Permit 1�
n CITY OF TIGARD PLUMBING PERMIT
�'.: COMMUNITY DEVELOPMENT Permit #: PLM2009 -00156
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 06/19/2009
Parcel: 2S102AB05200
Jurisdiction: Tigard
Site address: 9185 SW BURNHAM ST
Subdivision: Lot: 0
Project: Scott & Hookland Real Estate Partnership
Project Description: Install 180' of rain drains.
Owner: FEES
SCOTT & HOOKLAND REAL ESTATE PAR Quantity Description Date Amount
BY SCOTT, MICHAEL, 9185 SW BURNHAM ST
TIGARD, OR 97223 180 If Storm and Rain Drain 06/19/2009 $101.40
PHONE: 1 12% State Surcharge - 06/19/2009 $12.17
Plumbing
Contractor:
RAYBORNS PLUMBING INC
PO BOX 69
TUALATIN, OR 97062
PHONE: 503 - 692 -4139
FAX: 503- 691 -2328
Type of Use: COM
Class of Work: ALT Type of Const:
Occupancy Grp:
Stories:
Total $113.57
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
applicabl . All -work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issu ce, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
ity 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 OU ! .y ■ alli - _.03.246.6699 or 1.800.332.2344.
Issued By: ` /4* / _ Permittee ', nature: I.� ' _
i �Lf CJ�'�)-
Call 503.639.4175 by 7:00 a.m. for an inspection tha • usiness 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.
1 . 503 691 2328 Rayborns Plumbing 02:15:24 p.m. 06 -16 -2009 1 /3_
Plumbing Permit Application
Building Fixtures RECEIVED .
t�OR iiriace. c:tih: ()1.1 "
City of Tigard Received / _ �/_ (7
• 13125 SW Hall Blvd., Tiganl, OR 97223 I I U AI IV 1 6 2009 Dale 8y: ( ((J / e Permit No.: . iJQN �� /6
IIII Phone: 503.639.4171 Fax: 503.598.196 Plan Review / N / /Irw
Inspection Line: 503.639.4175 Date By Other Permit No
T I f ;:, R U Internet: www.ligatd- o r. g ov TIGARD 472)::, CITY OF � pD Date otifiReed adM5e"dRy ,o : / �
See Page 2 for
IN - G
( Supplemental Information
TYPE OF WoILD FEE* SCHEDULE
❑ New construction ❑ Demolition For special information use checklist.
Description 1 Qty. I Ea. I Total
, AAddition /alteration /replacement
❑ Other: New I- 2- family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (I) bath
249.20
I - and 2- family dwelling Commercial /industrial SFR (2) bath
350.00
❑ Accessory building ❑ Multi- family SFR (3) bath 39900
Each additional bath/kitchen 45.00
❑ Master builder ❑Other:
JOB SITE INFORMATION AND LOCATION Fire sprinkler { - sq. ft•) Paget
_ Site utilities
lob site address: � •� ��.5'L,...) E x'� } �
"-` Ck.l_ Catch basin or area drain 16 60
City /State /ZIP: ii a 04 . c k
,..)
