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Permit CITY OF TIGARD PLUMBING PERMIT 11 COMMUNITY DEVELOPMENT Permit #: PLM2012 -00150 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 06/04/2012 Parcel: 2S112BD07000 Jurisdiction: Tigard Site address: 14709 SW 79TH AVE Project: Pacific Evergreen Homes Subdivision: BRITTANY MEADOWS Lot: 6 Project Description: (1) backflow preventer Contractor: GREAT SCAPES INC Owner: PACIFIC EVERGREEN HOMES LLC 12473 SE CENTRAL PARK CT 7410 SW OLESON RD #133 PORTLAND, OR 97086 PORTLAND, OR 97223 PHONE: 503 - 784 -3869 PHONE: FAX: FEES Quantity Description Date Amount • 1 ea Backfiow Preventer 06/04/2012 $31.27 Specifics: 1 12% State Surcharge - 06/04/2012 $8.70 Plumbing Type of Use SF 41 ea Minimum Fee Adjustment - 06/04/2012 $41.23 Plumbing Class of Work: OTR 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 -0 0. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. Issued By: Permittee Signature: Call 503.639.4175 by 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 REcEivE:,._ l Qlt OFFICE: IiSI: OiVl_1` R eceived City of Tigard U Pe rmit No.: a 131 SW Hall Blvd., Tigard, OR 97223 JUN 0 4 2012 Plan Review (0 2 a01 � C Plan Review Other Permit No Phone: 503.718:2439 Fax: 503.598.1960 D Inspection Line: 503.639.4175 CITY 1O'/F TIGARD ± Date Rea B 4 See Pa e ntal 2 for T 1 C. n It D ardor. ov BUIl DING DIVISION y. Internet: www.ti 4' g www.tigard Notified/Method: Supplemeln[o TYPE OF WORK FEE* SCHEDULE New construction ❑ Demolition For special information use checklist Description I Qty. I 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 312.70 (g,1- and 2- family dwelling ❑ Commercial/industrial SFR (2) bath 437.78 SFR (3) bath 500.32 ❑ Accessory building ❑ Multi - family Each additional bath/kitchen 25.02 ❑ Master builder ❑ Other: Fire sprinkler ( sq. ft.) Page 2 JOB SITE INFORMATION AND LOCATION Site utilities: Job site address: L 104 sw lit Catch basin or area drain 18.76 City/State/ZIP: I�'{r 0 b ai l i- i- Li Drywell, leach line, or trench drain 18.76 If t 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 nn �� Water service (no. linear ft.: ) Page 2 Subdivision: /�f ` I Wy �1at V\ S I Lot no.: Fixture or item: Tax map /parcel no.: Backflow preventer I 31.27 DESCRIPTION OF WORK Backwater valve 12.51 �� � Clothes washer 25.02 I 'a■ '' l Ii • I c 1_ Dishwasher 25.02 Drinking fountain 25.02 Ejectors /sump 25.02 ❑ PROPERTY OWNER I ❑ TENANT Expansion tank 12.51 Name: Fixture /sewer cap 25.02 Floor drain/floor sink/hub 25.02 Address: Garbage disposal 25.02 City /State /ZIP: Hose bib 25.02 Phone: ( ) Fax: ( ) Ice maker 12.51 . rg APPLICANT ❑ CONTACT PERSON Interceptor /grease trap 25.02 Business name: G gAl I/I` G 9 Medical gas (value: $ ) Page 2 Primer 12.51 Contact name I l' _ Roof drain (commercial) 12.51 Address: L Pilt 1 �-1� DT Sink/basin/lavatory 25.02 City/State /4 P: IL 0) i ' • Solar units (potable water) 62.54 Phone: ( i`) /40 g b 7 Fax: : ( ) Tub /shower /shower pan 12.51 E -mail: Urinal 25.02 Water closet 25.02 CONTRACTOR Water heater 37.52 Business name: _ / Water piping/DWV 56.29 Address: , � Other: 25.02 City/State /ZIP: Subtotal Phone: ( ) Fax: ( ) Minimum permit fee: $72.50 CCB Lic.: 4 �' , Plumbing Lic. no.: Plan review (25% of permit fee) State surcharge (12% of permit fee) Authorized signature: ,n TOTAL PERMIT FEE „VA This p ermit application expires if a permit is not obtained within 180 days „ 1 a 1 al Date after it has been accepted as complete. *Fee methodology set by Tri -County Building Industry Service Board. I:\ Building \Permits\PLMU- PermitApp.doc 10 /01/09 440- 4616T(10 /02/COM/WEB) Plumbing Permit Application - City of Tigard Page 2 - Supplemental Information ` Fee Schedule: Residential Fire Suppression Systems: • Site Utilities Qty. Fee (ea) Total Square Footage: . Permit Fee: Footing drain - Is' 100' 50.03 0 to 2,000 $121.90 Footing drain - each additional 100' 37.52 • 2,001 to $169.69 • Sewer - 1st 100' 62.54 3,601 to 7,200 - $233.20 • 7,201 and greater $327.54 Sewer -each additional 100' 37.52 Water Service - 1st 100' 62.54 Medical Gas Systems: Water Service - each additional 100' 37.52 Valuation: Permit Fee: 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 Other Inspections or Fees Qty. Fee (ea) Total each additional.$100.00,or fraction thereof, to 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 additibnal'$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 fir'st$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 ", Plan Review for Plumbing Installations •,; `; 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. . . Quantity by (Fixture) Work Performed ❑ Anynew commercial buildirig with water service 2" and ' Fixture Type: ' . Replace greater, except systems designed and stamped by licensed Previous Capped Added Existing ' eng Baptistry/Font Tub /Sowr ❑ New exterior plumbing site utilities for any complex structure Bath hower Tub/S erlpool as defined in OAR918- 780 -0040. • Car Wash --Each Stall ❑ Medical gas and vacuum systems for health care facilities. Drive Stall ❑ Any multipurpose fire sprinkler system. Cuspidor/Water Aspirator ❑ 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 Wash Isometric or Riser Diagram . Floor Drain/sink - 2" • ❑ Isometric or riser diagram. is required for new buildings 4 „ that meet the qualifications above. "" " ,:.% Car Wash Drain ' Garbage - Domestic i . I .. Disposal - Commercial g - Industrial g Comments regarding fixture work: Ice•MachiRefrig..Drains L . Oil Separator (Gas Station) . Rec. Vehicle Dump Station • Shower -Gang -Stall Sink - Bar/Lavatory - Bradley - Commercial *Note: If the fixture work under this permit results in an , - Service increase of sewer EDUs, 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: I: \Building\Permits\PLM- PermitApp.doc 2 .