Permit (177) CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit#: PLM2016-00010
13125 SW Hall Blvd.,Tigard OR 97223 503 718 2439 Date Issued: 01/13/2016Parcel: 2S102DA00401
Jurisdiction: Tigard
Site address: 13125 SW HALL BLVD
Project: City of Tigard Subdivision: BARNUM PARK Lot: 9
Project Description: Backflow,preventer located in City Hall.
Contractor: DENNIS'SEVEN DEES LANDSCAPING INC Owner: TIGARD, CITY OF
7355 SE JOHNSON CK BLVD 13125 SW HALL
PORTLAND, OR 97206-9329 TIGARD, OR 97223
PHONE: 503-777-7777 PHONE:
FAX 503-777-2399
FEES
Quantity Description Date Amount
1 ea Backflow Preventer 01/13/2016 $31.27
Specifics: 1 12%State Surcharge- 01/13/2016 $8.70
Plumbing
Type of Use: COM 41 ea Minimum Fee Adjustment- 01/13/2016 $41.23
Class of Work: ALT Plumbing
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 1.8 32.2344.
Issued By: ermi a Ignature: Q
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 thejob site at the time of each inspection.
Plumbin¢ Permit Application A/3 0/310/0
Site Utilities `l�i�
City of Tigard ��,`t _��\ " Received Pettvit No.:
13125 SW Hall Blvd.,Tigard,OR q&V 1 DatnR : I I i 0
0 '>BW�.,'4`"Ist Plan Review `
Phone: 503.718.2439 Fax: 503.5 �6 Date/B : Other Per No.:
Inspection Line: 503.639.4175 ,/�-� Date Ready/By: loris: 0 See Page 2 for
Internet: www.tigmdor.gov �nN Notified/Method: Su kmenlal Information
14
❑New construction ❑ io For s cid information ua�a check4sL
Description Ea. I Total
❑Addition/alterationtreplacement ® pe New 1.2-family dwellings(includes 100 ft.for each utility connection)
_ •.i,F e xy., ctrl SFR(1)bath 312.70
❑ I-and 2-family dwelling ®Commercial/industrial SFR(2)bath 437.78
❑Accessory building ❑Multi-family SFR(3)bath 500.32
Each additional bad/kitchen 2.5.02
❑Master builder ❑Other: Fire sprinkler(_sq.ft.) Page 2
Site utilities:
saw
Job site address: 13125 SW Hall Boulevard Catch basin or area drain 18.76
Drywell,leach line,or trench drain 18.76
City/State/ZIP:Tigard 97223
Footing drain(no.linear ft:_) Page 2
Suite/bldgJapt.no.: I Project name:Tigard City Hall Manufactured horse utilities 50.03
Cross street/directions tojob site: Manholes 18.76
Rain drain connector 18.76
Sanitary sewer(no.linear R.:_) Page 2
Storm sewer(no.linear ft.:_) Page 2
Water service mo.linear 0.:_) Page 2
Subdivision: Lot no.: Future or item:
Tax map/parcel no.: Backflow preventer 1 31.27 31.27
Backwater valve 12.51
Clothes washer 25.02
install backflow preventer
Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
Expansion tank 12.51
Name: 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
MEa M ,liv`' �,s Interceptor/grease trap 25.02
Business name: Medical gas(value:$_) Page 2
_�ieAlyl' 4j Printer 12.51
Contact name:
Roof drain(commercial) 12.51
Address: Sink/basinAavatory 25.02
City/State/ZIP: Solar units(potable water) 62.54
Phone:( ) Fax::( ) Tub/shower/shower pan 12.51
E-mail: Urinal 25.02
y Water closet 25.02
v ,� a=�
.k o5F . '1*C`YiTA x #. H �;•R
Water heater 37.52
KIII
Business name:Dennis'Seven Dees Landscaping,Inc. WaterP i>�I n WV 56.29
P
Address:7355 SE Johnson Creek Boulevard Other: 25.02
City/Stale/ZIP:Portland,OR 97206 Subtotal
Phone:(503)777-7777 Y I I Fax:(503)777-2399 1 Minimum permit fee: $72.50 72.50
CCB Lic.:5009 % po t Plumbing Lic.no.:05LIBD1 Plan review (25%of permit fee)
State surcharge(12%of permit fee) 8.70
Authorized signature: -- TOTAL PERMIT FEE 81.20
Print name:Tiffany Bright Date: 12/31/15 This permit application expires if a permit is not obtained within 180 days
after it low been accepted as eompkte.
*fce methodology set by Tri-County Building Industry Swim Board.
I:\nuadinguk-rmllsV'I"MU-PermilApp.dia l(Al11 N GM)-4616o)Q10L OM/Wlin)
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule:
Residential Fire Suppression S stems
Bite Udh1 IftC[ 3 T .y
i)
Footing drain- I° 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 1 $233.20
Sewer- Ist 100' 62.54 7,201 and greater I $327.54
Sewer-each additional 100' 37.52
Water Service- 1st 100' 62.54
Medical Gas Systems
Water Service-each additional 100' 37.52 v
Storm&Rain Drain-]st 100' 62.54 �� 7 +'-". „v.r,,t
$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
each additional$100.00 or fraction thereof,to
and including$10,00.00.
Inspection of existing plumbing or for $10,001.10 to$25,000.00 $148.50 for the first$10,000.00 and$1.54 for
which no fee is specifically indicated 90.001hr 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$50,010.00 $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 90.1O/hr and including$50,100.10.
Additional plan review for revisions 90.001hr $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*.
'(hataft by Fhuhe' -1 e :pwa.= :
Fhtme Tnofar . atplaed
Work Perf«aid,.. � Addid adwak Plan review is required for any of the following.
Ba tis /Font Please check all that apply.
Bath -Tub/Shower ❑ Any new commercial building with water service 2"and
-Jacuz&WbirIpooI 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.
3"
4"
Car Wash Drain
Garbage -Domestic-non-food U Isometric or riser diagram is required for new buildings
Disposal -Domestic-food related that meet the qualifications above.
-Commercial-food related
-Industrial-food related
Ice MachJRehi .Drains
Oil Separator Gas Station) Comments regarding fixture work:
Rec.Vehicle Dump Station
Shower -Gang
-Stall
SmULav -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 Closer-Toilet fees assessed for the sewer increase must be paid before the
Urinal plumbing permit can be issued.
Other Fixtures:
http://www.ti gard-or.gov/document-centerBui ldi ng/PLM U-Permit App.d2c