Permit CITY OF TIGARD PLUMBING PERMIT
1 4 COMMUNITY DEVELOPMENT Permit #: PLM2009-00236
TIGAR 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 08/27/2009
Parcel: 1 S134CC01000
Jurisdiction: Tigard
Site address: 12170 SW MERESTONE CT
Subdivision: Lot: 0
Project: Bahrs
Project Description: Installation of residential backflow preventer for irrigation system.
Owner: FEES
BAHRS, ARTHUR HENRY & Quantity Description Date Amount
SANDRA CATHERINE, 12170 SW MERESTONE
CT 1 ea Backflow Prevention - RES 08/27/2009 $27.55
PHONE: 1 12% State Surcharge - 08/27/2009 $4.35
Plumbing
9 ea Minimum Fee Adjustment - 08/27/2009 $8.70
Contractor: Plumbing
SIGNATURE LANDSCAPE
PO BOX 304
TUALATIN, OR 97062
PHONE: 503 - 673 -0142
FAX: 503 - 673 -0189
Type of Use: SF
Class of Work: OTR Type of Const:
Occupancy Grp:
Stories:
Total $40.60
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
issuanc • ' ■ uspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Notification Center. Those rules are set forth in OAR 952- 001 -0010 through OAR 952 - 001 -0100. You may obtain a copy of the -
o r direct questions to OUN• by calling 503.246.6699 or 1.800.332.2344.
Issued By: /(/ ./ P ermittee Signature: /
Call 503.639.4175 by 7:00 a.m. for an inspection t . 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
FOR 'OFFICE -USE ONLY
City Of Tigard ! !tew oq Permit No.: w 13125 SW Hall Blvd, Tigard, OR 97223 Phone: 503.639.4171 Fax: 503.598.1960 k
Date /By: Other Permit No.:
Inspection Line: 503.639.4175
D
TIGAR Date Ready/By: Jur . ® See Page 2 for
Internet' www.ttgard- or.gov Notified/Method: Supplemental Information
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❑ New construction ❑ Demolition For special information use checklist
Description Qty. Ea. Total
.Addition/alteration/replacement ❑ Other: New 1- 2 - family dwellings (includes 100 ft. for each utility connection)
a.t t,4,, I t flCrTEGORY OI ;CONSTRUC t -, „ r. 3 ,y SFR (1) bath 249.20
(T - and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 350.00
❑ Accessory building ❑ Multi - family SFR (3) bath 399.00
❑ Master builder Each additional bath/kitchen 45.00
❑ Other:
, x « FORi_ s: f - ,:- Fire sprinkler ( sq. ft) Page 2
� ' V JOB ,Sf t t INMA tfk A c LOCATION - -
. _ . ,4., ... - a, «ai;w u, a .,t, ,k u> `.. , ,f >. . ,.,, 4A Site ut
Job site address: / / 7 o � 7162 es7v.at Ce - Catch basin or area drain 16.60
City /State /ZIP: //,3 ,,6 ( 972-23 Drywell, leach line, or trench drain 16.60
/ Footing drain (no. linear ft.: ) Page 2
Suite/bldg. /apt. no.: Project name: ,�,,a 6.,4_ lion, ‘ 5, 1 - Siery
Manufactured home utilities 110.00
Cross street/directions to job site:
,.� Manholes 16.60
/'u
/Z 2-& TO " - Rain drain connector 16.60
Sanitary sewer (no. linear ft.: ) 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
,,,,.,, ::e - .. ` . -. _..,: .:; :.� `a.xv s ,.: G,s °' r;. ' valve
, ;: 4 15A .. - Y)ESCl2,IPTIr N ='OF- WOiiiNI > Absorption 1 0
« � ._.. >.. .. 7Ia1 - : , ; ;: R. m4,,<. „. ,, , a s . K :_,, r. a .a ., .. zk ex. Backflow preventer Page 2 f. y
.....--- /
-a- % c. ..1-- 4./1. , *s . ��v j s 1�n",._. Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
,:�- �;: �: = Drinking fountain 16.60
P r ROPER X "OWNEYatit ®, TENA rx .. ;> ` g
1, a " ..e & ,._, , %,, . ,... .;. - m- : - -4 ` .. .tipAl Ejectors /sump 16.60
Name: /
/ 5 Expansion tank 16.60
Address: 4;2 /7 V .3t✓ /Ik2GfVntt Fixture /sewer cap 16.60
City /State /ZIP: ,e n..,,J) t 1'72-2.--3 Floor drain /floor sink/hub 16.60
Phone: ( ) Fax: ( ) Garbage disposal 16.60
*.,-2,2,,c;'''''', ":.: Y?d& k` ;ta:aru?.;p..° '..1'f`, -;,o17- t14 a., i.:.. *.;:- ,e e:.'. =•x:.;<r. itsvii r;,uE Hose bib 16.60
:4PL°TCANT ,:,:* ii>1 ®�rT.ACTr>orr
��a Ice maker 16.60
Business name: ‘ %'' 67 „,, f �� �- G ros ct,ai 6_i / .,h
Interceptor /grease trap 16.60
Contact name:
,� S.,01, Medical gas (value: $ ) Page 2
Address: te0. 60 3O 4 Primer 16.60
City /State /ZIP: s./ 5)706 Z Roof drain (commercial) 16.60
SOS) t, �3 _ D , .r7/• Fax: q Sink/basin/lavatory 16.60
Phone: (
/ (��> )Gj3 �l Tub /shower /shower pan 16.60
E -mail: Urinal 16.60
' . 4 i aA1, �' g CONTRA OR� - ,''' '' � s Water closet 16.60
Business name: ' ..t r - n s�pt G h1,` ,LA, Water heater 16.60
Address: Other:
ubtotal
City /State /ZIP: Minimum permit fee $72.50 3� L <
Phone: ( - ) Fax: ( ) Residential backflow minimum permit fee: $36.25 5' ..2..
