Permit r
CITY OF TIGARD PLUMBING PERMIT
0 : COMMUNITY DEVELOPMENT Permit #: PLM2009 -00117
T t G AR D 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 05/13/2009
Parcel: 2S1 04 BB06500
Jurisdiction: Tigard
Site address: 14161 SW STARDUST LN
Subdivision: Lot: 0
Project: Gobel
Project Description: Replace up to 100 feet of water service.
Owner: FEES
TAYLOR, DAN & GLENDA Quantity Description Date Amount
1484 EMMONS CANYON DR 100 If Water Service 05/13/2009 $55.00
ALAMO, CA 94507 1 12% State Surcharge - 05/13/2009 $8.70
PHONE:
Plumbing
18 ea Minimum Fee Adjustment 05/13/2009 $17.50
Contractor: - Plumbing
ANCTIL PLUMBING INC.
16900 SW MERLO ROAD
BEAVERTON, OR 97006 -0000
PHONE: 503 - 642 -7323
FAX: 503- 642 -7755
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp:
Stories:
Total $81.20
Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain a copy of the rules
Issued By: n n Permittee Signature: UL I i CO0 V�
� A `, VVlJ �
Call 503.639.4175 by 7:00 a.m. for an inspection that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
5 (e
.;� 'P Permit Application t"! d1-4- Y � 4A+ � ill �-.
Building Fixtures * 4 l•Y)l- ovf.ic r. USE ONLY
DD
City of Tigard rve
III 4 13125 SW Hall Blvd., Tigard, OR 97223 e)
O Date$ 5 • • Q 9 Parmit No. O 6 O ( t
� , Phone: 503.639.4171 Fax: 503.598.1960 • 0 "'ew 1
Other Permit No.:
■ • li n- I :ll
Inspection Line: 5°3 See P
Date ReadyBy -
Internet: www.tigard- or.gov aae for
Noti£cd/Method:� tiapptemoatai Information
TYPE OF WORK FEE* SCHEDULE
❑ New construction ❑ Demolition For special information use checklist
Description I Qty. { Ea I Total •
ddition/alteratiorx/replacemeur ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION • SFR (1) bath 249.20
'.!° - and 2 -family dwelling ❑ Commercial/industrial SPR (2) bath 350.00
❑ Accessory building ❑ Multi -family SFR (3) bath 399.00
❑ Master builder Each additional ba tb/ldtchen 45,00
❑ Other: ._
.. Fire sprinkler (_„_ sq. I.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities
- Job site address 1 6 I ,s as 4- j : Catch basin or area drain 16.60
City /State/ZIP: Drywall, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: Project name: Ga b e C Footing drain (no. linear ft.: _ - Page 2
Cross street/directions to job site: Manufactured home utilities 110:00
Manholes 16.60
' e r:3 Rain drain connector 16.60
Sanitary sewer (no, linear ft.: i ) Page 2
MAY 1 t t Storm sewer (no. linear ft'.: _____) Page 2
Subdivision: - L Lot no -: Water Service (no. linear $. _Page 2
Tax map /parcel no.:
Fixture or item
DESCRIPTION OF WORK - Absorption valve -7- 16,60
r Barlow preventer Page 2
CIJ w i 46 G r "` Backwater valve 16.60
Clothes washer _ 1660 1
Dishwasher 16.60 f
•
Oa' • OPERTY OWNER ❑ TENANT Drinking fountain 16.60 j (
Name: . Ele[xots/sump 16.60
Address: Expansion tank 16.60
Fixture/sewer cap 16.60
City/State/ZIP; Floor drain/floor sink/hub 16.60
Phone: ( ) • Fax; ( ) Garbage disposal 16.60
El APPLICANT ❑ CONTACT PERSON Hose bib _ 16.60
Business name: Ice maker - 16.60
Contact name:
Interceptor /grease trap 16.60
Medical gas (value: $_ ) Page 2
Address:
Primer 16.60
City/State/UP: Roof drain (commercial) 16.60
Phone: ( ) Fax: : ( ) -Roof
16.60
E-mail: • Tub /shower /shower pan 16.60
Urinal 16,60
CONTRACTOR
• closet
16.60
Business name: 4ic-'
• L "PL.( any i - A Jc, Water heater 16.60
Address: .� • 0 a Lt/ Meg Lo AD. other
City/State/ZIP: .1w VEM •ik.l / g? 0 7-0 pkp Subto ai
Phone; 6* ro (�Z- Z.3 1 ax: ( • f 5b3 -. 00 q 2.~ 7'T 7 Minimum permit fee: $ 72.50 �y
V ss Residential backflow minimum permit See: $36.25 7 CCB Lie.: 2 U I 1 $ Plumbing Lac) . /2. # Plan review (z5 %of permit fee) Authorized signature: State sarcharge (12% of permit fee) -
TOTAL PERM' ' FEE ✓ Q > 1 , 2 . p
Print name: . ; LI- t A/C 1 1.... Dater j r • This permit application expires if a permit is not obtained within
180 days after it has been accepted as complete.
