Permit CITY OF TIGARD PLUMBING PERMIT
111 1- COMMUNITY DEVELOPMENT Permit #: PLM2012 -00288
Date Issued: 10/08/2012
T F GARD 13125 SW Hall Blvd., Tigard OR 97223 503 718 2439 Parcel: 2S1126D07500
Jurisdiction: Tigard
Site address: 7894 SW HANSEN LN
Project: Brittany Meadows, Lot 11 Subdivision: BRITTANY MEADOWS Lot: 11
Project Description: Irrigation backflow for new SF
Contractor: GREAT SCAPES INC Owner: HERONWOOD PROPERTIES
12473 SE CENTRAL PARK CT 16615 MAPLE CIRCLE
PORTLAND, OR 97086 LAKE OSWEGO, OR 97034
PHONE" 503 - 784 -3869 PHONE: 503 781 -1981
FAX
FEES
Quantity Description Date Amount
1 ea Backflow Preventer 10/08/2012 $31 27
Specifics: 1 12% State Surcharge - 10/08/2012 $8 70
Plumbing
Type of Use: SF 41 ea Minimum Fee Adjustment - 10/08/2012 $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 -0090 Y1u 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 Application RECEIVED
Building Fixtures Folz OFFICE USE oNI.\
OCT 0 8 Received
City Tigard /
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n 1312 S W Hall Blvd., Tigard,OR 97223 r DateBy `� a /.2... /� � DO „ye?'
503 7 18.2439 Fax: 503 598 1960 � . I Plan Review
D Other Permit No /9:57-0V-04.2 MO ?
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g g Nohfied/Method Supplemental Information
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: -7RRii 5W 1 �Q� 14\I Catch basin or area drain 18.76
City /State /ZIP: � ) a -riT l Footing drain line, trench drain ag 2
I �' 1 Footing dram (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
(k) 1, 7 ' Rain drain connector 18 76
Sanitary sewer (no. linear ft • ) Page 2
Storm sewer (no linear ft.: ) Page 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
p, �/ Clothes washer 25 02
� *MA/ ?4 F D E I 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
❑ 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
CONTRACTOR Water closet 25.02
�� m 5 COQ. l /4 - Water heater 37.52
�
Business name: -G�fh I t Pie Water piping/DWV 56.29
Address: t 3 %C Cia P iA ' & Other. 25.02
City /State /ZIP: Ikv 9 c Subtotal
Phone: (St3)) U O 11) g 0 Fax: ( ) Minimum permit fee: $72.50 Z7, SO
CCB Lic.: �,Cj 1 g Plumbing Lic. no.: Plan review (25 %of permit fee)
State surcharge (12% of permit fee) O 70
Authorized signature: VI TOTAL PERMIT FEE f/r .20
Print name: ' ' J �� Date: �� 2 This permit application expires if a permit is not obtained within 180 days
after it has been accepted as complete.
"Fee methodology set by Tn -County Building Industry Service Board
I \ Building Tomas \PLMU- PermitApp doc 10/01 /09 440- 4616T(10 /OIJCOM/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 - 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 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
Storm & Rain Drain - 1st 100' 62.54 Valuation: Permit Fee:
$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
Q ty. Fee (ea) Total each additional $100.00 or fraction thereof, to
Other Inspections or Fees 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 ",
please indicate work performed by fixture. Failure to
accurately report fixtures could result in increased sewer fees * . Plan Review for Plumbing Installations
Quantity by Fixture Type Plan review is required for any of the following.
Fixture Type for Replace/ Please check all that apply.
Work Performed: Capped Added Relocate
Baptistry/Font ❑ Any new commercial building with water service 2" and
greater, except systems designed and stamped by licensed
Bath: - Tub /Shower
- Jacuzzi/Whirlpool engineer.
Car Wash: Each Stall ❑ New exterior plumbing site utilities for any complex structure
Drive tall as defined in OAR918- 780 -0040.
Cuspidor/Water Aspirator ❑ Medical gas and vacuum systems for health care facilities.
Dishwasher: Commercial ❑ Any multipurpose fire sprinkler system.
Domestic ❑ Any complex structure as defined in OAR918 -780 -0040.
Drinking Fountain
Eye Wash Submit 2 sets of plans with any of the above.
Floor Drain/sink: - 2"
3" Isometric or Riser Diagram
4 " ❑ Isometric or riser diagram is required for new buildings
-Car Wash Drain
Garbage Domestic non -food that meet the qualifications above.
Disposal: - Domestic food related
- Commercial food related
- Industrial food related
Ice MachiRefrig. Drains Comments regarding fixture work:
Oil Separator (Gas Station)
Rec. Vehicle Dump Station
Shower: -Gang
-Stall
Sink: - Lav/Bar non -food related
- Bradley
-Com/Serv/Util food related
- Service *Note: If the fixture work under this permit results in an
Swimming Pool Filter increase of sewer EDUs, a sewer permit will be issued and
washer - Clothes fees assessed for the sewer increase must be aid before the
Water Extractor p
WaterCloset - Toilet plumbing permit can be issued.
Urinal
Other Fixtures:
I: \Building\Permits\PLMF- PermitApp.doc 08/04/2011 2