Permit CITY OF TIGARD PLUMBING PERMIT
114 � , COMMUNITY DEVELOPMEN Permit #: PLM2013 00144
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 05/08/2013
Parcel: 1 S125DA10400
Jurisdiction: Tigard
Site address: 9425 SW 70TH AVE
Project: Panutich Subdivision: 1994 -061 PARTITION PLAT Lot: 1
Project Description: (1) backflow preventor
Contractor: ALL SEASONS & ALOHA BACKFLOW INC Owner: PANUTICH, ALEXANDER V & ELENA FA
PO BOX 1811 9520 NW CAXTON LN
BEAVERTON, OR 97075 PORTLAND, OR 97229
PHONE: 503 - 649 -2721 PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Backflow Preventer 05/08/2013 $31.27
Specifics: 1 12% State Surcharge - 05/08/2013 $8.70
Plumbing
Type of Use: SF 41 ea Minimum Fee Adjustment - 05/08/2013 $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 Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. You may,. • stain a copy oft r I
or direct questions to OUNC by calling 503.232.1987 or 1.. 8
Issued By: \1/1) it A Permittee Signature: may/, -A/61116C1
Call 503.639.4175 by 7:00 a.m. for the next available inspection ate. ,'
This permit card shall be kept in a conspicuous place on the job site until c6mpletion of the project.
Approved plans are required on the job site at the time of each inspection.
ri Plumbing Permit Application RECEivE , . , , ,
. , .
Site Utilities MAY 8 2013
City of Tigard . FOR �OF ICE US E ONLY . .
Received 7 '/
® Date/By: `� r�r3 S l Permit No.: h��- / ea-0 3 -- 00( `T_
V 13125 SW Hall Blvd., Tigard, OR 97223 p,i oF TIGAR P lan Review
: a Phone: 503.718.2439 Fax: 503.598.196 DateBy: Other Permit No.:
Inspection Line: 503.639.4175 BUILDING DIVISIOI\
TIGARD Ready /By: Read B y ru ns: El See P g e 2 for
Internet: www.tigard- or.gov 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
El I- and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 437.78
1:1 Accessory building Multi-family
SFR (3) bath 500.32
❑ Mu lti -famil
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: J y c/ r 0 q L/l Catch basin or area drain 18.76
City /State /ZIP: ---7-1 Drywell, leach line, or trench drain 18.76
A_
fP ¢ pt 7 ?2
Footing drain (no. linear ft.: ) Page 2
-
Suite/bldg. /apt. no.: I roject 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 l 31.27
D SCRIPTION OF WORK Backwater valve 12.51
����p� 7 � ] Clothes washer 25.02
)j l Dishwasher 25.02
Drinking fountain 25.02
Ejectors /sump 25.02
0 PROPERTY OWNER ID TENANT Expansion tank 12.51
Name: Gee it ta Pe H q .1 r/N 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
10 APPLICANT ❑ CONTAC PERSON Interceptor /grease trap 25.02
P � a- ( Wi p j Medical gas (value: $ ) Page 2
Business name: �`.'"',� O�
Contact name: f C � Primer 12.51
� ( e " �? Roof drain (commercial) 12.51
2 Q
Address: /7 / 6 Sul (..-c ,C Gi J -a "
`� r Sink /basin/lavatory 25.02
City /State /ZIP: 1S c .t,/ & so- y 2 f" Solar units (potable water) 62.54
Phone: ( 506 3 is Z
F ax: : ( ) Tub /shower /shower pan 12.51
E -mail: Urinal 25.02
Water closet 25.02
CONTRACTOR pU Water heater 37.52
Business name: hi? S.eq S 5:e ((&/u 7/ 7 0 w
n om . Water piping/DWV 56.29
Address: PQ 604 t gl ( / Other: 25.02
City /State /ZIP: t G K_. q 707 S Subtotal
Phone: ( 57A3 tp q -61 D-:-) ? i Fax: ( ) Minimum permit fee: $72.50
CCB Lic.: j q X 1 lumbing Lic. no.: Plan review (25% of permit fee)
1
r / State surcharge (12% of permit fee)
Authorized signature: f
/ l i 1` �
/ �- TOTAL PERMIT FEE g _ (>0
Print name: �� Date: r ,�� This permit application expires if a permit is not obtained within 180 days
s /I� .I after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
I:\Building\Permits\PLMU- PermitApp.doc 10/01/09 440- 4616T(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' 37.52 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 - l st 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
h 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 * .
Quantity by Fixture Type Plan Review for Plumbing Installations
Fixture Type for Replace/ Plan review is required for any of the following. Performed: Capped Added Relocate
Please check all that apply. y g
Baptistry/Font
Bath Tub /Shower ❑ Any new commercial building with water service 2" and
Jacuzzi/Whirlpool greater, except systems designed and stamped by licensed
Car Wash -Each Stall engineer.
-Drive Thru ❑ New exterior plumbing site utilities for any complex structure
Cuspidor/Water Aspirator as defined in OAR918- 780 -0040.
Dishwasher - Commercial ❑ Medical gas and vacuum systems for health care facilities.
- Domestic ❑ Any multipurpose fire sprinkler system.
Drinking Fountain ❑ Any complex structure as defined in OAR918- 780 -0040.
Eye Wash
Floor Drain/sink - 2" Submit 2 sets of plans with any of the above.
4 " Isometric or Riser Diagram
Car Wash Drain ❑ Isometric or riser diagram is required for new buildings
Garbage - Domestic - non - food
Disposal - Domestic - food related that meet the qualifications above.
- Commercial -food related
- Industrial -food related
Ice Mach./Refrig. Drains
Oil Separator (Gas Station) Comments regarding fixture work:
Rec. Vehicle Dump Station
Shower -Gang
-Stall
Sink/Lav - Non -food related
- Bradley
- Commercial- food related
- Service
Swimming Pool Filter *Note: If the fixture work under this permit results in an
Washer - Clothes
Water Extractor increase of sewer EDUs, a sewer permit will be issued and
Water Closet - Toilet fees assessed for the sewer increase must be paid before the
Urinal plumbing permit can be issued.
Other Fixtures:
I:\Building\Permits\PLMU- PermitApp.doc 2
1 Site Utilities — Plumbing Permit Application
Plan Submittal Requirements
TIGARD
A plumbing permit for site utility plumbing work is required for sanitary sewer, storm sewer
and potable water systems on private property.
1. SITE PLAN and vicinity map showing the geographic location (fully dimensional, drawn
to scale) labeled with:
A. ❑ map & tax lot # ❑ project name ❑ site address ❑ suite number
❑ zoning ❑ applicant name ❑ phone number
B. North arrow.
C. Scale (architectural or engineering only).
D. Street names.
E. Building pads with project location.
2. PLUMBING PLANS - Two (2) complete sets, civil only.
All details listed below shall be incorporated into the plumbing plans:
A. Storm drainage plan showing:
1) Finish elevations throughout the developed site.
2) Grade breaks determining area serving each catch basin.
3) Location of catch basins.
4) Pipe size.
5) Type of material.
6) Slope of piping.
7) Manholes and field drains.
8) Cleanouts provided for each 100 feet or fraction thereof.
9) Roof drain laterals specifying cleanouts at each upper terminal.
10) Location of existing or proposed connection to a public sewer line.
B. Utilities plan showing:
1) Sanitary sewer line location, pipe size, type of material, slope of piping, manholes
and cleanouts provided as required for storm.
2) Size and location of domestic water piping and drainage.
3) Proposed location of connection to a public water or sanitary sewer line.
1:\ Building \Permits\PLMF- PerrnitApp.doc 12/30/05