Permit CITY OF TIGARD PLUMBING PERMIT
2- COMMUNITY DEVELOPMENT Permit #: PLM2013 00238
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 07/15/2013
Parcel: 2S103AA00101
Jurisdiction: Tigard
Site address: 10865 SW WALNUT ST
Project: Fowler Middle School Subdivision:)O SUPPLEMENTAL PLAT NO.1: ANNE Lot: 7 -
Project Description: Install 57 ' of foundation drain and 62' of 4" of HDPE
Contractor: CIPRIANO & SONS CONSTRUCTION INC Owner: TIGARD - TUALATIN SCHOOL DISTRICT
27905 SE HALEY RD ATTN: BONITA MAPLETHORPE
BORING, OR 97009 6960 SW SANDBURG ST
TIGARD, OR 97223
PHONE: 503-663-7308 PHONE: 503 - 431 -4000
FAX: 503 - 663 -7008
FEES
Quantity Description Date Amount
57 If Footing Drain 07/15/2013 $50.03
Specifics: 62 if Storm and Rain Drain 07/15/2013 $62.54
1 12% State Surcharge - 07/15/2013 $13.51
Type of Use: COM Plumbing
Class of Work: ALT
Type of Const:
Occupancy Grp:
Stories:
Total $126.08
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 • • ork is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utili • otification - • er. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. You may obtain a copy of the rules
or iirect questions to OU • - ing 503.232.1987 or 1.800.332.2344.
Iss ed By: � Permittee Signature: /
Call 503.639.4175 by 7:00 a.m. for the next available inspec • n 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.
t '
Plumbing Permit Application
Site Utilities RECEIVED
City of Tigard Received .., No.:
v 13125 SW Hall Blvd., Tigard, OR 97 r t e B y : 9 // S / 3 PL�?oto / 3 - ov a 3 8
0 Phone: 5.03.718.2439 Fax: 503.59: . ' r 60 5 2 013 Plan Review
Date/By: Other Permit No.:
TI G A I(D
Inspection Line: 503.639.4175 Cl( OFTIGARD Date Ready/By: Jung: &I See Page 2 for
Internet: www.ti ard -or. ov
g g Iad11G DIVISION Notified/Metnod: Supplemental Information
TYPE O 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 (I) bath 312.70
❑ 1- and 2- family dwelling rid Commercial /industrial SFR (2) bath 437.78
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:
Job site address: I () (, CG) wu� ilnuA' CZ Catch basin or area drain 18.76
Drywell, leach line, or trench drain 18.76
City/State /ZIP:
T \GreWCQ f � , 22? Footing drain (no. linear ft_: 7) Page 2 50• '
Suite/bldg. /apt. no.: J Project name: name:6, I.,IS ezok/C Manufactured home utilities 50.03
Cross street/directions to job site: e)lac rneeYI Wo ck" Manholes 18.76
iJ 9 Cenr>et - 61 sw `/.liar n S-- d+"t$ Rain drain connector 18.76
,,AA Sanitary sewer (no. linear ft.: Page 2
SW - f%eje.Iftna,n Arve, Storm sewer (no. linear ft.: Page 2 &a> i
Water service (no. linear ft.: ) Page 2
Subdivision: I Lot no.: Fixture or item:
Tax map /parcel no.: Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
"� + Clothes washer 25.02
ins6�l 51 LP AQu icvk ai%r' f d 62. 0 Dishwasher 25.02
14 a 1 -PE Drinking fountain 25.02
Ejectors /sump 25.02
VI PROPERTY OWNER I ❑ TENANT Expansion tank 12.51
n �c \ t t Fixture/sewer cap 25.02
Name:
r r� /�u .v1 SciAno1 D∎
Floor dra sink/hub 25.02
Address: L ,,t..) crQVr. Zoah Garbage disposal 25.02
City/State/ZIP: , ;tn of- G Hose bib 25.02
Phone: (t03) 1.4 Si _ 14 ow Fax: (S-03) 431 - L.,OZO Ice maker 12.51
igi APPLICANT ❑ CONTACT PERSON Interceptor /grease trap 25.02
Medical gas (value: $ ) Page 2
Business name: n
C,Pr`ta 10 t S .n 0,„0.A.S4- , evr 1-i en
Primer 12.51
Contact name: ,U aT 1 t `OIO S Roof drain (commercial) 12.51
Address: 'Pc '? ID% Sink/basin/lavatory 25.02
City/ State/ZIP: : QI,0)O Solar units (potable water) 62.54
( 5 03) �(a Tub /s hower /shower
Phone: Fax: ( ) P
;log So3 fdv3 -took, pan 12.51
/n► Urinal I 25.02
E -mail:
CZ() NJ got1J d7 C'.c,"^c.664- t k)er - Water closet 25.02
CONTRACTOR
Water heater 37.52
Business name: Water piping/DWV 56.29
Address: Other: 25.02 •
City/State/ZIP: Subtotal 7 /A- ,
Phone: ( ) Fax: ( ) Minimum permit fee: $72.50
CCB Lic.: /43502 a b4 (1 4 Plumbing Lic. no.: 2 Plan review (25% of permit fee)
v State s (12% of permit fee) ! ? .. 54
Authorized signature: ?f / TOTAL PERMIT FEE I / 24 �
Print name: Date: 1 _ _ This permit application expires if a permit is not obtained within ISO days
f after it has been accepted as complete.
*Fee methodology set by Tri -County Building Industry Service Board.
1 :\ Building \ Permits 'PLMU- PermitApp.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 - 1 100' 50.03 0 to 2,000 $121.90
Footing drain - each additional 100' 57 37.52 2,001 to 3,600 $169.69
3,601 to 7,200 $233.20
Sewer - I st 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 - I st 100' C2, 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) 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 * .
Quantij by Fixture Type Plan Review for Plumbing Installations
Fixture Type for Replace/ Plan review is required for any of the following.
Work Performed: Capped Added Relocate
Baptistry/Font Please check all that apply.
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.
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:
http: / /www.tigard- or.gov /city_hal l/ departments /cd/docs/PLMU- PermitAp2 doc