❑ Addition/alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (1) bath 312.70
• (1S1 and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 437.78
SFR (3) bath 500.32
❑ Accessory building ❑ Multi- family
Each additional bath/kitehen 25.02
❑ Master builder ❑ Other:
Fire sprinkler ( sq. ft.) Page 2
- JOB SITE INFORMATION AND LOCATION Site utilities:
Catch basin or area drain 18.76
Job site address: p 21-1 �� 50..) �-, �,( � �„ ti
Drywell, leach line, or trench drain 18.76
City /State /ZIP: Footing drain (no. linear ft.: ) Page 2
Suite/bldg. /apt. no.: I 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.: _ ) Page 2
Subdivision: Lot no.: Fixture or item:
Tax map /parcel no.: Backflow preventer •l 31.27 31.
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 25.02
���✓ '`l' ! �7 -2- - "" i'c - Z-tiLAf A'' --'- Dishwasher 25.02
Drinking fountain 25.02
Ejectors /sump 25.02
❑ OPERTY OWNER ❑ TENANT Expansion tank 12.51
J Y v � �n� Fixture /sewer cap 25.02
Name: R� 1 (.- n i,� t_ n r e y " Floor drain /floor sink /hub 25.02
Address:
Garbage disposal 25.02
City /State /ZIP: Hose bib 25.02
Phone:50 ) 5I. ko "t Yti 0 Fax: ( ) Ice maker 12.51
❑ APPLICANT ❑ CONTACT PERSON Interceptor /grease trap 25.02
Business name:
Medical gas (value: $ ) Page 2
Primer 12.51
Contact name:
Roof drain (commercial) 12.51
Address: Sink/basin/lavatory 25.02
City/State /ZIP: Solar units (potable water) 62.54
Phone: ( ) Fax: : ( ) Tub /shower /shower pan 12.51
E -mail: Urinal 25.02
Water closet 25.02
' CONTRACTOR Water heater 37.52
Business name _ rL Li.v.1 v , \n Water pipingfDWV 56.29
Address: ; e5 ` _3' ' ' 1r' AZ4 (iZl4 L, Other: 25.02
City/State /ZIP: A a iv 0 ? 'O(. Subtotal 3 } , a �
Phone: ) l (-Co I 0 F ax: ( ) Minimum permit fee: $72.50, sj
CCB Lie.: 00 • Plumbing Lic. no.: Plan review (25% of permit fee)
1 State surcharge (12% of permit fee) `7f- 70
Authorized signature: �,, ' L,� lr TOTAL PERMIT FEE r 21)
Print name: �) ^ e f • This permit application expires if a permit is not obtained within 180 days
ri-i� - �/ t m �� illy �.'L� Dat (� 1 after it has been accepted as complete.
���jjj...///tt!"���" """ *Fee methodology set by Tri-County Building Industry Service Board.
I:\ Bui lding \Permits\PLMU- PermitApp.doc 10/01/09 440- 4616T(10 /02 /COMIWEB)
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' 50.03 0 to 2,000 $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 $5,000.00 Minimum fee $72.50
Storm & Rain Drain - each additional 100' 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
l� 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 $25,000.00.
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/hr 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 * .
Quantity by Fixture Type Plan Review for Plumbing Installations
Fixture Type for, Replace/
Work Performed: Capped Added Relocate Plan review is required for any of the following.
Baptistry/Font Please check all that apply.
Bath Tub /Shower ❑ Any new commercial building with water service 2" and
- Jacuzzi /Whirlpool greater, except systems designed and stamped by licensed
Car Wash -Each Stall engineer.
-Drive Thru ❑ New exterior plumbing site utilities for any complex structure
Cuspidor/Water Aspirator as defined in OAR918- 780 -0040.
Dishwasher - Commercial ❑ Medical gas and vacuum systems for health care facilities.
- Domestic ❑ Any multipurpose fire sprinkler system.
Drinking Fountain ❑ Any complex structure as defined in OAR918- 780 -0040.
Eye Wash
Floor Drain/sink - 2" Submit 2 sets of plans with any of the above.
-3"
Isometric or Riser Diagram
Car Wash Drain ❑ Isometric or riser diagram dia is required for new buildings
Garbage - Domestic - food g q g
Disposal - Domestic - food related that meet the qualifications above.
- Commercial -food related
- Industrial -food related
Ice Mach./Refrig. Drains
Oil Separator (Gas Station) Comments regarding fixture work:
Rec. Vehicle Dump Station
Shower -Gang
-Stall
Sink/Lav - Non -food related
- Bradley
- Commercial -food related
- Service
Swimming Pool Filter *Note: If the fixture work under this permit results in an
Washer - Clothes
Water Extractor increase of sewer EDUs, a sewer permit will be issued and
Water Closet Toilet fees assessed for the sewer increase must be paid before the
Urinal plumbing permit can be issued.
Other Fixtures:
I:ABuilding\Permits\PLMF- PermitApp.doc 02/24/2011 2