Permit - II
CITY TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT PERMIT #: PLM2006 -00511
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 11/7/2006
PARCEL: 2 S 104 D B -0510 0
SITE ADDRESS: 13255 SW 132ND AVE ZONING: R -4.5
SUBDIVISION: MAPLECREST LOT: JURISDICTION: TIG
Project Description: Storm drains, catch basins, (9) manholes & perf pipe.
CLASS OF WORK: NEW GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: FLOOR DRAINS; TRAPS:
STORIES: WATER HEATERS: CATCH BASINS: 2
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES:
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LINE: 0 ft
DISHWASHERS: RAIN DRAIN: 1,500 ft
Owner: FEES
WINDWOOD CONSTRUCTION INC Description Date Amount
12655 SW NORTH DAKOTA ST
TIGARD, OR 97224 [PLUMB] Permit Fee 11/7/2006 $887.20
[PLMPLN] Plan Review 11/7/2006 $221.80
Phone : 503- 780 -4375
[TAX] 8% State Surcha 11/7/2006 $70.98
Total $1,179.98
Contractor:
HOFFMAN HYDRONICS & PLUMBING
4808 LOWER DR
LAKE OSWEGO, OR 97035 REQUIRED ITEMS AND REPORTS
Contact # : PRI 503 -675 -0828
Reg #: LIC 156824
PLM 3 -497PB
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable laws. 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 than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 0001 -0010 through OAR 952 - 0001 -0100. You may obtain copies of
these rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
•
Issued By: - 171")"77 ... .4 4, e � Permittee Signature:
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.
Site Utilities
Plumbine Permit Application c®
City of Tigard i Permit No. 131 SW i g r d., Tigar R EG°\I
97223 � y /e, �y /r O`Q� SI/
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Phone: 503.639.4171 Fax: 50119% 4 L OO Plan Review u Date/BY �%/ rA Other Permit No.:
Inspection Line: 503.639.4175 Date Read B ru ®Se Pa e 2 for
Internet: www.ti
T 1 G n R D d - or. ov T%GAAp Ready/By: v � g
� g or/ OF D , vl s � (� (� Notified/Method: 6 � /� Supplemental Information
OF �Ik U G FEE* SCHEDULE
❑ New construction ❑Demolition For special information use checklist.
Description 1 Qty. I Ea. 1 Total
❑ Addition /alteration/replacement ❑ Other: New 1 - 2- family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (I) bath 249.20
❑ 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: / 2 ;2.2_ 4/ Catch basin or area drain 16.60 ^/� }V
City / State/ZIP: /6 6 6' 9 7 2 23 Drywall, leach line, or trench drain 16.60
N�, Footing drain (no. linear ft.: ) Page 2
Suite/bldg./apt. no.: I Project name: • /27 4"C . 5 /
I Manufactured home utilities 110.00
• Cross street/directions to job site: Manholes 16.60 f LB '6
Rain drain connector 16.60 77 "l
Sanitary sewer (no. linear II: ___ I 1 f �ge 2
Storm sewer (no. linear ft� 70 0 Page 2 61 '
Subdivision: I Lot no.: Water service (no. linear .
Fixture or item
Tax map /parcel no.: Absorption valve 16.60
DESCRIPTION OF WORK Backflow preventer Page 2
c o 61:1) / /" 0 p 5s ce Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
• ❑ PROPERTY OWNER I ❑ TENANT Drinking fountain 16.60
Ejectors/sump 16.60
Name: j(,,J1 Kri,(i -rJ,yi ( G i / ./ Expansion tank 16.60
Address: /g s' s - S' A,,,,....„../_4 1 0...., 4 4,,/ c _ Fixture /sewer cap 16.60
City/State/ZIP: p r 9 7.) .. 3 Floor drain/floor sink/hub 16.60
Phone: ( . 3 4-. ,,-1 3 . 4/3 ? 5' Fax: ( SZ.c3 S -- 76ag Garbage disposal 16.60
•
❑ APPLICANT ❑ CONTACT PERSON Hose bib 16.60
Ice maker 16.60
Business name: Interceptor /grease trap 16.60
Contact name: Medical gas (value: $ ) Page 2
. Address: Primer 16.60
City /State /ZIP: Roof drain (commercial) 16.60
Phone: ( ) Fax:: ( )
Sink/basin/lavatory 16.60
Tub /shower/shower pan 16.60
E -mail:
Urinal 16.60
CONTRACTOR Water closet 16.60
•
Business name: /' jj 5 did n f C 5 Water heater 16.60
Address: L/ O C7 Er � _Other:
r an / 1
City /State/ZIP: O U- - 97035- 7- LO Subtr • ,
Minimum permit fee: $72.ou i - -
Phone: ( ) 3/31 3 b 73 Fax: ( ) Regidential backflow minimum permit fee: $36.25 I_
�/) 4 � L Plan review (25% of permit fe ��/ r'a
��
CCB Lic.: Plumbing Lic. no.: 3-307 I State surcharge (8% of permit fee) 7O • rj
. Authorized signature: ,...........---7'_ . TOTAL PERMIT FEI3'
Print name: / �P A /e _' /tJ /0 I Date %4. , This per applicant,.. expires if a permit is not obtain..
