Permit 11 CITY OF TIGARD PLUMBING PERMIT
•. COMMUNITY DEVELOPMENT Permit# PLM2013 00244
Date Issued 07/18/2013
Ti GARD 13125 SW Hall Blvd Tigard OR 97223 503 718 2439 Parcel 2S115AB00200
Jurisdiction Tigard
Site address 16148 SW 113TH AVE 7
Project Woodsprings Apartments Subdivision WILLOW BROOK FARM Lot 25
Project Description Replace 60 of water service
Contractor MR ROOTER OF PORTLAND Owner WSTPI LLC
PO BOX 789 4260 GALEWOOD ST #A
GLADSTONE OR 97027 LAKE OSWEGO OR 97035
PHONE 503 653 5301 PHONE
FAX 503 653 5376
FEES
Quantity Description Date Amount
60 If Water Service 07/18/2013 $62 54
Specifics 1 12% State Surcharge 07/18/2013 $8 70
Plumbing
Type of Use MF 10 ea Minimum Fee Adjustment 07/18/2013 $9 96
Plumbing
Class of Work OTR
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 1 800 332 2344
Issued By Permittee Signature &‘--- j‘/
,Slif2Z 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
Plumbin Permit A lication
Building Fixtures EI ED FOR OFFICE ust: ONLY
City of Tigard 1 8 2S 3 DateByd 7p Permit No pUy ...„ y.
. V 13125 SW Hall Blvd Tigard OR 9722
639 4175
P hone 503 718 2439 Fax 503 59 Plan Review
A Other Permit No
�I OFTIG DateBy
TI G n R D Inspection Line 5W Date Ready/By 1 El See Page 2 for
Internet www tigard or gov BUILDING DIVISION Notified/Method Mc./ Supplemental Information
TYPE OF WORK FEE SCHEDULE
❑ New construction ❑ Demolition For special information use checklist
Description I Qty I Ea I Total
& Add1t1on/alterat1on/repIacement ❑ Other New l 2 family dwellings (Includes 100 ft for each utility connection)
CATEGORY OF CONSTRUCTION SFR (1) bath 312 70
❑ l and 2 family dwelling ❑ Commercial/industrial SFR (2) bath 437 78
building SFR (3) bath 500 32
❑ Accessory g � .Mulh family
Each additional bath/kltchen 25 02
❑ Master builder ❑ Other Fire sprinkler (_ sq ft) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities
Job site address I 6 (4 &t,,- f (d 1 . /-� (..c Catch basin or area drain 18 76
City/State/ZIP v p Drywell leach line or trench drain 18 76
Cit
y t i ' ( U'Z \ 1 a a y 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 Manholes 18 76
ron
V tt-r a GJ If t- Rain drain connector 18 76
Sanitary sewer (no linear ft ) Page 2
Storm sewer (no linear ft ) Page 2
Water service (no linear ft (DU) Page 2
Subdivision I Lot no Fixture or item
Tax map /parcel no Backflow preventer 31 27
DESCRIPTION OF WORK Backwater valve 12 51
D //1� r Clothes washer 25 02
4 1 (Q L Q 4p rc x Coo ' 4 0 -1 / � a ------4--, 5 e--(1/ c( Dishwasher 25 02
Pro, r„x 4-4 e_ , -L t.ia-Lc.- s I --4- c,-CP R -1- Drinking fountain 25 02
,-1 O-. Ejectors /sump 25 02
❑ PROPERTY OWNER I ❑ 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 ( ) Fax ( ) Ice maker 12 51
❑ APPLICANT ❑ CONTACT PERSON Interceptor /grease trap 25 02
Business name Mr, � ,(� Medical gas (value $ ) Page 2
0
Contact name / Primer 12 51
C I" S`f'�er _ Roof drain (commercial) 12 51
Address P (S,k '1 $ Sink/basin/lavatory 25 02
City /State /ZIP G (S As, -, c G, CI 70 a'1 Solar units (potable water) 62 54
Phone ( 3 ) 'pa 3 (' , I u - Fax ( ) Tub /shower /shower pan 12 51
E mail Urinal 25 02
Water closet 25 02
CONTRACTOR
Water heater 37 52
� e ----: Business name ,9 /At , Water piping/DWV 56 29
Address Other 25 02
City/State /ZIP Subtotal
Phone ( ) Fax ( ) Minimum permit fee $72 50 7,2 5
?` G ` / Plumbing Lie no "41344
Plan review (25/ of permit fee)
CCB Lie 43
State surcharge (12/ of permit fee) 0,,d
Authorized signature TOTAL PERMIT FEE J21 02 v
P name ej....-,__ Date 7 / / ici/ 7 This permit apphca expires if a permit is not obtained within 180 days
111 v
after it has been accepted as complete
Fee methodology set by Tn County Building Industry Service Board
1 \B Id g\Perm t \PLMU Perm tApp doe 10/01/09 4404616T(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
Sewer 1st 100 62 54 3 601 to 7 200 $233 20
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
Storm & Ram Dram 1st 100 62 54 Valuation Permit Fee
$1 00 to $5 000 00 Minimum fee $72 50
Storm & Ram 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
Q ty Fee (ea) Total each additional $100 00 or fraction thereof to
Other Inspections or Fees 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
❑ Any new commercial building with water service 2 and
Baptistry/Font greater except systems designed and stamped by licensed
Bath Tub /Shower
Jacuzzi/Whirlpool engineer
Car Wash Each Stall ❑ New exterior plumbing site utilities for any complex structure
Drive Stall as defined in OAR918 780 0040
Cuspidor/Water Aspirator ❑ Medical gas and vacuum systems for health care facilities
Dishwasher Commercial ❑ 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 buildmgs
Car Wash Drain that meet the qualifications above
Garbage Domestic non food
Disposal Domestic food related
Commercial food related
Industrial food related
Ice Mach /Refng 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 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