Permit CI TY OF TIGARD PLUMBING PERMIT
° a COMMUNITY DEVELOPMENT PERMIT #: PLM2007 - 00355
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 8/8/2007
PARCEL: 1 S133DD -16500
SITE ADDRESS: 11994 SW 129TH PL ZONING: R
SUBDIVISION: VILLAGE AT SUMMER LAKE PARK 5 LOT: 201 JURISDICTION: TIG
PROJECT: CHIN
Project Description: 1 sink for kitchen remodel.
CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: R3 FLOOR DRAINS; TRAPS:
STORIES: WATER HEATERS: CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: 1 URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES:
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Owner: FEES
LARRY 8, EL CHIN
11994 SW 129TH Description Date Amount
TIGARD, OR 97223 [PLUMB] Permit Fee 8/8/2007 $72.50
[TAX] 8% State Surcha 8/8/2007 $5.80
Phone : 503 -579 -1994 Total $78.30
Contractor:
OWNER
REQUIRED ITEMS AND REPORTS
Contact # :
Reg #:
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. ei____ 1
1 0 Issued By: ,� / _ ,, At , 4 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.
Plumbing Permit Application
RECEIVED OFFICE USE ONLY
City of Tigard Dat ve. X0 7 '31 Perm itSPL, 07_00
V 13125 SW Hall Blvd., Tigard, OR 9Al21fi 1 ) ':% 2007
C Plan Revi-
Phone: 503.639.4171 Fax: 503.59 6A Other Permit No.:
Inspection Line: 503.639.4175 C. 1 8F f IGAR Date D Date/ Re
T I G A Il U Ready/By: - y: ® See Page 2 for
Internet: www.tigard- or.gov BUILDING DIVISION Notified/Method: Supplemental Information
TYPE OF WORK FEE* SCHEDULE
-❑ New construction El Demolition For special Information use checklist
Description I 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 249.20
El 1- and 2- family dwelling El Commercial/industrial SFR (2) bath 350.00
El Accessory building 12 Multi-family SFR (3) bath 399.00
El Master builder Each additional bath/kitchen 45.00
❑ Other: Fire sprinkler ( sq. ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities
Job site address: 1 , 9 54- sw t2 u ' `� (� t-tae Catch basin or area drain 16.60
City/State/ZIP: 11 L 6 ) , C -j yZ3 Drywell, leach line, or trench drain 16.60
/ Footing drain (no. linear ft.: ) Page 2
Suite/bldg. /apt. no.: I Project name:
Manufactured home utilities 110.00
Cross street/directions to job site: Manholes 16.60
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Rain drain connector 16.60
Sanitary sewer (no. linear ft.: ) Page 2
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Storm sewer (no. linear ft.: ) Page 2
Subdivision: I Lot no.: Water service (no. linear ft.: _) Page 2
Fixture or item
Tax map /parcel no.: Absorption valve 16.60
DESCRIPTION OF WORK . Backflow preventer Page 2
A lJ LD I /N.16 SI IJ * ct< T --0- Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
❑ PROPERTY OWNER I ❑ TENANT Drinking fountain 16.60
Ejectors/sump 16 :60
1,,,t\‘,/ Name: KEY.QE CA..4-Ir l Expansion tank 16.60
H
Address: ) \L1'i L . .L I _ q ! �� -e-E Fixture /sewer cap 16.60
City /State /ZIP: • it+. D 0 t2 C Z2_. j Floor drain/floor sink/hub 16 :60
el _ � t -
Phone: (So3) 51 l Fax: ( ) Garbage disposal 16.60
El APPLICANT CI 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
in/lavatory 16.60
Phone: ( ) Fax: : ( ) / /shower /shower pan 16.60
E -mail: Urinal 16.60
CONTRACTOR • Water closet 16.60
Business name D I \) , Water heater 16.60
Address: Other:
City /State /ZIP: Subtotal
Minimum permit fee: $72.50
Phone: . ( ) Residential backflow minimum permit fee: $36.25
_ _ - .
CCB Lic.: . Plumbing Lic. no.: Plan review (25% of permit fee)
Authorized signat \Y( 1.---� State surcharge (8% of permit fee)
I TOTAL PERMIT FEE ?�
Print name: Ica J_).. CHI �I Date: d 1 (v 1 This permit application expires if a permit is not obtai within
180 days after it has been accepted as complete.
*Fee methodology set by Tri -County Building Industry Service Board.
1:\ Building \Pennits\PLM- PermitApp.doe 12/27/06 440- 4616T(10 /02/COM/WEB)
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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 - I s< 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 Valuation: Permit Fee:
$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 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
Inspection of existing plumbing or each additional $100.00 or fraction thereof, to
specially requested inspections - per hour 72.50 and including $50,000.00.
Subtotal: $50 and up $742.00 for the first $50,000.00 and $1.20 for
each additional $100.00 or fraction thereof.
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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
Tub /Sr CI New exterior plumbing site utilities for any complex structure
Bath - hower
Tub /S i/ erlpool as defined in OAR918- 780 -0040.
CI Car Wash Each Stall Medical gas and vacuum systems for health care facilities.
Drive Stall ❑ 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
that meet the qualifications above.
-4"
Car Wash Drain
Garbage - Domestic Comments regarding fixture work:
Disposal - Commercial
- Industrial
Ice Mach./Refrig. Drains
Oil Separator (Gas Station)
Rec. Vehicle Dump Station
Shower -Gang
-Stall
Sink - Bar/Lavatory atory *Note: If the 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
Swimming Pool Filter plumbing permit can be issued.
Washer - Clothes °
Water Extractor
Water Closet - Toilet
Urinal
Other Fixtures:
is\ Building \Permits\PLM- PermitApp.doc 12/27/06