Permit Support Document .-
4,
Plumbing Permit ApplicatioNECEIVE
Site Utilities
City of Tigard MAY 0 31.021 Received 03 Permit No.:LL.tal 2021 GO t(o
III • 13125 SW Hall Blvd.,Tigard,OR 97223 Date/By:
' CITY OF TIGARD Plan Review ,12.-2n1 ,nn1 J�
Phone: 503.718.2439 Fax: 503.598.1 Other Permit '
Date/By:
Inspection Line: 503.639.4175 �UIL�I�CI�IcIQn
T 1 G A Ii U Internet: www ti ard-or. ov DIVISION Date Ree/Metho Inns. See Page 2 for
g g Notified/Method: Supplemental Information
TYPE OF WORK FEE* SCHEDULE
❑New construction ❑Demolition For special information use checklist
Description I Qty. I Ea. I Total
❑x Addition/alteration/replacement ❑Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(1)bath 312.70
❑x I-and 2-family dwelling ❑Commercial/industrial SFR(2)bath 437.78
0 Accessory building ❑Multi-family SFR(3)bath 500.32
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: 9995 SW Garrett St Catch basin or area drain 18.76
Drywell,leach line,or french drain 18.76
City/State/ZIP: Tigard,OR 97223 Footing drain(no.linear ft.:_) Page 2
Suite/bldg./apt.no.: 1 Project name: Manufactured home utilities 50.03
Cross street/directions to job site: SW Barnum Dr Manholes 18.76
-x Rain drain connector 18.76
�t�►vxie (�� ,� _ /' <! Sanitary sewer(no.linear ft.:�) 1 Page 2 62.54
"'mod / �- r �eu1�%*' /�'G✓I^^,x �j�l >�'! Storm sewer(no.linear ft.: ) Page 2
v Water service(no.linear ft.: ) 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
Sewer line installation and connection to the sewer main with Dishwasher 25.02
4"HDPE via excavation to disconnect from existing septic Drinking fountain 25.02
system. Ejectors/sump 25.02
I1 PROPERTY OWNER I ❑ TE _ Expansion tank 12.51
Name: Fixture/sewer cap 25.02
Steve Jensen
Floor drain/floor sink/hub 25.02
Address: 9995 SW Garrett St Garbage disposal 25.02
City/State/ZIP: Tigard,OR 97223 Hose bib 25.02
Phone:( ) Fax: ( ) Ice maker 12.51
)` ® APPLICANT 0 CONTACT PERSON Interceptor/grease trap 25.02
Business name: PDX Property Innovations Medical gas(value:$_) Page 2
Primer 12.51
Contact name: Katie Kost
Roof drain(commercial) 12.51
Address: 6792 SW Florence Ln Sink/basin/lavatory 25.02
City/State/ZIP: Portland,OR 97223 Solar units(potable water) 62.54
Phone:( 503)833-2449 Fax: :( ) Tub/shower/shower pan 12.51
E-mail: sales@axiompdx.com Urinal 25.02
Water closet 25.02
CONTRACTOR
Water heater 37.52
Business name: PDX Property Innovations Water piping/DWV 56.29
Address: 6792 SW Florence Ln Other: 25.02
City/State/ZIP: Portland,OR 97223 Subtotal
Phone:(503 )833-2449 Fax:( ) Minimum permit fee: $72.50 9.96
Plan review (25%of permit fee)
CCB Lic.: 202227 Plumbing Lic.no.: PB 1769 State surcharge(12%of permit fee) 8.70
Authorized signature: TOTAL PERMIT FEE 81.20
Print name: Katie Kost Date: 4/21/21 This permit application expires if a permit is not obtained within ISO days
after it has been accepted as complete.
°Fee methodology set by Tri-County Building Industry Service Board.
1:1Building\evnils1PLM11-PermdApp.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:
ware Footage: Permit F '
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-1st 100' 62.54 Medical Gas Systems:
Water Service-each additional 100' 37.52 Feet
-
Storm&Rain Drain-1st 100' 62.54 81Uatlon: n Iyertnit
$1.00 to$5,000.00 Minimum tee$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
Inspections or Fees Qry. Fee(ea) Total and ineach cluding ional$100.00 or fraction thereof,to
ng$110,000.00
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 PlumbingI iQ
Fixture Type for Replace/ .z
Work Performed: Capped Added Relocate Plan review is required for any of the following.
Baptistry/Font Please check all that apply.
Bath Tub/Shower El 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 0 New exterior plumbing site utilities for any complex structure
Cuspidor/Water Aspirator as defined in OAR918-780-0040.
Dishwasher -Commercial D 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" Isometric or Riser Diagram
Car Wash Drain
Garbage Domestic-non-food ❑ 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 Mach./Refrig.Drains
Oil Separator(Gas Station) Comments regarding fixture work:
Rec.Vehicle Dump Station
Shower -Gang
-Stall
Sink/Lay -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:
1:1Building\Permits\PLMU_PermitApp.doc 2
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. El map&tax lot# ❑ project name ❑ site address El suite number
El 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.
I:1Building\Permits\PLMF-PennitApp.doc 12/30/05