*Free methodology set by Tri -County Building Industry Service Board.
I: IBuildineemlitCPI ,MP"ParrohAOV.doc 12/27/D6 ..,, __ -...
. -- Plumbiing Permit Application - City of Tigard
Page - Supplemental Information
_ Fee Schedule: Residential Fire Suppression Systems:
Site Utilities Qty. Fee (ea) Total .Squa F ootage: Permit Fee: •
rooting drain - le 100' 55.00 0 to 2,000 $115.00
Footing drain - each additional 100' 46.40 2 to 3 $160.00
Sewer- 1st 100' 55.00 - _ to 7,200 $220.00
7,201 and greater $309.00
Sewer - each additional 100' - 46.40 -
Water Service - 1st 100' / 55,00 S'- Medical Gas Systems:
' Water Service - each additional 100' 46.40 _ Valuation: Permit Fee: W
Swan 6t Rain Drain - 1st 100' 55.00 $1.00 to $5,000.00 Minimum fee $72.50
•
Storm & 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 additional $100.00 or fraction thereof: to and
including $10,000.00.
Commercial Back Flow Prevention Device 46.40 $10,001.00 to $25,000.00 $148.50 fbr the first $10,000.00 and $1.54 for
Residential Bacidlow Prevention Device each additional $100.00 or fraction thereof. to
(minimum permit fee $36.25) 27.55 and including $25,000.00.
Rain Drain single family dwelling - 65.25 $25,001.00 to $50,000.00 $379.50 for the first $25,000,00 and $1.45 for
Inspection of existing plumbing or each additional $100.00 or fraction thereof. to
specially requested inspections - per hour 9250 and including $50,000,00.
• Subtotal: $50,001.00 and up $742.00 fbr the first $50,000.00 and $1,20 for
each additional $100.00 or fraction thereof.
•
fc
Fixture Work: AY ti �D 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 (Future) Work Performed greater, except systems designed and stamped by licensed
Fixture Type: • Replace engineer.
• 'Previous , .Capped • Added :F7d9tiag ' ❑ New exterior plumbing site utilities for any complex structure
Bortisiry/Font as defined in OAR918 -780 -0040.
Bath - Tub /Shower ❑ Medical gas and vacuum systems for health care facilities.
- 7acuzzi/Whirfpooi R ❑ Any multipurpose fire sprinkler system.
Car Wash -Each Stall ❑ Any complex structure as defined in OAR918- 780 -0040.
-Drive Thru
Cus dot/Water As castor Submit se ts of plans with any of the above.
Dishwasher - Commercial P Y
- Domestic
Drinlcing �� Isometric • o R.iserDiagram .
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 g g
- Industrial
Ice Mach,/Rcfrig. Drains
Oil Separator (Gas Station)
Rec. Vehicle Dump Station - -
Shower aatg —"
-Cl
-Stall — -
Sink - Bar/Lavatory
Bradley *Note: If t he fixture work under this permit results in an
- Commercial increase.of sewer EDUs, a sewer permit will be issued and
- Service fees assessed for the sewer. increase must be paid before the
Swimmin Pool Filte plumbing permit can be issued.
Washes - Clothes p g lm
Water Extractor
Water Closet - Toilet
Urinal
•
Other Fixtures:
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