Permit CITY OF TIGARD PLUMBING PERMIT
• COMMUNITY DEVELOPMENT Permit #: PLM2009 -00264
T I GARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 09/25/2009
Parcel: 1S134AD06202
Jurisdiction: Tigard
Site address: 10500 SW NIMBUS AVE T
Subdivision: Lot: 0
Project: Solid Rock Fellowship
Project Description: Install 1/2" RP device.
Owner: FEES
ROBINSON, CONSTANCE Quantity Description Date Amount
10240 SW NIMBUS AVE #L3 1 ea Backflow Prevention - 09/25/2009 $46.40
PORTLAND, OR 97223 COM
PHONE: 1 12% State Surcharge - 09/25/2009 $8.70
Plumbing
26 ea Minimum Fee Adjustment - 09/25/2009 $26.10
Contractor: Plumbing
MIKE PATTERSON PLUMBING
. 15028 S MITCHELL LN
OREGON CITY, OR 97045
PHONE: 503 - 632 -7374
FAX: 503 - 632 -5647
Type of Use: COM
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: 0. i , Permittee Signature: ( ^^
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. '
4 !, '..
Plumbing Perm AuulicatiolT CElVED
Building Fixtures SEP 2 4 2009 FOR OFFICE USE ONLY
City of Tigard Received = Permit No.: Pinporn , nip4
°
1.312 5 SW Hall Blvd., Tigard. OR 97 OF Nan Bel
N Rev
e Phone: 503.639.4171 Fate 503.5 --; ; r
TIGARp InspectwnLine: 503.639 1 INGDIVISION
pateiBT• Other Permit No.:
Date Ready/By:
Internet www.tigard or.gov c Sec Page 2 In f
Notified/Method C Supptemen
TYPE OF WORK FEE` SC?EDULE
❑ New construction ❑ Demolition For special information use checklist
Description I Qty. I Ea. I Total
IV Addition/alteration/replacement ❑ Other: New I- 2-family dwellings ngs (includes 100 fl. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (I) bath 249.20
❑ I- and 2- family dwelling El Commercial /industrial SFR (2) bath 350.00
❑ Accessory building ❑ Multi- family SFR (3) hash 399.00
Each additional bath /kitchen 45.00
❑ Master builder ❑ Other:
Fire sprinkler ( sq. ft) Page 2
JOB SrTE INFORMATION AND LOCATION
Site utilities
Job site address: 1 0501) 5 W 1...1 i yyl, bu5 Catch basin or area drain 16.60
City/State/ZIP: Drywell, leach line, or trench drain 16.60
Suite/bldgJapt. no.: I Project name:� Footing drain (no. linear ft.: ) Page 2
-
Cross street/directions to job site:
SO Manufactured home utilities 110.00
Vkdi 12 a -k x01 1.1 Shin Manholes
16.60
Rain drain connector 16.60
Sanitary sewer (no. linear It: ) Page 2
Storm sewer (no. linear ft.: _) Page 2
Subdivision: I Lot no.: Water service (no. linear ft: ) Page 2
Tax map/parcel no.: Fixture or item
DESCRIPTION OF WORK • Absorption valve 16.60
Backtlow preventer Page 2
V15 L4 ( 42_ P g
� 111 � 11 Bad cwa tervalve 16.60
Clothes washer 16.60
t
Dishwasher 16.60
❑ PROPERTY OWNER I ❑ TENANT Drinking fountain 16.60
Name:
Ejectors/sunnp 16.60
Expansion tank 16.60
•
Address: I Fixture/sewer cap 16.60
City/State /ZIP: Floor drain /floor sink/hub 16.60
Phone: ( ) Fax: ( ) Garbage disposal 16.60
❑ APPLICANT ❑ CONTACT PERSON Hose bib 16.60
Business name: Ice maker _ 16.60 L
Interceptor /grease trap 16.60
Contact name:
Address: Medical gas (value: $ � ) Page 2
Primer 16.60
City /State2IP: Roof drain (commercial) 16.60
Phone: ( ) Fax: : ( ) Sink/basirvlavatory 16.60
E-mail: Tub/shower /shower pan 16.60
Urinal 16.60
CONTRACTOR Water closet 6.60
Business name: I v t l et pe +e„cSOy) pi urYl 01 .),161 Water heater 16.60
Address: 15r�2A G _ Al I "Y�.(/iel ( 1,17 Other:
I
City/State/ZIP: CI � r � iz +-
gl0, t 1g Subtotal (.40, L tO
Phone: `� Minimum permit fix: $72.50
( ) 1 032. 1 Fax: ( %I��) (032, • e...rJ - Residential backflow minimum permit fee: $36.25
CCB Lic.: �' Plumbing Lic. no.: 3.35.9 f - Plan review (25% of permit fee)
Authorized signature: / 3 , State surcharge (12% of permit fee)
J / ■ 4. .:4,... " TOTAL PERMIT FEE i°/ 1
Print name: • 1P,'11 PI f p Yrp Date: e 12L/ t9 1 This permit application expires ifa permit is not obtaincZl'within
��''�� `• / l 180 days alter it has been accepted as complete.
