Permit . - er
CITY OF TIGARD PLUMBING PERMIT
°. COMMUNITY DEVELOPMENT Permit #: PLM2009 -00074
T IGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 04/06/2009
Parcel: 1S 125DC06500
Jurisdiction: Tigard
Site address: 9670 SW SHADY PL
Subdivision: Lot: 0
Project: Gilbert
Project Description: Install residential backflow preventer for irrigation.
Owner: FEES
GILBERT, JOEL S & MARSHA I Quantity Description Date Amount
4802 SW SCHOLLS FERRY RD STE C 1 ea Backflow Prevention - RES 04/06/2009 $27.55
PORTLAND, OR 97225 1 12% State Surcharge - 04/06/2009 $4.35
PHONE:
Plumbing
9 ea Minimum Fee Adjustment 04/06/2009 $8.70
Contractor: - Plumbing
LEWIS LANDSCAPE SERVICES INC
14314 SW ALLEN BLVD #510
BEAVERTON, OR 97223
PHONE: 503 - 524 -3679
FAX: 503- 213 -5921
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
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 cation • -r. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100 i may obtain a copy of the rules
Iss ed By: / Permittee ignature:
■
_.01__Ae...i 4.4. - , Af■-.
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.
'is
Plumbing Permit Application
Building Fixtures FOR OFFICE 1 S ON1.1
Cl SW Ha11 Tigard, OR 97283 R - 2 2009 Date y: 2 49
• )l Permit No.: I L //o000/ �
P hone: 5036394171 Fax: 5035981960 Plan Review
i m 503. 639.4171 503. 598.1960 Other Permit No.:
T I G A ii D CITY OF TI GARD Daf R eady/By: F1 See Page 2 for
Inspection Line: 50 3.639.4175
• Internet www.tigard-or.gov R DIVISION Notified/Method � I supPlemeamt Information TYPE OF ORK FEE* SCHEDULE -
❑ Np, construction ❑ Demolition For special inform: aka use checklist
Description I Qty. I Ea. I Total
tidition/alteration/replacemeat ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
/ CATEGORY OF CONSTRUCTION SFR (1) bath 249.20
0'1- and 2-family dwelling ❑ Commercial/industrial SFR (2) bath 350.00
❑ Accessory building ❑ Multi - family SFR (3) bath 399.00
Each additional bath/kitchen 45.00
• ❑ Master builder ❑ Other
Fire sprinkler (_ sq. ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities - -
Job site address 91 Styt) Sktika 4(1(� Catch basin or area drain 16.60
City/State/BP: -r A 09-- - 9 - , Drywell, leach line, or trench drain 16.60
Suite/bldg./apt. no.: Project name: Footing drain (no. linear It.: _J Page 2
Manufactured borne utilities 110.00
Cross street/directions to job site: ,
Manholes 16.60
Rain drain connector 16.60
Sanitary sewer (no. linear ft.: __) Page 2
Storm sewer (no. linear ft.: _) Page 2
Subdivision: I Lot no.: Water service (no. linear ft.: 1 r Page 2
Future or item
Tax mapfpar el no.: -
Absorption valve 16.60
DESCRIPTION OF WOR Bac ow , p�m� / Wage 2 A7
,
>n , e. AL 27n �
t .- -c17 v3 (7th'.Q ► 02- `-cm., Backwater valve 16.60
_ _ r t�`� Clothes washer 16.60
�1/C Dishwasher 16.60
II'tOPERTY OWNER 1 . ❑ TENANT
Drinking fowdain 16.60
Ejectors/sump 16.60
Name: ':� [� 1 • , �`� Expansion tank 16.60
Address: tp`zo ,S).,1/43 S ,L. � I. Fixture/sewer cap i 6.60
cit Ti �L . 11 2_23 Floor drain /floor sink/hub 16.60
Phone: (5 2) 1 Fax: ( ) Garbage disposal 1.6.60
DAI'PLICANP I ❑ CONTACT PERSON Hose bib 16.60
� � Ice maker 16.60
Business name: I P A.4 ) ` 5. t `G�^ 4' I C Q - Interceptor /grease trap - 16.60
Contact name: 1(,,y -9, 1 C .) >¢ I Lam' ('�IJeI '510 Medical gas (value: $ ) Page 2
Address: f.Jp,C_ ems✓ i (712_ - 17() 017 Primer 16.60
City /State/ZIP: Roof drain (commercial) 16.60
P": ( n 5 at'l _ � � - 9 , I Fax:: ( I5 9 2 ‘? ( 2.4 Sirtk/basiuilavetary 16.60
1 Tub/Alma/shower pan 16.60
E -mail: Urinal 16.60
CONTRACTOR Water closet 16.60
Business name: : 5 `44 , v . f .� (. Water heater 16.60
Address: I 1 A 1 4 St70 & Li.eA, a. A 0 Other:
City/Stare/ZIP: 9DesNVe_e , 0 - g TEXT 5 Subtotal
YA
`/ Minimum permit fee: $72.50 2 6 . a rj
Phone: (5 ) J ;.1.... , to �9 Fax: ( 3) 11 3 - 5t 2 Residential backflow minimum permit fee: $36.25 d
c.caLkm. ii,p, ( 12..- Plumbing Lie. ' " y Q 9503 Plan review (25% of pnmit fee) -t -"
✓V "� State surcharge (12% of permit fee)
Authorized signature `
-� TOTAL PERMIT FFE
Print name: J tZ S �,(,U h S I Date: -2, oq 1 This permit application expires if a permit is not obtained within
l 180 days after it has been accepted as complete.
