Permit CITY OF TIGARD PLUMBING PERMIT
., COMMUNITY DEVELOPMENT Permit#: PLM2020-00344
T t C,q R D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 9/2/2020
Parcel: 2S110BC10500
Jurisdiction: Tigard
Site address: 12048 SW CAFFALL LN
Project: Theetge Subdivision: BULL MOUNTAIN VIEW ESTATES Lot: 3
Project Description: Moving/replacing plumbing for kitchen sink,dishwasher,garbage disposal,hose bib;adding water supply line for
refrigerator ice maker and water piping/DWV,
Contractor: Owner: THEETGE, MARK ALLEN&WENDY K
12048 SW CAFFALL LN
TIGARD, OR 97224
PHONE: PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Dishwasher 08/31/2020 $25.02
Specifics: 1 ea Garbage Disposal 08/31/2020 $25.02
1 ea Hose Bib 08/31/2020 $25.02
Type of Use: SF 1 ea Sink 08/31/2020 $25.02
Class of Work: ALT 1 ea Water PipinglDWV 08/31/2020 $56.29
Type of Const: 1 12%State Surcharge- 08/31/2020 $20.27
Occupancy Grp: Plumbing
Stories:
Total S176.64
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: & a'jQ�� Permittee Signature: a, /T
, �'�J fJ�f j,,-?'7d m//
CCCSSS(((/(/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 ApplicatiRCC I\it
Building Fixtures CC C FOR OFFICE. I. O\LY
City of Tigard AUG 2 4 2020 Received
`'r g DateeB L Permit N(J
13125 SW Hall Blvd.,Tigard,OR 9v y o `3�� �� I L�Zd�(��D o3rf
60Plan Review
Phone: 503.718.2439 Fax:•5035 OrTIGARD Other Permit No.:
k5 DateBy:
Inspection Line: 503.639.4175 I DING DIVISION Date Ready/By: 7uris ® See Page 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 I❑Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
.. CATEGORY OF CONSTRUCTION SFR(1)bath 312.70
1651-and 2-family dwelling D Commercial/industrial SFR(2)bath 437.78
SFR(3)bath 500.32
0 Accessory building 0 Multi-family
Each additional bath/kitchen 25.02
0 Master builder ®Other:
Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address:12048 sw Caffall Ln Catch basin or area drain 18.76
Drywell,leach line,or trench drain 18.76
City/State/ZIP:Tigard Or 97224
Footing drain(no.linear ft.:_) Page 2
Suite/bldg./apt.no.: I Project name: Manufactured home utilities 50.03
Cross street/directions to job site: 120th 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 I: ) Page 2
Subdivision: Lot no.: Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 25.02
Moving plumbing for Kitchensink adding supply line for Refrig. Dishwasher 25.02 x
2 -s Drinking fountain 25.02
r
477, , .Ejectors/sump 25.02
® PROPERTY OWNER ( ❑ TENANT Expansion tank 12.51
Name:mark theetge Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address:12048 sw Caffall Ln Garbage disposal 25.02 x
City/State/ZIP:Tigard Or 97224 Hose bib 25.02 x
Phone:( 50)3 503-939-0394 Fax:( ) Ice maker 12.51
el APPLICANT ' 0 CONTACT PERSON Interceptor/grease trap 25.02
Business name: Medical gas(value:$_) Page 2
Primer 12.51
Contact name:
Roof drain(commercial) 12.51
Address: Sink/basin/lavatory 25.02 x
City/State/ZIP: Solar units(potable water) 62.54
Phone:( ) Fax: : ( ) Tub/shower/shower pan 12.51
E-mail: al 62 3.9 47 0 (k; Y 4 ti c IAA_e , C p IA Urinal 25.02
Water closet 25.02
CONTRACTOR
Water heater 37.52
Business name:Owner Water piping/DWV 56.29 x
Address: Other: 25.02
City/State/ZIP: Subtotal f S(pr 37
Phone:( ) Fax:( ) Minimum permit fee: $72.50
Plan review (25%of permit fee)
CCB Lie.: Plumbing Lic.no.:
State surcharge(12%of permit fee) 021r a7
Authorized signature: MarkTheetge TOTAL PERMIT FEE 4.]5rr.2g--
Print name:Mark Theetge Date:8/14/20 This permit application expires if a permit is not obtained wjjlri 174:ys 6, v
after it has been accepted as complete. ""I..
*Fee methodology set by Tri-County Building Industry Service Lard.
l:\Building\Permes\PI.MU-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- 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-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) 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*. Plan Review for Plumbing Installations
Quantity by Fixture Type Plan review is required for any of the following.
Fixture Type for Replace/ Please check all that apply.
Work Performed: Capped Added Relorate
❑ Any new commercial building with water service 2"and
Baptistry/Font greater,except systems designed and stamped by licensed
Bath: -Tub/Shower
engineer.
-Jacuzzi/Whirlpool
Car Wash -Each Stall 0 New exterior plumbing site utilities for any complex structure
as defined in OAR918-780-0040.
-Drive Thru
Cuspidor/1VaterAspiTator 0 Medical gas and vacuum systems for health care facilities.
Dishwasher: -Commercial 0 Any multipurpose fire sprinkler system.
Domestic El 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"
3" Isometric or Riser Diagram
4,. 0 Isometric or riser diagram is required for new buildings
-Car Wash Drain that meet the qualifications above.
Garbage -Domestic non-food
Disposal: -Domestic food related
-Commercial food related
-Industrial food related
Ice Mach./Refrig.Drains Comments regarding fixture work:
Oil Separator(Gas Station)
Rec.Vehicle Dump Station
Shower: -Gang
-Stall
Sink: -LavBar non-food related
-Bradley
-Com/Serv/Util food related
-Service *Note: If the fixture work under this permit results in an
Swimming Pool Filter increase of sewer EDUs,a sewer permit will be issued and
Washer-Clothes fees assessed for the sewer increase must be paid before the
Water Extractor
Water Closet-Toilet plumbing permit can be issued.
Urinal
Other Fixtures:
I:\Building\Permits\PLMF_PermitApp.doc 08/04/2011 2
Dianna Ornelas
From: m62960@yahoo.com
Sent: Saturday, August 29, 2020 9:01 AM
To: #Building Permit Technicians
Subject: Re: Permit Application - 12048 SW Caffall Ln
Caution!This message was sent from outside your organization.
Hi Dianna,
ok please strike that from the application.
thanks,Mark Theetge
On Friday, August 28, 2020, 09:33:49 AM PDT, #Building Permit Technicians <tigardbuildingpermits@tigard-or.gov>
wrote:
Hi Mark,
On the plumbing permit application is lists in the description 'Adding length for existing line to relocate cook top'. What
does this mean? Is this a gas line extension? If so, that work is done under a mechanical permit.
Please advise.
Thank you.
Dianna L. Ornelas
Building Division Services Supervisor
City of Tigard I Community Development
13125 SW Hall Blvd I Tigard, OR 97223
503-718-2430 Direct 1503-718-2439 Permits
From: m62960@yahoo.com <m62960@yahoo.com>
Sent: Friday, August 28, 2020 8:57 AM
1