Permit CITY OF TIGARD PLUMBING PERMIT #: PLM2009 -00327
111 Pe rmit
2 . COMMUNITY DEVEL OPMENT
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 11/10!2009
Parcel: 2S103DB06300
Jurisdiction: Tigard
Site address: 11345 SW AMBIANCE PL
Subdivision: GENESIS NO. 2 Lot: 23
Project: Stevenson
Project Description: Replace up to 100' sewer line.
Owner: FEES
SCHWAB, JOHN E & Quantity Description Date Amount
BRINK - SCHWAB, K R, 11345 SW AMBIANCE
TIGARD, OR 97223 100 If Sewer Service 11/10/2009 $62.54
PHONE: 1 12% State Surcharge - 11/10/2009 $8.70
Plumbing
10 ea Minimum Fee Adjustment - 11/10/2009 $9.96
Contractor: Plumbing
ROBERT J STEVENSON CONSTRUCTION
12820 SW 22ND AVE
LAKE OSWEGO, OR 97034
PHONE: 503 - 245 -8694
FAX:
Type of Use: SF
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 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: - /T (� C 4VAIt4 Permittee Signature:
�d ` Y Vl 1
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.
Flutbing Permit Application
RECEIVE, FOR OFFICE USE ONLY
(] Received P ,�„ � � o q . � �, Q 27
II City of Tigard NOV 1: U 2009 Re eive PermitNo.: rfv1(J� ea
„ 13125 SW Hall Blvd., Tigard, OR 97223
Plan Review
Phone: 503.639.4171 Fax: 503.598.19 Other Permit No.:
Date /
` C I TY OF TIGARD
Inspection Line: g 03.6394175 BUILDING DIVISION Date Ready By lu ris: ®See Page 2 for
TIGARD Internet: www.ti and -or. 8 ov
Notif / Method: �� Supplemental Information •
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❑ New construction ❑ Demolition For special information use checklist.
Description Qty. [ Ea. Total
Addition /alteration/replacement ❑ Other: New 1 dwellings (includes 100 ft. for each utility connection)
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: �1q0w Al. :w „` , CATEG ifiN aC®NSTRU�CTION ,4 T \3 A i r _ SFR (1) bath 312.70
1 - and 2- family dwelling
Accessory building ❑Commercial /industrial
❑ Multi- family SFR (2) bath 437.78
SFR (3) bath 500.32
Each additional bath /kitchen 25.02
❑ Master builder ❑ Other: Fire sprinkler ( sq. ft.) Page 2
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3.,; s _ M1yy'(('ION ANDILOC, O &Z -fI ;i ;� .• ', ' Site utilities:
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Job site address: GO ■ Catch basin or area drain 18.76
// �`� ( � Pi..,-;
� Drywell, leach line, or trench drain 18.76
City /State /ZIP: �Yei 1a r 4 A (Le T79 -.9-.3
Footing drain (no. linear ft.: _ ) Page 2
Suite /bldg. /apt. no.: 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.: _) w - Page 2
Storm sewer (no. linear ft.: ) Page 2
Water service (no. linear ft.: _) Page 2
Subdivision: I Lot no.: Fixture or item:
Tax map /parcel no.: Backflow preventer 31.27
;' " a. I':,= r >e..;,,',:'4 '-i - .,, , •f 3p iiiik-, M ' -` , ; ca^ si ': a r Backwater valve 12.51
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Clothes washer 25.02
5 - - /R4_.i-1 e-- w Dishwasher 25.02
Drinking fountain 25.02
Ejectors /sump 25.02
, R . i , v 'r tix.tmis .;ay.}rt;xf ol. ii i' ,-. A-t l o .p,. ' - _elo, y5: ',c.rw. I
r� �,ar,�4` .., � - ' "; �� = 'w��'�'•;.�r;;•:.x.� #,v.t,,, t�.. Expansion tank 12.51
® PROP R aY °' UWNER 't.a t uf' k r . r . g , a, ri - +r,
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Name: Fixture /sewer cap 25.02
Floor drain /floor sink/hub 25.02
Address:
Garbage disposal 25.02
City /State /ZIP: Hose bib 25.02
Phone: ( ) Fax: ( ) Ice maker 12.51
