Permit Y CITY OF TIC7A® PLUMBING PERMIT
4t4 COMMUNITY DEVELOPMENT Permit #: PLM2013 -00062
TIGARD 13125 SW Hall Blvd , Tigard OR 97223 503.718 2439
Date Issued: 02/21/2013
v Parcel: 2S103DA05601
Jurisdiction: Tigard
Site address: 13430 SW 107TH AVE
Project: Buchanan Subdivision: FANTASY HILL Lot: 6
Project Description: Install of residential backflow preventer for irrigation
Contractor: SAN FRANCISCO LANDSCAPING & MAINTENANCE Owner: BUCHANAN, KARYN L
19297 ALLISON RD NE 13430 SW 107TH AVE
HUBBARD, OR 97032 PORTLAND, OR 97223
PHONE 503 - 957 -7604 PHONE
FAX•
FEES
Quantity Description Date Amount
1 ea Backflow Preventer 02/21/2013 $31 27
Specifics: 1 12% State Surcharge - 02/21/2013 $8 70
Plumbing
Type of Use SF 41 ea Minimum Fee Adjustment - 02/21/2013 $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 Notific- '. . -nter. 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 • .estions to • • N : calling 503.232 1987 or 1 800.332 2344.
Issued =y: 44 Permittee Signature: fr , 1 ��
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.
Plumbin Permit A lication
Building Fixtures CEIVED Fort OFFICE USE ONLY
City of Tigard Received
gar FEB_ 2 1 2013 Date/By. 0 $/ / 3 Permit No L � 13 ' 60062.
a 13125 SW Hall Blvd., Tigard,OR 9722
Plan Review
t II Phone: 503.718 2439 Fax: 503.59. 60 Date/ Other Permit No .
Inspection Line. 503.639.4175 CITY OFTIGARD Date Read /B Tuns PI Page 2 for
TIGARD Ready /By: g
Internet: www.tigard - or.gov BI III,DING DIVISION Notified/Method Supplemental Information
TYPE OF WORK FEE* SCHEDULE
Est New. construction ❑ Demolition For special information use checklist
Description 1 Qty. 1 Ea. 1 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
r 1- and 2-family dwelling ❑ Commercial/industrial SFR (2) bath 437 78
SFR (3) bath 500.32
''0 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:
Rut-
Catch basin or area drain 18.76
Job site address: �-. I 1 1 30 `O 3O } `'1 ry
City /State /ZIP: 012— r —� 7 Z Drywell, leach line, or trench drain 18.76
l l� Footing drain (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
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 I 31.27 '1.2.."1,
DESCRIPTION OF WORK Backwater valve 12.51
` (� r Clothes washer 25.02
i'b'O - A \\ C Ti O+t� 0 e Ot-W b LC F(OW • 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 dram (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
Water heater 37.52
Business name: 5 p k . yN ' F V G v c J S W ?aiSLo, e 1 .., . Water piping/DWV 56.29
Address: i ck ZG A. \ ,, v., y 0 ci 0 C • Other: 25.02
City /State /ZIP: KVb(OQs,-G, Q Q_ ci — k 0 3 2 . Subtotal
(92) ) q.6 1 - (p 0 7 �
Phone: Fax: ( ) Minimum permit fee: $72.50
CCB Lic.: L Oa // ?, Plumbing Lic. no.: Plan review (25% of permit fee) aD
State surcharge (12% of permit fee) �f
Authorized signature: V /U -"'�.,\ - TOTAL PERMIT FEE p.,00
.,00
Print name: ,,, _____I , j � Date: O 2 . Zl This permit application expires if a permit is not obtained within 180 days
°l i after it has been accepted as complete.
*Fee methodology set by Tn -County Building Industry Service Board
1 \Buildmg\Permns\PLMU- PermiiApp 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 - l' 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
Valuation: Permit Fee:
Storm & Rain Drain - 1st 100' 62.54
$1.00 to $5,000.00 Minimum fee $72.50
Storm & Ram 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 ",
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
engineer.
- Jacuzzi/Whirlpool
Car Wash Each Stall ❑ New exterior plumbing site utilities for any complex structure
Drive Stall 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 Mach./Refrig. 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:
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