Permit CITY OF TIGARD PLUMBING PERMIT
`� COMMUNITY DEVELOPMENT Permit #: PLM2011 -00329
Date Issued: 11/02/2011
TIGARD 13125 SW Hall Blvd , Tigard OR 97223 503.718 2439 Parcel: 1S136AA00702
Jurisdiction: Tigard
Site address: 10205 SW 70TH AVE
Project: HILLS Subdivision: 2007 - 031 PARTITION PLAT Lot: 2
Project Description: Replacing water piping, 30 ft of water service and (1) bathroom tub. Electrical permit may be needed if house
grounding is affected
Contractor: BRUNER PLUMBING Owner: HILLS, JAMES R
PO BOX 23985 10205 SW 70TH AVE
TIGARD, OR 97281 TIGARD, OR 97223
PHONE. 503 - 484 -5105 PHONE.
FAX 503 - 624 -2173
FEES
Quantity Description Date Amount
30 If Water Service 11/02/2011 $62.54
Specifics: 1 ea Tub /Shower /Shower Pan 11/02/2011 $12.51
1 ea Water Piping /DWV 11/02/2011 $56.29
Type of Use: SF 1 12% State Surcharge - 11(0212011 $15 76
Class of Work: ALT Plumbing
Type of Const:
Occupancy Grp:
Stories:
Total $147 10
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 Permittee Signature:
Call 503.639.4175 by 7:00 a.m. for the next available inspection 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 a FOR OFFICE USE ONLY
City of Tigard
R eceived
II � 72 2 �'� /1 ii 87- r Permit No P a1+ j�0 "l
ill SW Hall Blvd , Tigard, OR 972 �1� Plan Review v / z
Phone: 503.718 2439 Fax 503.598960 ® '1� �\ DateBy Other Permit No
Inspection Line: 503.639.4175 \ A\ �t yQ`
TLGARD Internet \\) �"<,•. „,F.,;,;”) Date Ready/By Juns El See Page 2 for
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. :� Notified/Method i fp„ Supplemental Information
TYPE OF WORK 4": FEE* SCHEDULE
❑ New construction .•! F special information use checklist
❑ Demgtition' P f
Description I Qty I Ea. I 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
I- 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:
�/� 2- C.7 5 c j / ��� ��TL �� Catch basin or area drain 18 76
Job site address. v l /l/ C1
City/State/ZIP: /� / C � Drywell, leach line or trench drain 18
y { ��� O / 7 2 Z Footing drain (no linear ft : ) Page 2
Suite/bldg. /apt. no.: I Project name: %' 7/' Manufactured home utilities 50.03
Cross street/directions to job site: �� k l ! 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 It • 1 Page 2 6sa Sli
Subdivision: [Lot no.: Fixture or item:
Tax map /parcel no.: Backflow preventer 31 27
DESCRIPTION OF WORK Backwater valve 12.51
//'' � Clothes washer 25 02
( J c fi/ � C7I y- (/t". / // < G� _ Dishwasher 25 02
V1,9,4.----) ` , -- (,Ct j_ Drinking fountain 25 02
} Ejectors /sump 25 02
❑ PROPERTY OWNER I ❑ TENANT Expansion tank 12 51
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
❑ 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 /Z ,-,
E -mail: Urinal 25 02
CONTRACTOR Water closet 25 02
Water heater 37 52
Business name: e vo . I. v , Water piping/DWV it, 56.29 SZo 'Lei I
Address: p (} , 13 Ok 3'' e r ' Other: 25 02
City /State /ZIP: i Ti! 47,-A e) C l 72,g 73 % % Subtotal
/
Phone: (s „:9 fa 2 ! t 0 Fax: (S,7)) 62_y 2 `i Minimum permit fee: $72 50
CCB Lic.: 1 � Plumbing Lic. no.: �^ / , Plan review (25% of permit fee)
g g 2 , 7 y r_) 1 _-, State surcharge (12% of permit fee)
Authorized signatur ��� TOTAL PERMIT FEE IN t J
Print name: /�/ � This permit application expires if a permit is not obtained within 180 days
v v �� � � Date: OA it has been accepted as complete.
*Fee methodology set by Tri- County Building Industry Service Board.
I \Building\Permits\PLMIJ- PermitApp doe 10/01/09 440- 4616T(10/02 /COM/WEB)
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' j 62.54 � ,t-
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
p 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"
4 " Isometric or Riser Diagram
Car Wash Dram ❑ Isometric or riser diagram is required for new buildings - Domestic -non -food s
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 increase of sewer EDUs, a sewer permit will be issued and
Water Extractor p
Water Closet - Toilet fees assessed for the sewer increase must be paid before the
Urinal plumbing permit can be issued.
Other Fixtures:
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