Permit A .
CITY OF TIGARD PLUMBING PERMIT
Il i COMMUNITY DEVELOPMENT Permit#: PLM2009 -00288
TIGARD 13125 SW Hall Blvd.. Tigard OR 97223 503.639.4171 Date Issued: 10/13!2009
Parcel: 2S 103DB08500
Jurisdiction: Tigard
Site address: 11165 SW MORGEN CT
Subdivision: Lot: 0
Project: Clark _
Project Description: Backflow preventer
Owner: FEES
CLARK, WESLEY C Quantity Description Date Amount
11165 SW MORGEN CT
TIGARD, OR 97223 1 ea Backflow Preventer 10/13/2009 $31.27
1 12% State Surcharge - 10/13/2009 $8.70
PHONE:
Plumbing
41 ea Minimum Fee Adjustment - 10/13/2009 $41.23
Contractor: Plumbing
BEAVERTON PLUMBING INC
13980 SW TV HWY
BEAVERTON, OR 97005
PHONE: 503 - 643 -7619
FAX: 503 - 643 -7620
Type of Use: SF •
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 questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By: tAA 1 Permittee Signature: 6t
V �I
• Call 503.639.4175 by 7:00 a.m. for an inspection that business day. 0
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.
'10/07/2009 12;07pm #732 Page 02/03
.
- . �'lumbin>? Permit App l i ec.s3 , LiL EIVED
Building Fixtures OCT 0 7 2009 FOR OFFICE: I :SE Or LY
1111 - City of Tigard Received
Date/HV: Permit No.: PLN1
V 13125 SW Ilan Blvd., Tigard, e n% TIGARD " _ J .293 • Phone: 503.(39,4171 Fax- Plan Review Ihte/5y: Other Pumit No,;
inspection Line: 503.639.41 I DIVISION
Date Rea m Rau: See p iron
l 1 G •� H t dY Internet: www.tigard•nr.gov u
� nr. ov g Notificd/M�hl Supplemental Information
❑ New construction 0 Demolition For special information use crrrrJdicc
Description I Qty. I Ea 1 Total
® Addition/aberrtion /replacement ❑ Other. New 1- 2 -family dwellings (includes 100 ft. for each utility connection)
? •.0 tTEQO . -. 4:O
. TC . 1 ...' <l „• ± < SFR (1) bath 312.70
Rlr: ?iCf`Rt7C1 OL�1 >'ss s ; „0 :
s "
® 1- tmd 2- funnily dwelling ❑ Commercial/industrial SFR (2) bath 437.78_ -
SFR (3) bath 500.32
0 Accessory building ❑ Multi - family
Each additional bath/kitchen 25.02
❑ Master builder ❑ Other: ) Page 2
ter Fire sprinkler ( sq. ft
., .. •._ .> JOB'SITE INF, IiM b . 011. :I sOC47 1 .Olit :, .r Site utilities:
Job site address: 11165 SW Morgen Ct Catch basin or area drain 1 8.76
Drywall, leach line, or trench drain 18.76
City /State/ZiP: Tigard, Oregon 97223
Footing drain (no. linear ft.: ,_) Page 2
5uite/bldgJapt no.: Project name: Wes Clark Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
Rain drain connector 18.76
Sanitary SCWCT (no. linear ft.: Page 2
Storm sewer (no. linear ft.: Page 2
Water service (no. linear ft,: ) Page 2
Subdivision: Lot rto.: Fixture nr Item:
Tax map /parcel no.: " l3ackflow prey enter I 31.27 31.27
r.:. ,_t.• ••• _ a <;;.•r Backwater valve 12.51
=. .: ;DES IUiV, 0 QRK .,. ._<...... > Y < 4 _ <
' .�:. . „ ..: �'; . Clothes wisher 25.02
install a new Double Check Dishwasher 25.02
Drinking fountain 25.02
• - Ejectors /sump 25.02
PER•TY O ER'%� : ' `'41 :. :1 :.:k * = 1'E0:1 7"} ~ . <` z' °:i Expansion tank 12.51
Fixture/sewer cap
Name: Wes Clark
Floor drain /floor sink/hub 25.02
AddreSS: 11165 SW Morgen Ct '
Garbage disposal 25.02
City/State/ZIP: Tigard, Oregon 97223 Hose bib 25.02
Phone: (503)336.0230 Fax: (503)336.0230 Ice maker 12.51
y a : R .. ::, 25.02
s i .'ppj Y 1; +' ;: IVI7 ws:''. E1is".,• TI i lmcrceptor /greasctrap ,
;.r
Business name: Beaverton Plumbing, Inc Medical gas (value: $ ) Page 2
- Primer 12.51
Contact name: Casey Stephens Roof drain (commercial) 12.51
Address: 13980 SW Tualatin Valley Hwy Sink/basin/lavatory 25,02
•
City /State/ZTP: Beaverton, Oregon 97005 Solar units (potable water) 62,54
Phone: (503) 643.7(,19 Fax: : (503) 643.7620 Tub/shower /shower pun 12.51
Urinal 25.02
E -mail: Sue(a)beavcrtonplumbing.coln
25.02
`":'
: �,.::. Water chisel
:=EON,C -4.0.TbR", . ':, a;;s.:a: dr -� : r?''