i
LC CB Lie.: i 6,/ / Plumbing Li no.: Plan review (25% of permit fee) ,
Authorized signatur°.
State surcharge (12% of permit fee) 1�. 35
_ / „it / TOTAL PERMIT FEE tJ , (�(J
Print name 5f 1 v' Date: 7 0 4 1 This permit application expires if a permit is not obtain d within
- / / 180 days after it has been accepted as complete.
*Fee methodology set by Tri- County Building Industry Service Board.
I \Building\Permits\PLM- PermitApp doc 12/27/06 440- 4616T(10 /02 /COM/WEB)
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Sup ression Systems:
x ?., .« . >TO aI�" '. sg ,....t ; .,,a< a:x.; ,. avA : t i ..::rxx',;- �`„�., ,..,,,;� a "
Qty Fee,(ea }
° ..�, � = � s
� �_.. <.��._..�.,_ <�S.grivare�Foota�e � x , PeririY>t�Fee, ....s�.� ��..
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 100' 46.40 Valuation °PC '�Illlt Fe n , , �
Storm & Rain Drain - 1st 100' 55.00 "� " " ""
$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
g - -u ix, .t aitem� ' « •.,. 6 , additional $100.00 or fraction thereof, to and
. . r or s . Q Fee �ea� .: _., total
>• - . -- ..•��� . • �._ - ? H . - 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 .>-r -V 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
Inspection of existing plumbing or each additional $100.00 or fraction thereof, to
and including $50,000.00.
specially requested inspections - per hour 72 50
Subtotal: $50,001 and up $742.00 for the first $50,000.00 and $1.20 for
>� - each additional $100.00 or fraction thereof
Commercial Fixture Work: •
Are you capping, adding or replacing fixtures? If "yes " , �x plan`Rey><ew for P Yiiiribl Enstallat1011s�*
please indicate work performed by fixture. Failure to Plan review is required for any of the following.
accurately report fixtures could result in increased sewer fees * . Please check all that apply.
❑ Any building new commercial buildin with water service 2" and
j iii . _,,�:'. �," . " ,�;. .,. , :- ,__<.�- :.ms . �;:f '3 .:R`e`" lacez,. designed and licensed
? „Fixture � � � � -� ��� �� � �� � "�"���” greater, except systems des ed a d stam ed b
�: a , i6 �_ S 3 �
�.���� „sue_. -. m �� ..� P, r evtops��.� ; Capped�?g,Atld��s;: „Ex�sfut�. °� engineer.
Baptistry/Font
Bath - Tub /Shower ❑ New exterior plumbing site utilities for any complex structure
as defined in OAR918 780 - 0040.
- Jacuzzi /Whirlpool
Car Wash Each Stall 1=1 Medical gas and vacuum systems for health care facilities.
Drive Thru ❑ Any multipurpose fire sprinkler system.
Cuspidor /Water Aspirator E] Any complex structure as defined in OAR918 -780 -0040.
Dishwasher - Commercial
Domestic Submit 2 sets of plans with any of the above.
Drinking Fountain
Eye � t . k• :gym � � ' �� � � � 1�
E e Wash 4;` s , ,..SOTn t)r C.A.T' iSCx ldgl'altl t, ;
Floor Drain /sink - 2” ❑ Isometric or riser diagram is required for new buildings
that meet the qualifications above.
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 *Note: If the fixture work under this permit results in an
-Bradley
- 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