5 • a" R" . h, " Interceptor/grease tra 25.02
9 , :`. APPLQIGt1NiT� , r) Ac, s. ®.CONTACT .EERSO >,, trap
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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
1
- Y.,,: -1:. .-, - t,. ; y ,. .4. b s, ;4,-, - sy Water closet 25.02
J �. $fit I ���py� 'hi�F+ �.���,,.. 1�, .;.. .x� , •�{� y;' } *�'S`aY ,p,rhq•
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Water heater 37.52
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Business name: ! \ `\ f -P.� - S (9'yA -- ( l Water m DW V 56.29
Address: /
pp i�
� U 2_6 S CO a . v1/4-4,-- Other: 25.02
City /State /ZIP: k Sw at- 776 3 7 Subtotal
Phone: (�-r 3 ) 0.4 ( 9 L( Fax: ( ) Minimum permit fee: $72.50
CCB Lic.: _ Sr iS. kt Plumbing Lic. no.: Plan review (25% of permit fee)
,.. 5 .-- (,
State surcharge (12% of permit fee)
Authorized signature: l i TOTAL PERMIT FEE M ,
Print name: Date: C 0 -6, This permit application expires if a permit is not obtained within 180 days
f R O �! (/ Q�/LS�-Y`- / after it has been accepted as complete.
*Fee methodology set by Tri- County Building Industry Service Board
rl BuildinglPermits \PLMU- PermitAppdoc 10/01/09 440- 4616T(I0/02/COM /WEB)
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
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#.S`1te Vtllltl'eS 5 x :,,Qt3.° Eee ( ? " ; W Total F A 67; 'ti =41- ; .4
.�.� .�a.,..�..�, . _ , .,- :. _ � Squ�are� ootage � erm �-� ��;��
Footing drain - 1' 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 -:;�;- - >_ i;t ° _. r akt:- s , h,rr• a` = : ,'
Valua , , Perm>itFee:: ��{���
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
.° Tt va�+� *r.r =r ;;�s:ar a°;;w 6 -F�t`° .?t ;_. { r 1f k
° m therIfn pec Qty q r . ee�ea�' . Torar each additional $100.00 or fraction thereof to
{ � t10I1,.S��Or�F�eS 1 � 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:
"yes",
Are you capping, adding or replacing fixtures? If es,
��; �. �; P�lanRe�><' ew��for�F� s� -.- � =�,�
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.
❑ Any new commercial building with water service 2" and
Replacer.; _ greater, except systems designed and stamped by licensed
a, .Previous - 'Capped -- Aid a& .Existin
p - {"- s
4Aed . engineer.
Baptistry/Font
Bath - Tub /Shower ❑ New exterior plumbing site utilities for any complex structure
as defined in OAR918- 780 -0040.
- Jacuzzi /Whirlpool
Car Wash -Each Stall
1=1 Medical gas and vacuum systems for health care facilities.
-Drive Thru ❑ Any multipurpose fire sprinkler system.
Cuspidor /Water Aspirator El Any complex structure as defined in OAR918- 780 -0040.
Dishwasher - Commercial
Domestic Submit 2 sets of plans with any of the above.
Drinking Fountain .s .^ ;µ ,.,
Eye Wash A Isnetric�or Ri'sextDia ramkh - '
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
Disposal - Commercial
- Industrial Comments regarding fixture work:
Ice Mach. /Refrig. Drains
Oil Separator (Gas Station)
Rec. Vehicle Dump Station
Shower -Gang
-Stall
Sink - Bar/Lavatory
- Bradley
- Commercial *Note: If the fixture work under this permit results in an
- Service increase of sewer EDUs, a sewer permit will be issued and
Swimming Pool Filter fees assessed for the sewer increase must be paid before the
Washer - Clothes
Water Extractor plumbing permit can be issued.
Water Closet - Toilet
Urinal
Other Fixtures:
I:\ Building \Permits \PLMF- PermitApp.doc 2