Permit CITY OF TIGARD PLUMBING PERMIT
• COMMUNITY DEVELOPMENT Permit #: PLM2012 -00182
T I GARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 06/28/2012
Parcel: 1S133AD05400
Jurisdiction: Tigard
Site address: 12955 SW HAWKS BEARD ST
Project: Connelly Subdivision: AMART SUMMER LAKE Lot: 98
Project Description: Replace 3' of sanitary sewer line.
Contractor: OWNER Owner: CONNELLY, MARK & A LORENA
12955 SW HAWKS BEARD ST
TIGARD, OR 97223
PHONE:
PHONE: 503 - 891 -4792
FAX:
FEES
Quantity Description Date Amount
3 If Sewer Service 06/28/2012 $62.54
Specifics: 1 12% State Surcharge - 06/28/2012 $8.70
Plumbing
Type of Use SF 10 ea Minimum Fee Adjustment - 06/28/2012 $9.96
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 -0090. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
grit Issued By: ■ 1- lir /. Permittee Signature: —
• Call 503.639.4175 by 7:00 a.m. for the next available in ction 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 Applicatio r Ill .
� r � : � Felt OI FICE litil: ONI.I`
Received P M � O /c2 OO / cp� •
City of Tigard 'JUN 2 8 2 012 04 / / Penr;itN 'f ,
INI
v 13125 SW Hall Blvd., Tigard, 97223 Dat ` G � /
C Plan Revie
Phone: 503.718.2439 Fax 503.598.196 �± Other Permit No.:
Inspection Line: 503 - . . i y -OF TI i_i Da Rea.
e
' T I G A It D / + 1 I�� I R [H Notified/Method: ' Date Ready kris: ® See Page Z for
Internet: www tigard- or.gov RI III DING D� , SI °1v fied/Mhod: 7 Supplemental Information
TYPE OF WORK FEE* SCHEDULE
For special infornrafion use checklist •
❑ construction ❑ Demolition
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
'1- and 2- family dwelling ❑ Commercial/industrial SFR (2) bath 437.78
building SFR (3) bath 500.32
❑ Accessory g ❑ Multi- family
Each additional bath/kitchen 25.02.
❑,Master builder . ❑ Other: Fire sprinkler ( sq. ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities: .
e \-- 2C1 v
• Job site address: (2_75 (( , �L k f , jf , , '_, () Catch basin or area drai 18.76
City/State /ZIP: l � --- � � ( Drywell, leach line, or trench drain 18.76
Footing drain (no. linear, ft.: _ Page 2 •
Suite/bldg. /apt. no.: I Project name: <6",,,.,_ Manufactured home utilities 50.03
Cross street/directions to job site: S!t r~ . 'Manholes 18.76
Rain drain connector - 18.76
Sanitary sewer (no. linear ft.: ' Page 2 (p a , sy
Storm sewer (no. linear ft.: . Pa 2
Water service (no. linear ft.: Page 2 '
Subdivision: I Lot no.: Fixture or item:
• Tax map /parcel no.: Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 25.02
Dishwasher 25.02
Drinking fountain 25.02
Ejectors /sump 25.02
•
PROPERTY OWNER I ❑ TENANT Expansion tank 12.51
Name: �' ,{ q Fixture/sewer-cap G' `� v G / ' h '�af /1.'1, / Floor drain/floor sirdc/hub' 25.02
Address: f ZS c S" . 5A,,.4 ,,,C S 74 Garbage disposal 25.02
City/State /ZIP: �",Q Hose bib • - 25
Phone: (!'0 7) - ({ -` 7 5 Fax: ( ) Ice maker , 12.51
❑ APPLICANT ❑ CONTACT PERSON Interceptor /grease trap 25.02 '
Business name: '
Medical gas (value: $ ) Page 2
Primer 12,51
Contact name: Roof drain (commercial) 12.51
Address: Sink/basin/lavatory 25.02 ,
City/State /ZIP: Solar units (potable water) 62.54
Phone: ( ) Fax: : ( ) Tub /shower /shower pan 12.51 .
E -mail: Urinal 25.02
Water closet 25.02 .
CONTRACTOR
Water heater 37.52
Business name: d t.(.) ft/E Water piping/DWV 56.29
Address: Other: 25.02 '
City /State /ZIP: .. . . ' Subtotal
Minimum permit fee: $72:50 sr)
Phone:( ) Fax: ( ) ��.
CCB Lic.: Plumbing Lic. no.: Plan review (25% of permit fee)
State surcharge (12% of permit fee) . j 70
Authorized siig . TOTAL PERMIT FEE f /, 02.0 Print name: (/ ' C e `i Date: ' s
This permit application expires ifa permit is not obtained within 180 days
- ?-R ' 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 - 1 100' 50.03 0 to 2,000 $121.90
Footing drain - each additional 100' 37.52 2,001 to 3,600 $169.69
• 3,601 to 7,200. $233.20
Sewer - 1st 100' / 62.54 6,62,5y 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
p 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 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 first $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 ❑ Any new commercial building with water service 2" and
Fixture Type: Replace greater, except systems designed and stamped by licensed
' Previous Capped Added Existing engineer.
Baptistry/Font
Tub /Sowr ❑ New exterior plumbing site utilities for any complex structure
Bath - hower
Tub/S erlpool as defined in OAR918- 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 ❑ 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
that meet the qualifications above. -
4 „ - - - - _ _
Car Wash Drain • . •
Garbage . - Domestic_ _ • _ _ , - _ . . _ . _ _ _ ..
Disposal - Commercial
-Industrial.. Comments regarding fixture work:
Ice MachiRefrig. Drains
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: •
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