.� .. $ .�:_ . .. '. .. ... ::!J,::S " .••. ,:.., a:: - ...< Miter - � ,.<.. ..... Wut heater 17.52
Business name: Beaverton Plumbing, Inc _ Water pipinr/DWV - 56.29
Address: 13980 SW Tualatin Valley Hwy Other: 25.02 _
City/State/ZIP: Beaverton, Oregon 97005 Subtotal 31.27
Phone: (503) 643.7619 Fax: (503) 643.7620 Minimum permit fee: 572.50 , 72.50
CCB 'Lie.: 12889 Plumbing Lie. no.: 34-4P11 _ Plan review (25% of permit fee)
State surcharge (12% of permit fee) 8.70
Authorized signature: (�0�rl _ TOTAL PERMIT FEE 81,20
Print name: Susan Dean ��✓✓�� Date; 10/7/2009
This permit application expires if a permit Is not obtained within 180 days
after it has been accepted as complete.
"Fee mdhodotogy set by Tri- Cormly Building ledustry Service Board,
l:1 r1uildinsTermii sTIMU- PermitApp.dee 10/01/09 440- 4616T(10104/COIWWEB)
10/07/2009 12:07pm #732 Page 03/03
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
- --
Footing drain -1" 100' 50.03 0 to 2.000 $121.90
Fowling drain - each additional 100' 37.52 2,001 to 3,600 $169.69
3,601 to 7,200 $23320
Sewer - I st 100' 02.54 7,201 and greater $327.54
Sewer - each udditionul 100' 37,52
Water Service - 1st 100' 62.54
Medical Gas Systems:
Water Service - each additional 100' 37.52
Storm It 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
'O'ther
Q °'t 1Fe1e (ei F. il); t ` each additional $100.00 or fraction thereof, to
Inspections:or.:Fees);. > 'c.:: . > .... .
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 fcc 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 fast $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 ", a K' I ltio ui5
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.
Qnnntitt try `,(FikfoiONV..orkTe"r'forniid: ❑ Any new commercial building with water service 2" and
Fixture Type: :: `.: °' u a` ; s::=; r > ;:': ";;; :' ;;Replace greater, except systems designed and stamped by licensed
• :: i /iu ;: ` t e orfe u `;'E >J1d ; .. engineer.
Baptistry/Font
-Tub/Shower ❑ New exterior plumbing site utilities for any complex structure
Bath - Tub
Ju /Showerlpool as defined in OAR9I8- 780 -0040.
-Each Stall ❑ Medical gas and vacuum systems for health care facilities.
Car Wash -
-Each Stall ❑ Any multipurpose fire sprinkler system.
Cuspidor/Water Aspirator 1=I Any complex structure as defined in OAR918- 780-0040.
Dishwasher - Commercial
- Domestic Submit sets of plans with any of the above.
Drinking Fountain
Eye Wash s' ; ;Isomet)1'i 01' Riser -;Diagrant ,........ .
Floor Drain/sink - 2" _ ❑ Isometric or riser diagram is required for new buildings
- 3" that meet the qualifications above.
-4^
Car Wash Drain
Uarbugc - Domestic
Disposal - Cuuuuercial
-Industrial Comments regarding fixture work:
Ice Mach./Rcfrig. Drains
ail Separator (Gas Station)
Rec. Vehicle Dump Station
Shower -Citing —
-Stall
Sink - Bur/Lavatory
- Bradley
- Commercial *Note: If the fixture work under this permit results in an
- Service increase of sewer EflUs, a sewer permit will be issued and
Swimming Pool Filter fees assessed for the sewer Increase must be paid before the
Washer - Clothes
Water Extractor plumbing permit can be issued.
Water Closet - Toilet
Urinal
Other Fixtures:
httpJ /www.tigard- or.gov /city_hal I /depattments/cd /docs/PLM F- PermitAppdoc