111 *Fee methodology set by Tri -County Building Industry Service Board.
f: wuildi °g\Prnniu\PLMF- PerraitAppd°c 12127■6 4404616T(10/02ICOM /WEB)
L'd LZ69 £1,Z s!Me1 wig dO£:Zl 60 ZO add
1.
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 - l 100' 55.00 0 to 2.000 $115.00
Footing drain - each additional DO' 46.40 ' - 2,001 to 3.600 £160.00
3.601 to 7,200 $220.00
Sewer - 1st 100' 55.00 7,201 an jreatcr $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: Permit Fee:
Storm 8c Ram Drain - 1st 100' 55.00 $1.00 to $5,000.00 Minimum fee $72.50
Stone & 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
Fixture or Item Qty' Fee (ea) Total including $10.00. 1,0.0 r fraction thereof, to and
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 Baclulow Prevention Device -. each additional $100.00 or fraction thereof to
(minimum permit fee $36.25) I 27.55 �� 7 � and including $25,000.00.
Rain Drain, single family dwelling 65.25 $25,001.0010 $50,000.00 $379.50 for the first $25,000.00 and $1.45 for
each additional S100.00 or fraction thereof, to
Inspection of existing plumbing or and including $50,000.00.
specially requested inspections - per hour 72.50 $50,001.00 and up $742.00 for the first $50,000.00 and $1.20 for
Subtotal: _ •11.' each additional $100.00 or fraction thereof.
Commercial Fixture Work: Plan Review for Plumbing Installations
Are you capping, adding or replacing fixtures? If "yes", Plan review is required for any of the following.
- please indicate work performed by fixture. Failure to Please check all that apply. ..
accurately report fixtures could result in increased sewer fees *. ❑ Any new commercial building with water service 2" and
Quantity by (Fixture) Work Performed . greater, except systems designed and stamped by licensed
Replace
engineer.
Fixture T ype: •
Peisioas Capped Added Existing ❑ New exterior plumbing site utilities for any complex structure
BaptisuyfFont as defined in OAR918 -780 -0040.
Bath - Tub /Shower ❑ Medical gas and vacuum systems for health care facilities.
- Jacuzzi/Whirlpool ❑ My multipurpose fare sprinkler system.
Car Wash - Each Stall ❑ Any complex structure as defined in OAR918- 780-0040.
-Drive mm
' Cuspidor/Water Aspirator _ Submit 2 sets of plans with any of the above.
Dishwasher - Commercial
- Domestic
Drinking Fountain Isometric or Riser Diagram
Eye Wash ❑ Isometric or riser diagram is required for new buildings
Floor Drain/sink - 2" that meet the qualifications above.
- 3"
- 4"
Car Wash Drain
Garbage - Domestic Comments regarding fixture work:
Disposal - Commercial
- Industrial
i Ice Mar:h/Refrig. Drains
Oil Separator (Gas Station) _ -
Rec. Vehicle Dump Station •
Shower -Gang ,
-Stall
Sink - Bar/Lavatory _
-By Note: If the fixture work under this permit results in an
-Conunercial 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 Fitter plumbing permit can be issued.
Washer - Clothes i _
Water Extractor
Water Closet - Toilet -
Urinal
Other Fixtures: .
ii8uilding\vemoits\PLM-P rmicnw.doe 12mro5
Z 269 si,ei wig dl£ :Zl 60 ZO .idy