Permit CITY OF TIGARD PLUMBING PERMIT
' COMMUNITY DEVELOPMENT Permit #: PLM2011 -00314
Date Issued: 10/21/2011
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503 718 2439 Parcel: 2S111 BC01000
Jurisdiction: Tigard
Site address: 10270 SW VIEW TER
Project: BAUMAN Subdivision: GREENBRIER Lot: 8
Project Description: 100 ft. of sanitary sewer Reimbursement district fees paid 10/21/11
Contractor: LOVETT EXCAVATING INC. Owner: BAUMAN, C WAYNE & MARY
PO BOX 86280 10270 SW VIEW TER
PORTLAND, OR 97286 TIGARD, OR 97224
PHONE: 503 - 504 -2847 PHONE:
FAX 503 - 288 -1630
FEES
Quantity Description Date Amount
100 If Sewer Service 10/21/2011 $62.54
Specifics: 1 12% State Surcharge - 10/21/2011 $8.70
Plumbing
10 ea Minimum Fee Adjustment - 10/21/2011 $9 96
Type of Use SF 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 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 -0090 You may obtain a copy of the rules
or direct questions to OUNC by calling 503.232 1987 or 1 800 332 2344
Issued By: Permittee Signature: •
Call 503.639.4175 by 7:00 a.m. for the next available inspection da e.
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
City _ -
Building Fixtures FOR OFFICE USE ONLY
ty of Tigard � � �1 Received
13125 SW Hall Blvd., Tigard, OR 972 -r D ate /By • Permit No u o p __ 1 i
Plan Review
Ili a ; Phone 503 718.2439 Fax. 503. °S' 1 °1. , l '10\ Date /By Other Permit No $ ki —
T 1 G ARD' Inspection Line: 503 639.4175 C) , Q Date Ready By tons H See Page 2 for
Internet www.tigard - gov C\ r PP Notified/Method: 7....6 ' Supplemental Information
TYPE OF WORK ,,..``'' n� 1vC \ FEE* SCHEDULE
❑ New nstruction ❑ Deflla03� � For special information use checklist
`` ,1,1r Description For
Ea. I Total
Addition /alteration replacement ❑ Ott New 1- 2- family dwellings (includes 100 ft for each utility connection)
• CATEGORY OF CONSTRUCTION SFR (1) bath 312 70
O - and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 437 78
SFR (3) bath 500 32
❑ Accessory building ❑ Multi - family
Each additional bath/kitchen 25 02
❑ Master builder ❑ Other: Fire sprinkler ( sq ft) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: ;1 U 7 Q S ii), v 2 L cG/ N e Catch basin or area drain 18.76
Tim, 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: WEZ f 4z. d- M �/ J 73auna� Manufactured home utilities 50 03
Cross street/directions to job site: J ! Manholes 18 76
Rain drain connector 18 76
Sanitary sewer (no linear ft la I Page 2 6 <5 7
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
DESCRIPTION OF WORK Backwater valve 12.51
f� Clothes washer 25.02
7 )AreP hJ� - 1 - D c� -e-o -t iC�C) IT df Se'We.' -, Dishwasher 25 02
Drinking fountain 25.02
Ejectors /sump 25.02
[PROPERTY OWNER I ❑ TENANT Expansion tank 12 51
Name: /)), i (0,1 P lap y a, Q C'x0.4, Fixture /sewer cap 25 02
! ► V r Z Floor drain /floor sink/hub 25 02
Address. /bS 6 3,Wr V to/ / 4' 7 - a c .e
Garbage disposal 25 02
City /State /ZIP: /) Y 1 ( �
/ V - (r "---7 � Hose bib 25 02
Phone: ( 5 3) ii _ �{/� ,-2i f/ Fax: ( ) Ice maker 12 51
❑ APPLICANT ❑ CONTACT PERSON Interceptor /grease trap 25 02
1 4 ' q el l -f Medical gas (value $ ) Page 2
Business name:
v�� 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
CONTRACTOR Water closet 25.02
Water heater 37 52
Business name: )(OLdfCt . / [ S" ,t J v I . \ ^R Water piping/DWV 56 29
Address: ii v, B '»� Other 25 02
City /State /ZIP I t , u z G � 1 , Subtotal
n
Phone: �C.)3 )5 )4Z,/ Fax: ( ) Minimum permit fee. $72 50
CCB Lic : 05507 Plumbing Lic. no.: Plan review (25% of permit fee)
z 4,, State surch (12 %ofpermit fee) �'7t
Authorized signature A, , TOTAL PERMIT FEE R ( i/ / tii___
This permit application expires if a permit is not obtained within 180 days
Print name ; L :: // / li // Date: /v _` af ter it has been accepted as complete.
*Fee methodology set by Tn- County Building Industry Service Board
1 \Buildmg\Permus\PLMU- PermiApp doe 10/01/09 440- 46I6T(l0 /02 /COM/WEB) / Q. (e/ / ( k`
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' 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
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 Plan Review for Plumbing Installations
Quantity by Fixture Type Plan review is required for any of the following.
Fixture Type for Replace/ Please check all that apply.
Work Performed: Capped Added Relocate
Baptistry/Font ❑ Any new commercial building with water service 2" and
greater, except systems designed and stamped by licensed
Bath - Tub /Shower
- Jacuzzi/Whirlpool engineer.
Car Wash Each Stall ❑ New exterior plumbing site utilities for any complex structure
Drive Thm as defined in OAR918- 780 -0040.
Cuspidor/Water Aspirator ❑ Medical gas and vacuum systems for health care facilities.
Dishwasher Commercial ❑ Any multipurpose fire sprinkler system.
Domestic ❑ Any complex structure as defined in OAR918- 780 -0040.
Drinking Fountain
Eye Wash Submit 2 sets of plans with any of the above.
Floor Drain/sink - 2"
3" Isometric or Riser Diagram
❑ Isometric or riser diagram is required for new buildings
-Car Wash Drain
Garbage Domestic non -food that meet the qualifications above.
Disposal - Domestic food related
- Commercial food related
- Industrial food related
Ice Mach /Refrig. Drains Comments regarding fixture work:
Oil Separator (Gas Station)
Rec Vehicle Dump Station
Shower -Gang
-Stall
Sink -Lav /Bar non -food related
- Bradley
- Com /Serv/Util food related
- Service *Note: If the fixture work under this permit results in an
Swimming Pool Filter increase of sewer EDUs, a sewer permit will be issued and
Washer - Clothes fees assessed for the sewer increase must be paid before the
Water Extractor
Water Closet- Toilet plumbing permit can be issued.
Urinal
Other Fixtures
l: \Building \Permits \PLMF - PermitApp.doc 08/04/2011 2