Permit q CITY OF TIGARD PLUMBING PERMIT
s • COMMUNITY DEVELOPMENT Permit #: PLM2012 -00372
T E G A.R D 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 12/26/2012
Parcel: 2S102CB03401
Jurisdiction: Tigard
Site address: 10045 SW GARRETT ST
Project: Coates Subdivision: FREWING'S ORCHARD TRACTS Lot: 9
Project Description: replacement 50 ft sanitary sewer line
Contractor: MR ROOTER OF PORTLAND Owner: COATS, ROBERT LEE
PO BOX 789 10045 SW GARRETT ST
GLADSTONE, OR 97027 TIGARD, OR 97223
PHONE: 503 - 598 -1084
HONE: 503 - 653 -5301
FAX: 503 - 653 -5376
FEES
Quantity Description Date Amount
50 If Sewer Service 12/26/2012 $62.54
Specifics: 1 12% State Surcharge - 12/26/2012 $8.70
Plumbing
Type of Use: SF 10 ea Minimum Fee Adjustment - 12/26/2012 $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. o obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: ji ...ta.. t .
Permittee Signature: ,�7r/ y"
WI &le
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 Applicatio
Building Fixtures FOR OFFICE USE ONLY
City of Tigard DEC 26 ?:*i R` ev i 94,9/0- s1( Permit Nor' 4 ,)vld. - c;:(j_ J�.-
IN - r 13125 SW Hall Blvd., Tigard, OR 97223
a Plan Review
Phone: 503.639.4171 Fax: 503.59 $.�Al&Qr OF Date/By: Other Permit No.:
1.1CARD Inspection Line: 503.639.4175 ll 1lll �Y Date Rea /B Jwi ® See Page 2 for
1; g BU ILDING DIVISION Notified/Method: i (W
Internet: WWW.tI azd-or. ov Notified/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
XIl- 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: 1 j �AN.1 V ( �- SA- . Catch basin or area drain 18.76
Drywell, leach line, or trench drain 18.76
City /State /ZIP: C t: d C) Q. g17.2
Footing drain (no. linear ft.: ) Page 2
Suite/bldg. /apt. no.: ( Project name: Manufactured home utilities 50.03
Cross street/directions to job site: A.i qC Manholes 18.76
V Rain drain connector 18.76
- Sanitary sewer (no. linear ft.: $0) I 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
Backwater valve 12.51
DESCRIPTION OF WORK
r�-� Clothes washer 25.02
�-t Q`a�.� =7u � L,� �
� l� i Dishwasher I 25.02 I
(>(� t�, J Drinking fountain 25.02
Ejectors /sump 25.02
❑ PROPERTY OWNER I ❑ TENANT Expansion tank 12.51
Name: ' - .(+ Li.x j Fixture /sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address: \ 013b ' D\J Goa't(.e sk-- . Garbage disposal 25.02
City /State /ZIP: ST t 0 Q... C A - 12Z' Hose bib 25.02
Phone ' ) C S . 14'S' \ (: Fax: ( ) Ice maker 12.51
R APPLICANT ❑ CONTACT PERSON Interceptor /grease trap 25.02
Business name: s v C 3c) -e_( "P1 l_tv� f� . Medical gas (value: $ ) P 1 2 2
Primer 12.. 51
Contact name: V.R, �(' Roof drain (commercial) 12.51
Address: � x:;)( 7sC\ Sink/basin/lavatory 25.02
City /State /ZI \ack byA. ` o� Cti'� 0/2:1 SolSolar units (potable water) 62.54
Phone) 'S 'b- S Jb \ Fax: : Ebb 11 - .-1(p Tub /shower /shower pan 12.51
E -mail: 5t4 tm My 'Co c{( ���. ( -,�}w� Urinal 25.02
`_ Water closet 25.02
v` n Water heater 37.52
CONTRACTOR
Business name: l,( 2_„ --`
,:s ', U�. Water piping/DWV 56.29
Address: ^,� x n x �J�� Other: 25.02
City /State /ZIP: -A)V 1 V V Subtotal
Phone: ( ) Fax: ( ) Minimum permit fee: $72.50
'`` \v
CCB Lic.: \� y 1 (AI 13 Plumbing Lic. no.: `' Plan review (25% of permit fee)
` (-
State surcharge (12% of permit fee)
Authorized signature: [ TOTAL PERMIT FEE ��
Print name �.a'1 J n ` o f Date: ( 2. z . 0 - 2 This permit application expires if a permit is not obtained within 180 days
after
( V1 it has been accepted as complete.
*Fee methodology set by Tri- County Building Industry Service Board.
1 :\ Building '.Pennits\PLMU- PermitApp.doe 10/01/09 440- 46I6T(l0/02/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 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
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 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
Bath -Tub/Shower ❑ New exterior plumbing site utilities for any complex structure
Tub /S i/Whirlpool as defined in OAR918- 780 -0040.
Car Wash Each Stall ❑ Medical gas and vacuum systems for health care facilities.
Drive tall ❑ 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
3 that meet the q ualifications above.
Car Wash Drain
Garbage - Domestic
Disposal - Commercial
- Industrial Comments regarding fixture work:
Ice Mach. /Refrig. 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 P
Water Extractor plumbing permit can be issued.
Water Closet - Toilet
Urinal
Other Fixtures:
I: \Building \Permits \PLMF - PermitApp.doc 2