Permit CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit#: PLM2013 -00175
T [G AR D 13125 SW Hall Blvd., Tigard OR 97223 503.718 2439 Date Issued: 06/06/2013
Parcel: 25111 DC07300
Jurisdiction: Tigard
Site address: 9400 SW BRENTWOOD PL
Project: Bauer Subdivision: SUMMERFIELD NO.9 Lot: 491
Project Description: Sewer repair.
Contractor: PIPE REPAIR SERVICES Owner: BAUER LIVING TRUST
PO BOX 5603 9400 SW BRENTWOOD PL
PORTLAND, OR 97228 -5603 TIGARD, OR 97224
PHONE: 503 - 701 -9625 PHONE:
FAX: 503 - 772 -9220
FEES
Quantity Description Date Amount
100 If Sewer Service 06/06/2013 $62 54
Specifics: 1 12% State Surcharge - 06/06/2013 $8 70
Plumbing
Type of Use: SF 10 ea Minimum Fee Adjustment - 06/06/2013 $9 96
Plumbing
Class of Work: ALT
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 obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332 2344
Issued By: Permittee Signature: 4 ^
•
i#i
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 Application RECEIVED / ( - 0 ? u i , . I - 0d;
Building Fixtures FOR OFFICE USE ONLY
City of Tigard JUN 04 2013 Rec C/ N 1 8 T a ir) A 0017 5
D a ce ive Permit No.:
Iii
a 13125 SW Hall Blvd., Tigard,OR 97223 D�
0 Phone: 503.718.2439 Fax: 503.598.19On OFTIGA Plan Review Other Permit No..
Inspection Line: 503.639.4175 p * Date R e
l I G A R U ard -0r. ov BUII.DING DI Date Ready/By luris 65 See Page 2 for
Internet: www.ti
g g Notified/Method: 1 (y Supplemental Information
TYPE OF WORK FEE* SCHEDULE
❑ New construction ❑ Demolition For special injorrnalion use checklisL
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
1- and 2- family dwelling ❑ Comercial/industrial SFR (2) bath 437.78
m
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: I
Catch basin or area drain 18.76
Job site address: 9'Y D 0 5 k/ 0 0.01 --Tw cop 1
Drywell, leach line, or trends drain 18.76
City/State /ZIP:
Footing drain (no. linear ft.: ) Page 2
Suite/bldg. /apt. no.: I Project name: 0 j 0 0
Manufactured home utilities 50.03
(.: Cross street/directions to job site: Manholes 18.76
` VO Rain drain connector 18.76
p(4.41//ps.t Sanitary sewer (no. linear<L / Page 2 (pa .
Storm sewer (no. linear ft.: ) Page 2
C4 Water service (no. linear ft.: ) Page 2
s Subdivision: I Lot no.: Fixture or item:
, map /parcel no.: Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 25.02
,4 $ fi Lt,` /J leX pii/ii-z_ Dishwasher 25.02
Drinking fountain 25.02
sg 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
I cs Address:
Garbage disposal 25.02
4 • City /State/ZIP: Hose bib 25.02
Phone: ( ) Fax: ( ) Ice maker 12.51
` ❑APPLICANT ONTACT PERSON Interceptor/grease trap 25.02
�y Business name: Medical gas (value: $ ) Page 2
po,,- Primer 12.51
• Contact name:
Roof drain (commercial) 12.51
C Address: Sink/basin/lavatory 25.02
City/State/ZIP: Solar units (potable water) 62.54
Phone: (5-03 7o/ • y 62C-1 •• ( ) Tub /shower /shower pan 12.51
E -mail: Urinal 25.02
CONTRACTOR Water closet 25.02
Water heater 37.52
Business name: P /re X h A' S ir L// G A. Water piping/DWV 56.29
Address: Other: 25.02
City/State /ZIP: Subtotal (pa .Sy
(5 7 l/ / -99� ( S p 7 - 9 Minimum permit fee: $72.50 '7) ,5D
Phone: L , Fax: G / L
CCB Lic.: /6 8 7 9/ - Plumb' g Lic. no.: e2, g Plan review (25% of permit fee)
State surcharge (12% of permit fee) 1_ ?p
Authorized signature: TOTAL PERMIT FEE g ' -
Print name: ,0 4/1 01. Date: if Qr I This permit application expires if a permit is not obtained within 180 days
after it has been accepted as complete.
*Fee methodology set by Tn -County Building Industry Service Board.
1 \Building\Permits\PLMU pp doe 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 - 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' I 62.54 (49,),5-11 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
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) L ' , • . •6 , 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° 6 $742.00 for the first $50,000.00 and $1.20 for
(minimum charge - I/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 Replsc `Please '-checl�,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 Thru as defined in OAR918- 780 -0040.
Cuspidor/Water
-Drive ❑ 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"
Isometric or Riser Diagram
❑ 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 MachiRefrig. Drains Comments regarding future work:
Oil Separator (Gas Station)
Rec. Vehicle Dump Station
Shower: -Gang • .. s . _� •-
-Stall • ' t inn w
Sink: - Lav/Bar non -food related
- Bradley
- Com/Serv/Util food related
- Service , _ ' *Note: If th fixture work under this-permit results.in an
Swimming Pool Filter > increase of sewer EDUs, a sewer permit will be issued and • Washer - Clothes s
Water Extractor fees assessed for the sewer increase must be paid before the
Water Closet - Toilet plumbing permit can be issued.
Urinal
Other Fixtures
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Site Address Folder No.
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Name / Date