Permit r , 1
CITY OF TIGARD PLUMBING PERMIT
• IN C =n COMMUNITY DEVELOPMENT Permit PLM2009 -00186
'TIGARD 13125 SW Hall Blvd , Tigard OR 97223 503 6394171 Date Issued 07/15/2009
Parcel 25103DC00819
Jurisdiction Tigard
Site address 11250 SW FAIRHAVEN ST
Subdivision Lot 0
Project Halderson
Project Description Connect existing house to sewer service
Owner FEES
HALDORSON, LELAND K Quantity Description Date Amount
JEAN E, 11250 SW FAIRHAVEN
TIGARD, OR 97223 100 If Sewer Service 07/15/2009 $55 00
PHONE 1 12% State Surcharge - 07/15/2009 $8 70
Plumbing
18 ea Minimum Fee Adjustment - 07/15/2009 $17 50
Contractor Plumbing
LOVETT EXCAVATING INC
PO BOX 86280
PORTLAND„ OR 97286
PHONE 503 - 288 -1527
FAX 503- 288 -1630
Type of Use COM
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 rons-t O UNC r� ,' by calling 503 246 6699 or 1 800 332 2344
,A JC , /`
Issu d8y 0 ,/,_ Permittee Signature Z4 ✓/ 4 _n
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
Plum bing Permit Application
Building Fixtures
- City of Tigard Receoed 7 (/5 70 / Pen" No / A ti7 W ,art) //. /
I N I
13125 SW Hall Blvd Tigard, OR 97223 y te 71 fo
Plan Review
Phone 503 639 4171 Fax 503 598 1960 Date/By Other Permit No OW9-120b/.0 2
Inspection Line 503 639 4175 l
'.T.16ARD' Date Ready /By ru�r�! S See Page t for
Internet WW \A ugard - goy Non fied 'Method v� /f /C/ Su pplemental form a lion
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x-'.. tti ,ate'
For special information use checklist
❑ New construction ❑ Demolition
Description I Qty Ea Total
❑ Addition/alteration /replacement ❑ Other New 1 - 2 - faintly dwellings (includes 100 ft for each utility connection)
, ^' ` ifi nftGORY'OF ONS'IRUCTIO1\ j: a; = SFR (I) bath 249 20
❑ I- and 2- faintly dwelling ❑ Commercial /industrial SFR (2) bath 350 00
❑ Accessory building ❑ Multi -family SFR (3) bath 399 00
Each additional bath/kitchen 45 00
❑ Master builder ❑ Other _ __ _ Fire sprinkler
5 ' !tf? `. J6Bis rf-13∎ 61olkilON a' ry t - .,4 g p ( so ft) Paget
I i, VAND tiOCATION -- 4,e ` ' y g
Site utilities
lob site address en Catch basin or area drain 16 60
City/State/ZIP 771 A id / aji Dry V a- Dry - yield teach line, or trench drain 16 60
Smle/bldg /apt no Protect name #4/.,,004750/1/ Footing drain (no linear ft ) Page 2
Manufactured home utilities 110 00
Cross street/directions to lob site
Manholes 16 60
Rain drain connector 16 60
Sanitary sewer (no linear ft / (0) Page 2
Storm sewer (no linear ft ) Page 2
Subdivision Lot no
Water service (no linear ft ) Page 2
Tax map /parcel no Fixture or item
Absorption xalve 16 60
-, ax fare ` ' DESCRIP IWI Oirk „ . Ytex• y; rP
^"'i T � � �� ;�i - �- �� - � -«� -r- � i r--•v+ = "rte': � Backfl ow preventer Page 2
e!'91 o44Qt .-,- _1t- Backwater valve 16 60
Clothes washer 16 60
Dishwasher 16 60
" - ' ®' OWAVEC `r r " I ' : L r"is TENAN ,, ` .: -t -at`'- Drinking fountain 1660
/ _- ' Electors /sump 16 60
Name G r /a 1i , 9 Jea 14 5 l /0' n Expansion tank 16 60
Address / /'r - 1 C w j ?if ha ✓pi of Fixture /sewer cap 1660
City /State /ZIP T1.at'a( �� ___� . 3 C Floor drain /floor sink/hub 1660