Or
Drywell, leach line, or trench drain 16.60
Suite /bldg. /apt, no.: Project name: Footing drain (no. linear ft.: ) Page 2
Cross street /directions to job site: Manufactured home utilities 110.00 _
Manholes 16.60
Rain drain connector 16.60
Sanitary sewer (no. linear It.: ) Page 2
Stonn sewer (no. linear ft.:/) Page 2 //9/ ¥O
Subdivision: Lot no.: Water service (no. linear ft.: ) Page
Tax map /parcel no.: Fixture or item
DESCRIPTION OF WORK Absorption valve 16.60
Backflow preventer Page 2
t tilft fa', 4�tfPl`. /g462 �f: Backwater valve
16.60
Clothes washer 16.60
Dishwasher 16.60
❑ PROPERTY OWNER ❑ TENANT Drinking fountain 16.60
Name: - Ejectors/sump 16.60
Address: Expansion tank 16.60
Fixture /sewer cap 16.60 ,
City /State /ZIP: -•
Floor drain/floor sink'hub 16.60
Phone:( ) _
Fax: ( ) Garbage disposal
1 6.60
❑ APPLICANT ❑ CONTACT PERSON Hose bib 16.60
Business name r ) Ice maker
: II 16.60
6V W� ; vt Interceptor /gr'easetrap
Contact name: 4,) i P 1`
16.60
Medical gas (value: S 1 Page ge 2 2
Address: \e&,1 O 6 � �
p 4tP � Printer 16.60
City /State /ZIP:
- 0, T70 6 Roof drain (commercial) 16.60
Phone: (gip )
0D__ -LI ( f Fax: : (,5p3) 6e4 - -D3 ag Sink basin;lavatory 16.60
E-mail: /J�� r t
Tub/shower/shower pan 16.60
f S/ ter'�t L .0 `d � Urinal
CONTRACTOR 16.60
Business name: (I r_ Water closet _ 16 60
t/ \'�y C . 1 j • Water heater 16.60
Address: 9c& ei 0 G; 190 le_ Other:
City /State /ZIP: -'�' 1 n__ +j .� Subtotal /g / t +' "
l y Minimum permit fee: 572.50
Phone:
( �3 ) 69� _I / 3 Fax: (5 ) 6R I �.b` p R es id ential backtlow minimum pennit lee: 536.25
CCB Lie.. -
5� Plumbing Lic. no.: 19-1,64 I Plan review (25% of permit fee)
Authorized signature: State surcharge (12% of pennit fee) /a•77
TOTAL PERM IT FEE
Print name: ,e!r- /4 s// rt Date: -// -rte'
'�/ This permit application expires if a permit is not obtained within
180 days after it has been accepted as complete.
*Fee methodology set by Tn- County Building Industry Service Board„
I Building Permits rt.s+r -rn a » , app al, i, a,
a ania ru on`cotiw'enr
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02:15:46 p.m. 06 -16 -2009 2 /3
i.
'503 69� 2328 Rayboms Plumbing ®
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 - I" 100' 55.00 0 to 2,000 $115.00
Footing drain - each additional 100' 46.40 2,001 to 3.600 $160.00
Sewer - 1st 100' 55.00 3,601 to 7,200 $220.00
7,201 and greater $309.00
Sewer - each additional 100' 46.40
Water Service - I st 100' 55.00
Water Service - each additional 100' 46.40 Medical Gas Systems:
Storm & Rain Drain - 1st 100' / 55.00 ( Valuation: Permit Fee:
Storm &Rain Drain - each additional 100 / ' $1.00 to $5,000.00 Minimum fee $72.50
46.40 $5,001.0010 $10,000.00 $72 50 for the First $5,000.00 and 51.52 for each
Fixture or Item Qty. Fee (ea) Total additional $100.00 or fraction thereof, to and
Commercial Back Flow Prevention Device 46.40 including $10,000.00.
$10,001.00 to $25,000.00 $148.50 for the first $10,000.00 and $1.54 for
Residential 8ackilow Prevention Device each additional $100.00 or faction thereof to
(minimum permit fee $3625) _ 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
specially requested inspections - per hour 77,40 and including $50,000.00.
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 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
Quantit 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
_ - Jacuzzi /Whirlpool
❑ Medical gas and vacuum systems for health care facilities.
Car Wash Each Stall ❑ Any multipurpose fire sprinkler system.
CI Drive Thtu Any complex structure as defined in OAR918- 780 -0040.
Cuspidor /Water Aspirator
•
Dishwasher - Commercial Submit 2 sets of plans with any of the above.
- Domestic
Drinking Fountain - Isometric or Riser Diagram
Eye Wash O 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
Disposal - Commercial Comments regarding fixture work:
- 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 EllUs, a sewer permit will be issued and
- Service
fees assessed for the sewer increase must be paid before the
Swimming Pool Filter
Washer - Clothes plumbing permit can be issued.
Water Extractor
Water Closet - Toilet "
Urinal
Other Fixtures:
i Bu'IdtnS Pei nuts' PLLI- PertnitApp doc 1 2-27 -Oh