Permit • CITY OF TIGARD PLUMBING PERMIT
'' ' COMMUNITY DEVELOPMENT Permit#: PLM2022-00133
Date Issued: 4/6/2022
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 2S111DB06800
Jurisdiction: Tigard
Site address: 15400 SW ALDERBROOK DR
Project: SNYDER Subdivision: SUMMERFIELD NO.7 Lot: 393
Project Description: (1)hose bib and relocating 15 of sanitary sewer and 15 ft.of water service for remodel.
Contractor: RIVER CITY ENVIRONMENTAL Owner: SNYDER, OWEN R
PO BOX 30087 SNYDER, GAIL V
PORTLAND, OR 97220 15400 SW ALDERBROOK DR
TIGARD, OR 97224
PHONE: 503-252-6144 PHONE:
FAX: 503-288-3658
FEES
Quantity Description Date Amount
15 If Sanitary Sewer 04/06/2022 $62.54
Specifics: 15 If Water Service 04/06/2022 $62.54
ea Hose Bib 04/06/2022 $25.02
Type of Use: SF 1 12%State Surcharge- 04/06/2022 $18.01
Class of Work: ALT Plumbing
Type of Const:
Occupancy Grp:
Stories:
Total $168.11
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
Issued By: Permittee Signature:
Call 503.639.4175 by 7:00 a.m.for the next available in ectlon 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
Building Fixtures FOR OFFICE USE ONLY
RECE eceived
City of Tigard �\ !C Cf fG/� / -� Permit No.: /Y __ } �� t 3�
IIII ■ 13125 SW Hall Blvd.,Tigard,OR 97223 V C any TJ�J OZ!r�(/`Vv Y
S Plan Review Other Permit No.:
Phone: 503.718.2439 Fax: 503.598.1960 Date/By:
1 i i.AR Il Inspection Line: 503.639.4175 ApR 5 2fl22 Date Ready/By: Jens: H See Page 2 far
Internet: www.tigard-or.gov Notified/Method: Supplemental Information
TYPE OF WORK CITY OF TIGARD FEE* SCHEDULE
0 New construction ❑Det5MI N G fl IVI S I O h, 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(1)bath 312.70
Er-and 2-family dwelling ElCommercial/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: j 5y 0'U S t,./ 4L O 6k a/Lv0/C t�C. Catch basin or area drain 18.76
T! (,A R A U I Drywell,leach line,or trench drain 18.76
City/State/ZIP:
z 9 1 Z.Z'1/ Footing drain(no.linear ft:_) Page 2
Suite/bldg./apt.no.: I Project name:
5-NrItcManufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
Rain drain connector 18.76
Sanitary sewer(no.linear ft.: I Page 2 G'a(_cal
Storm sewer(no.linear ft.: ) Page 2
Water service(no.linear ft.: (r ) t Page 2 .d.S--IZ
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
.44J✓(N6; ktrc-ii f,.i WAr E2 ANg ca F15r( 70 Dishwasher 25.02
N41/ 0190I7-/44.*-0 O.v /4-onn(. Mc, vt006 /405E. Drinldng fountain 25.02
6 131 Ejectors/sump 25.02
❑ PROPERTY OWNER I 0 TENANT Expansion tank 12.51
Name: / I t ,r A 1 e.r- Fixturelsewer cap 25.02
U V Floor drain/floor sink/hub 25.02
Address:
Garbage disposal 25.02
City/State/ZIP: Hose bib i 25.02 !„1`
Phone:( ) Fax:( ) Ice maker 12.51
El APPLICANT 0 CONTACT PERSON Interceptor/grease trap 25.02
Medical gas(value:$_) Page 2
Business name: Rr✓E l? G cry ENJ',t o,....G./7-'1-4-
Contact name: ,g 1 Pnmer 12.51
c SS/L Ltn d$ Roof drain(commercial) 12.51
Address: ~
Sw /v ^y{� it.,? ' Sink/basin/lavatory 25.02
City/State/ZIP: 70K.TLAn,O ol?. Solar units(potable water) 62.54
Phone:( So 3) Z SZ - 6 /y ' Fax: :( ) Tub/shower/shower pan 12.51
E-mail: Urinal 25.02
Water closet 25.02
CONTRACTOR
Water heater 37.52
Business name: Rtvq,rt. Lt r7 It N✓IL'v NTAL Water piping/DWV 56.29
Address: 5a/D ,v 6 /al T f' Other: 25.02
City/State/ZIP: Pot Tt e 0 r2- Subtotal j}ZJ.j L,
Phone:(5a 3) Z-5 Z -I,/Y9 Fax:( ) Minimum permit fee: $72.50
CCBLic.: ( t{'7 '� SS Plumbing 26-781 P Plan review (25%of permit fee)
State surcharge(12%of permit fee) i r,6 I
Authorized signature: TOTAL PERMIT FEE 1 4 g, j
Print name: ,J E S/0 L J,,.as,y--( Date: ty`�j0/�,/Z Z This permit application expires if a permit is not obtained within 180 days
after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
I:fBuidiag\PermitsoPLMU-PcrmitApp.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-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 S233.20
Sewer-1st 100' 62.54 /
(p� 7,201 and greater $327.54
Sewer-each additional 100' 37.52
Water Service-1st 100' 62.54 62?,,5-1,3 Medical Gas Systems:
Water Service-each additional 100' 37.52
Storm&Rain Drain-1st 100' 62.54 Valuation: Permit Fee:
$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 Relocate
Baptistry/Font El Any new commercial building with water service 2"and
Bath:pt -Tub/Shower greater,except systems designed and stamped by licensed
engineer.
-Jacuzzi/Whirlpool
ElCar Wash: Each Stall New exterior plumbing site utilities for any complex structure
Drive Thll as defined in OAR918-780-0040.
ElCuspidor Water Aspirator Medical gas and vacuum systems for health care facilities.
Dishwasher: Commercial El 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"
3" Isometric or Riser Diagram
4 ❑ 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: -Lay/Bar 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 be paid before the
Water Extractor must
Water Closet-Toilet plumbing permit can be issued.
Urinal
Other Fixtures:
I:\Building\Permits\PLMF_PermitApp.doc 08/04/2011 2