HH 180 days after it has been accepted as complete. / / 79 ■ 9 Q
g
7 80- 7 ! L 2 ...7.;- ...7.;- *Fee methodology set by Tri -County Building Industry Service Board.
I:\ Building \Pamits\PLMU- PermitApp.doc 06/26/06 J 440- 4616T(I0/02/COM/WEB)
PlumbingPermit 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 - I n 100' 55.00 0 to 2,000 $115.00
Footing drain - each additional 100' 46.40 2,001 to 3,600 $160.00
3,601 to 7,200 $220.00
Sewer - 1st 100' 55.00
7,201 and greater $309.00
Sewer - each additional 100' 46.40
Water Service - 1st 100' 55.00 Medical Gas Systems:
Water Service - each additional 100' 46.40
Storm & Rain Drain - 1st 100' 55.00 ss Valuation: Permit Fee:
$1.00 to $5,000.00 Minimum fee $72.50
Storm & Rain Drain - each additional 100' 4 /4 46.40 a/'LYr D $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) _; . um. 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 for the first $10,000.00 and $1.54 for
Residential Backflow 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
each additional $100.00 or fraction thereof; to
Inspection of existing plumbing or
and including $50,000.00.
specially requested inspections - per hour 72.50
Subtotal: t ;r, $50,001.00 and up $742.00 for the first $50,000.00 and $1.20 for
w ,,' each additional $100.00 or fraction thereof.
Fixture Work: Plan Review for Complex Structures •
Are you capping, adding or replacing fixtures? If "yes", A "complex structure" is defined as an installation of a plumbing
please indicate work performed by fixture. Failure to system that meets any of the following criteria
accurately report fixtures could result in increased sewer fees *. Please check all that apply.
Quantity by (Fixture) Work Performed ❑ Any new commercial building.
Fixture Type: Replace ❑ Any new exterior plumbing site utilities.
Previous Capped Added Existing ❑ A commercial building with installation, alteration or addition
Baptistry/Font of nine (9) or more new or relocated plumbing fixtures.
Bath - Tub /Shower ❑ Medical gas and vacuum systems for health care facilities
- Jacuzzi/Whirlpool providing services to human beings.
Car Wash - Each Stall ❑ Plumbing installations, alterations or additions to food service
- Drive Thru facilities where new plumbing fixtures, including interceptors,
Cuspidor /Water Aspirator are being installed for the food service area.
Dishwasher - Commercial ❑ Any new residential building containing three (3) or more
- Domestic dwelling units.
Drinking Fountain ❑ Any NFPA 13 -D multipurpose fire sprinkler system.
Eye Wash
Floor Drain /sink 2" Submit 2 sets of plans with any of the above.
-3"
-4"
Car Wash Drain Isometric or Riser Diagram
• Garbage - Domestic ❑ Isometric or riser diagram is required for new buildings
Disposal - Commercial three (3) or more stories in height.
- Industrial
Ice Mach./Refrig. Drains
Oil Separator (Gas Station) Comments regarding fixture work:
Rec. Vehicle Dump Station
Shower -Gang
-Stall
Sink - Bar/Lavatory
- Bradley
-Commercial
- Service
Swimming Pool Filter *Note: If the fixture work under this permit results in an
Washer - Clothes increase of sewer EDUs, a sewer permit will be issued and
• Water Extractor
Water Closet - Toilet fees assessed for the sewer increase must be paid before the
_ Urinal , plumbing permit can be issued.
Otht=PFixtures:
is\ Building \ Permits \PLM- PermitApp.doc 07/06/05