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CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit#: PLM2022-00206
Date Issued: 6/8/2022
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 2S102DC00505
Jurisdiction: Tigard
Site address: 9175 SW EDGEWOOD ST
Project: PDX Property Sewer Connection Subdivision: EDGEWOOD Lot: 13
Project Description: Decommission septic and hook up to city sewer
Contractor: PDX PROPERTY INNOVATIONS Owner: SABBE,APRIL
6792 SW FLORENCE LN 9175 SW EDGEWOOD ST
PORTLAND, OR 97223 TIGARD, OR 97223
PHONE: 503-869-2913 PHONE.
FAX:
FEES
Quantity Description Date Amount
115 If Sanitary Sewer 06/08/2022 $100.06
Specifics: 1 12%State Surcharge- 06/08/2022 $12.01
Plumbing
Type of Use: SF
Class of Work: ALT
Type of Const:
Occupancy Grp:
Stories:
i
Total $112.07
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: (crr /A�/`_`G�0/ Permittee Signature: S're'
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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 Application RECEIVED
Site Utilities MAY 2 2022 FOR OFFICE t'si ONLY
Received [� �N�,
City of Tigard a eived v 2Z �tv Permit No.:9Lffi 2QZZ 0Z D
ill 11 13125 SW Hall Blvd.,Tigard,OR 97223 CITY ®FIGA" Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 Other Permit No.S.A z„01.,0
Inspection Line: 503.639.4175 BUILDING DIVI /By:
T I G A R D Date Ready/By: Juris- WI See Page 2 for
Internet: www_tigard-orgov Notified/Method: Supplemental Information
TYPE OF WORK FEE* SCHEDULE
❑New construction E 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(1)bath 312.70
® I-and 2-family dwelling ElCommercial/industrial SFR(2)bath 43278
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: 9175 SW Edgewood St Catch basin or area drain 18.76
City/State/ZIP: Tigard OR 97223 Drywell,leach line,or trench drain 18.76
Footing drain(no.linear ft.:_) Page 2
Suite/bldg./apt.no.: Project name: Manufactured home utilities 50.03
Cross street/directions to job site: Halcyon Terr Manholes 18.76
Rain drain connector 18.76
Sanitary sewer(no.linear ft.:1155) Page 2
Storm sewer(no.linear ft.:_) Page 2
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
Decomission septic and install 85'of new sewer via boring with 4"HDPE from house to Dishwasher 25.02
edge of asphalt.We will re-route sewer in crawl space to front of home connecting to new. Drinking fountain 25.02
sewerapprOX. 30'ft Ejectors/sump 25.02
0 PROPERTY OWNER 0 TENANT 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:( 1 Fax:( ) Ice maker 12.51
® 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
City/State/ZIP: Solar units(potable water) 62.54
Phone:( ) Fax: :( ) Tub/shower/shower pan 12.51
E-mail: Urinal 25.02
Water closet 25.02
CONTRACTOR
Water heater 37.52
Business name: PDX Property lnnovatiosn _ 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
CCB Lie.: 202227 Plumbing Lic.no.:PB 1769 Plan review (25%of permit fee)
State surcharge(12%of permit fee)
Authorized signature: Ugvea 2i.ehd TOTAL PERMIT FEE
Print name: Bruce Zielsdorf O Date. This permit application expires if a permit is not obtained within 180 days
6/2/2022 after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
r.\Building\Permits\PLMU-PermitApp.doc 10/01/09 440-46t6T(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 $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*.
Quantity by Fixture Type Plan Review for Plumbing Installations
Fixture Type for Replace/Work Performed: Capped Added Relocate plan re less is required for any of the Ibllossing.
Baptism/FontPlease 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 0 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"
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/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:
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