Permit --t--- CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit #: PLM2011 -00346
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 11/17/2011
Parcel: 1 S135DCO2601
Jurisdiction: Tigard
Site address: 11767 SW 91ST AVE
Project: WAFFORD Subdivision: NORTH TIGARDVILLE ADDITION Lot: 63
Project Description: Replacing interior water piping and 50 ft. of water service.
Contractor: DAVIS PLUMBING Owner: WAFFORD, ROBERT W & CHRISTINA M
16008 SE SOUTHVIEW AVE 11767 SW 191ST AVE
MILWAUKIE, OR 97267 TIGARD, OR 97223
PHONE: 503 - 307 -1920 PHONE:
FAX:
FEES
Quantity Description Date Amount
50 If Water Service 11/17/2011 $62.54
Specifics: 1 ea Water Piping /DWV 11/17/2011 $56.29
1 12% State Surcharge - 11/17/2011 $14.26
Type of Use: SF Plumbing
Class of Work: ALT
Type of Const:
Occupancy Grp:
Stories:
Total $133.09
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 18 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by-• e Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. You may obtain a cop of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800:
Issued By: ' ittee Signature:
Call 503.639. •y 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 Atiplication
Building Fixtures g t �a ati FOR OFFICE USE ONLY •
City of Tigard ° Received
• �� Date/By // /7 /1 �-p Permit No..p/ M „ li �/J, W
II
® 13125 SW Hall Blvd., Tigard, OR ^97 23, % Plan Review "/ G! tv �Y
i ` Phone: 503.718.2439 Fax:� - 598.1'960 e
t Date/By:
Permit No.:
Inspection Line: 503 `
Ti G A ' RD Internet: wtvtv.tigazd - or.go � � ,f�C�+�, Date Ready/By: Jules: H See Page 2 for
( s ` Notified/Method: � p Supplemental Information
c. ,' . , „•; „, a s:,4', F „WO ', n ' y/„ ,, , ., . , F
,�.�� _, � 1 - - _.. _ 4• ,- ... " ,.. �. '.� � ��^s' . _ .. ° a. sti��z a� ° .a. � 5 0- . ; E E..SCHEDULE .% . •' .a.,r'J
El
Y ti
New construction ❑ I ,co For special information use checklist
\� Description Qty. I Ea. I Total
Addition/alteration/replacement ❑
Other. New 1- 2- family dwellings (includes 100 ft. for each utility connection)
er'H`; �'� ,a ;. t ' " CONSTRUCTION" .,, ,,e ; SFR (1) bath 312.70
1- and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 437.78
❑ Accessory building ❑ Multi - family SFR (3) bath 500.32
Each additional bath/kitchen 25.02
❑ Master builder ❑ Other
Fire sprinkler ( sq. ft.) Page 2
4i y >r, .. g
- :t5: w JOBa ,
. , �'� -'� ,� ;t ° � , ' S ITE: �INFORMA 'PIO ",I;OCAT ." ��, ' '5 " , Site utilities:
Job site address: / / 7 St--) 7/57 5"7 -U e Catch basin or area drain 18.76
rd Drywell, leach line, or trench drain 18.76
/3
City /State /ZIP: l t� ,p f7 �j
/' f G/ / 0 � ` 1 7 2_2-3 Footing drain (no. linear ft.: ) Page 2
Suite/bldg./apt. no.: I 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.: ) Page 2
Storm sewer (no. linear ft.: ) Page 2
Water service (no. linear ft.: 5t9 / Page 2 6,I, s.,
Subdivision: I Lot no.: Fixture or item:
Tax map /parcel no.: Backflow preventer 31.27
"'' <4 Backwater valve .44 r `' ";�" •- : .Fk :',..;,���i.; ,,, * DESCRIPTION";OF� WORK:„ ` f ..,� Backwa r v 12.51
- - r. �� 4 . Clothes washer 25.02
Ref Zf Ze" liC >!q .-r / l n o t ^ 'F- 31 1 T. . Dishwasher
�_ �/ 25.02
eYf l r� d JLY e F r eAr , &A._ Drinking fountain 25.02
Ejectors/sump 25.02
µTM r ., ' ❑;'PROPERTY zikisiEIt r,. ;,' • ® TENANT Expansion tank 12.51
Name: d e l 4 �i �� Fixture /sewer cap 25.02
Address: JJ i Floor drain/floor sink /hub 25.02
Garbage disposal 25.02
City /State /ZIP:
Hose bib 25.02
Phone: ( ) Fax: ( ) Ice maker 12.51
y ° ° ® APP ICAN'r ❑ CONTACT PERSON • Interceptor /grease trap 25.02
Business name: Medical gas (value: $ ) Page 2
Contact name: Primer 12.51
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
�,y t y r r ,ar .. Water closet 25.02
R " ' , ; '
° _ ° a. ' � , °•' ''['' ;. ` C O N TRACTOR o 9;_, , ,. :y ,
R 0 _ . ,w . . . .. . Water heater 37.52
Business name: '` 5 S L)9Vr "l / /ih Water piping/DWV / 56.29
Address: / b t70 e 5 c s,,,,..„..4 f) fi4� 4 10 Other: ` 25.02 t
'
City /State /ZIP: /n/ LW ,i �.4 �' _ , a K Subtotal i ig-, g3 `
Phone: (503 ) 3 0 -7_ // j . 0 / Fax: ( ) Minimum permit fee: $72.50_
CCB Lic.: Z 3 S f 0 s t '/ 1 Plumbing Lic. no.: �
r43 Plan review (25% of permit fee) ----- � r
State surcharge (12% of permit fee) f "/J ,A C,
g i�6�.'
Authorized signature: /�� 7/ /vf
� �� / TOTAL PERMIT 133 �T
Print name: o $ 5' 0 j Date: //, f'9 f/ This permit application expires if a permit is not obtained wi in 180 days
after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site Utilities "` • ' Qty.; Fee(ea)_ S uare°Foota e:*'::.' Permit: Fee.r.: ":
Footing drain - 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 ( -r Medical Gas Systems:
Water Service - each additional 100' 37.52
°F
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
r Fee °(ea): `Total" each additional $100.00 or fraction thereof, to
;yOtIlCelLtispect onS4r, Fees° y'; 9'.a . , ,. 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 *.
Qaantiy,byFixtu e TYpe:. °Plan °'Rev ew.`for Plumb ri ^Iinstallat on_s;
Fixture Type for Replace/
C up a nadea • Relocate , Plan review is required for any of the following.
W,orkPerfoitned. _ �,;. - Please check all that apply.
Baptistry/Font
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.
4sometric or Riser._ Diagram`
Car Wash Drain ❑ Isometric or riser diagram is required for new buildings
Garbage - Domestic -non -food
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
Washer - Clothes *Note: If the fixture work under this permit results in an
Water Extractor increase of sewer EDUs, a sewer permit will be issued and
Water Closet - Toilet fees assessed for the sewer increase must be paid before the
Urinal plumbing permit can be issued.
Other Fixtures: