Permit y CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit #: PLM2009-00095
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 04/22/2009
Parcel: 2S 111 CC 15000
Jurisdiction: Tigard
Site address: 10115 SW HIGHLAND DR
Subdivision: Lot: 0
Project: MacQueen
Project Description: French Drain back yard to street and hook rain drains up to street.
Owner: FEES
MACQUEEN, LAWRENCE P & Quantity Description Date Amount
MARJORIE A, 10115 SW HIGHLAND DR
TIGARD, OR 97224 200 If Storm and Rain Drain 04/22/2009 $101.40
1 ea Backwater Valve 04/22/2009 $16.60
PHONE: 1 12% State Surcharge - 04/22/2009 $14.16
Plumbing
Contractor:
DENNIS P ROOD CONSTRUCTION
30010 ROODS RD
SHERWOOD, OR 97140
PHONE: 503 - 780 -6898
FAX: 503 - 625 -1830
Type of Use: SF
Class of Work: OTR Type of Const:
Occupancy Grp:
Stories:
Total $132.16
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 N. ication - • -r. Tho - ules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100 You may obtain a copy o • e r les
Issu =d By: , Permittee Signature: •
. -A,
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.
Plumbing Permit Application
- building Fixtures RECEIVED FOR: OFFICE USE .ONLY
II Cl of Ti and Received n ,----- 131 SW Hall Blvd., Tigard, OR 97223 APR 2 2 2009 Date/By: V 1 2 r� Permit No.: LM �/
q
'2 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 Date /By: Other Permit No.:
TI G A R D Inspection Line: 503.639.4175 CITY OF TIGARD Date Ready/By: lens: El See Page 2 for
Internet: www.tigard- or.gov BUILDING DIVISION Notified /Method:
Supplemental Information
TYPE OF WORK. : . FEE* SCHEDULE •
❑ New construction ❑ Demolition For special information use checklist
Description I Qty. 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 249.20
E 1 and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 350.00
❑ Accessory building 111 Multi-family SFR (3) bath 399.00
❑ Master builder Each additional bath/kitchen 45.00
❑ Other:
Fire sprinkler ( sq. ft.) Page 2
' . y .'JOB; S INFORMATION, .AND LOCATION Site utilities
Job site address: / l� /, //
S . j l ef ,,, c.Q b‘-- Catch basin or area drain 16.60
City /State /ZIP: y is. (� G ! 74 t+1 L Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: Project name: �± ( Footing dram (no. linear ft.: ) Page 2
f/ t . !'� "� Manufactured home utilities 110.00
Cross street/directions to job site:
/ Manholes 16.60
.1 r e ' r ii,^� � l��t. L, ,Y Rain drain connector 16.60
✓ / Sanitary sewer (no. linear ft.: _ ) Page 2
Storm sewer (no. linear ft. ) , Page 2 /6/, (/0
j� Water service (no. linear ft.: ) Page 2
Subdivision: l Lot no.:
Tax map /parcel no.: Fixture or item
Absorption valve 16.60
'DESCRIPTION OF WORK' ' Backflow preventer Page 2
J1 C-11 DCI,YI B ca-k: )GlYi1 4km Backwater valve v 16.60 A , jp�
7441 k Clothes washer !`� 16.60
.S - f �'t.e...4 Dishwasher 16.60
❑ .PROPERTY OWNER I Drinking fountain 16.60
-
❑ TENANT'
n^ � Ejectors /sump 16.60
Name: I , MAC/ rr..-- M t . { Expansion tank 16.60
Address: /D //j /,�[._ Ah." C {. Fixture /sewer cap 16.60
�5r, r- � 7 Z 2 �-
City /State /ZIP: '� Floor drain /floor sink/hub 16.60
Phone: (cog) �/6f- ---7 7q9 Fax: ( ) Garbage disposal 16.60
. ❑,..APPLICANT . ' , ❑ CONTACT PERSON . Hose bib 16.60
' Ice maker 16.60
Business name: r
Interceptor /grease trap 16.60
Contact name: Medical gas (value: $ ) Page 2
Address: Primer 16.60
City/State /ZIP: Roof drain (commercial) 16.60
Phone: ( ) Fax :: ( ) Sink/basin/lavatory 16.60
Tub /shower /shower pan 16.60
E -mail:
_ Urinal 16.60
CONTRACTOR Water closet 16.60
Business name: l 41s1 -roc Water heater 16.60
Address: 3 D Other:
Subtotal
City /State /Z1P: 5�� _
f G
? q1/ cc-n Minimum permit fee: $72.50 J /6 00
Phone: (51) 3) 7rej� g Fax: ($i3) 6 l$ f'.3 Residential backflow minimum permit fee: $36.25 .
CCB Lie.: r? A l jll ( Plumbing Lic. no.: ?R 6_s-0 Plan review (25% of permit fee) �"
l
Authorized signature: le , State surcharge (12% of permit fee) r6
tar TOTAL PERMIT FEE I/
Print n ame: _ ` ; r . Date: 6 . ? �4 q This permit application expires if a permit is not obtained within
180 days after it has been accepted as complete.
*Fee methodology set by Tri- County Building Industry Service Board.
I:\Building\Permits\PLMF- PermitApp.doc 12/27/06 440- 4616T(t0 /02 /COM/WEB)
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site. Utilities , ,Qty. Fe tea)" : T °tall, Square Footage:. Permit Fee -1 I
Footing drain - is` 100' 55.00 0 to 2,000 $1 15.00
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 100' 46.40
Storm & Rain Drain - 1st 100' 55.00 Valuation:` `..` Permit_ Fee:
$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
• . Qt'.. ;Fee (ea) , .Total additional $100.00 or fraction thereof, to and
.Fixture or ftem`° r , .. including $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
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 Installat 4,,
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
rm
_ • Quantity by (Fixture) Work Performed greater, except systems designed and stamped by licensed
Fixture.Type :- • Replaee " engineer.
` . Previous Capped 111 . Added " Existing'` New exterior plumbing site utilities for any complex structure
Baptistry/Fon 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 ❑ Any complex structure as defined in OAR918- 780 -0040.
-Drive Thru
Cuspidor /Water Aspirator Submit 2 sets of plans with any of the above.
Dishwasher - Commercial
- Domestic _ - -
Drinking Fountain : : m. ISOffietll'ic -or Riser l)lagram`
Eye Wash ❑ 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 Comments regarding fixture work:
Disposal - Commercial
- 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 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:
i. \Building\Permits\PLM- PermitApp doc 12/27/06