'Fee methodology set by Tri- County Building Industry Service Board.
•
Z d Lt 9S-Z£9-COS Uer ett :60 60 bZ deS
:i. , ,..
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site Utilities Qty. Fee (ea) Total
Footing drain - 1° 100' Square Footage: Permit Fee:
55.00 0 to 2,000 $115.00
Footing drain -each additional 100' 46 2,001 to 3,600
$160.00
Sewn - 1st 100' 55.00 3,601 to 7,200 $220.00
Sewer - each additional 100' 7,201 and greater $309.00
46.40
Water Service - 1st 100' 55.00
Water Service - each additional 100' 46.40 Medical Gas Systems:
Valuation: Permit Fee:
Storm & Rain Drain - 1st 100' 55.00
Storm & Rain Drain - each additional 100 $1.00 to $5,000.00 Minimum fee $72.50
46.40 $5,001.00 to $10,000.00 $72.50 for the first $5,000.00 and $1.52 for each
Fixture or Item Qty. Fee (ea) Total additional $100.00 or fraction thereof, to and
ack B
Commercial Flow Prevention Device ( 4640 Li including $10,000.00.
Residential l ack ow prevention Device �0 '�� $10,001.00 to $25,000.00 $148.50 for the first $10,000.00 and $1.54 for
(minimum permit fee $36 25) each additional $100.00 or fraction thereof, to
Rain Drain, single family dwelling 27.55 _ and including $25.000.00.
65.25 $25,001.00 to $50,000.00 $379.50 for the fast $25,060.00 and $1.45 for
inspection of existing plumbing or each additional $100.00 or fraction thereof to
specially requested inspections - per hour 72.50 and including $50,000.00.
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:
fixtures? If "yes ", Plan Review for Plumbing Installations
Are you capping, adding or replacing
please indicate work performed by fixture. Failure to Plan review is all that required for any of the following.
Please check all that apply.
accurately report fixtures could result in increased sewer fees * . ❑ Any new commercial building with water service 2" and
r
Fixture Type; Quaoti by (Fixture) Work Performed greater, except systems designed and stamped by licensed
Replica engineer.
Baptistry/Font Previous Carolled ' Added Existing ❑ New exterior plumbing site utilities for any complex structure
Bath Tub /Shower as defined in OAR918- 780 -0040.
Tub/Sh /Whirlpool ❑ Medical gas and vacuum systems for health care facilities.
Car Wash Each Stall ❑ Any multipurpose fire sprinkler system.
Drive Thar ❑ Any complex structure as defined in OAR918- 780 -0040.
Cuspidor/Water Aspirator
Dishwasher - Commercial Submit 2 sets of plans with any of the above.
- Domestic
Drinking Fountain Isometric or Riser Diagram
Eye Wash
❑ Isometric or riser diagram is required for new buildings
Floor Drain/sink 2"
3" that meet the qualifications above.
4"
Car Wash Drain
Garbave -Domeestic
D p�sa1 om Comments regarding fixture work:
- Industrial
Ice MachfRefrig. Drains ,
Oil Separator (Gas Station)
Rea Vehicle Du . 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
Swimmer: Pool Filter fees assessed for the sewer increase must be paid before the
Washer - Clothes plumbing permit can be issued.
Water Extractor
Water Closet - Toilet
Urinal
Other Fixtures:
•
£'d Lti9S Uef 8917:60 60 17Z deS