Phone ( 39 - tfz r/ Fax ( ) i �* •p SON Garbage disposal 16 60
( - e2 k i4li aTh R.y'4 / 1` .. a ; ,: Q GOTTe1 ;. Hose bib 1660
Ice maker 16 60
Business name - -
Interceptor /grease trap 16 60
Contact name Medical gas (value $ ) Page 2
g'
Address Primer 16 60
City/State/ZIP Roof drain (commercial) 16 60
Phone ( ) Fax ( ) Sink/basin /lavatory 1660
Tub /shower /shower pan 16 60
E-mail
O
,„ _ Urinal 16 60
‘:"'
:"'21 41 r14 ;
- a,;,1W �,=>. , CONTRACTR °y`?s`gall-= . Water _
r . <:� -.p� closet 1660
Business name -- �� / Water heater 16 60
Address 4 Other
City /State /ZIP Subtotal
Minimum permit fee $72 50
Phone ( ) Fax ( ) Residential hackflow minimum permit fee $36 25
CCB Lic Plumbing Lic no Plan review (25% of permit fee)
_/J �'' State surcharge (12% of permit fee)
Authorised signature `! r /�l j�
A\ �'V' r^D� tV TOTAL PERMIT FEE
Print name L 4, ) J s Date ' c „a - m 0 Fhis permit application expires if a permit is not obtained within
- - 180 days after it has been accepted as complete.
"Fee methodology set by In-County Building Industry Service Board
i ABuil drngNe' mr¢PLMF- PermaApp doe 12/27/06 410456 r00/02/COM/WEB)
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: � Residential Fire Suppression Systems:
S1telUliliiies; n '.:5*, x'�;, 5a .r:2 l'.Qty ',Fcer(CS) " "..enrotal:r.: _ •s__, 8z. -sa' - ro° -a:,i
a'., �n,e t s_ ; , u` •- .. ,p
t, . m , ,• 4 8- Footage:, Per- mit € � 0:7411: k,
Footing drain - 1 100 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 oo' 46 40 ; Ualuat on: =`-,,, 4, p , ermit F e e " 2 , `" '' ==
Storm & Rain Drain - 1st 100' 55 00 gy . -'+�_
$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
Flxtl 1'C O �It ` "r ` •'" +Qt 3"5'` Fe e=(ea) ' `""ct 'o iil
` additional $100 00 or fraction thereof, to and
including :cs. ,_....., °nkv.�' N".1+5 t"'l;,f k =. -' g $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 $50,001 00 and up $742 00 for the first $50,000 00 and $1 20 for
Subtotal each additional $100 00 or fraction thereof
Commercial Fixture Work: � x Plan'Review forY'Ptumb ng�•I,nsta lahonsE;„ ti
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
>`f,.'`'a"�' "'at'? "' S%Quanhtv■tfy;(Frztu'r•e) Wbrk:YerioFmeds greater, except systems designed and stamped by licensed
liFixturetType:h @;•'f..;q ;a Rti n?" t s ' � ' 1`4.1 wRefilecev' engineer
i m= P7 k Wk ice# "'.r'. Rrevruos -- "Cappead stAaaea':*P a Ezisnnq,`- ❑ 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 ❑ An) complex structure as defined in OAR918- 780 -0040
-Drive Thru
Cuspidor /Water Aspirator Submit 2 sets of plans with any of the above.
Dishwasher - Curnmerual
- Domestic :, a �s.� , - Arrh ...e, - +w as._
Drinking Fountain E" Y50217QII;1ciOCh Rlsers�Diag
Eve Wash ❑ Isometric or riser diagram is required for new buildings
Flour Drain/sink - 2" that meet the qualifications above
-3'
-4"
Car Wash Dram
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 /Lai atory
- Bradley *Note: If the fixture work under this permit results in an
- Cmmaeicial 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
r 19urldrngiPermiis 4l- M- PernnApp doe 12/27/06