Permit CITY OF TIGARD PLUMBING PERMIT
1.. COMMUNITY DEVELOPMENT Permit#: PLM2013-00316
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 09/12/2013
Parcel: 1 S135DCO2401
Jurisdiction: Tigard
Site address: 11795 SW 91ST AVE
Project: Kachelmeyer Subdivision: NORTH TIGARDVILLE ADDITION Lot: 63
Project Description: Install 55'of storm sewer and connect new catch basin to street.
Contractor: RAYMOND ANTHONY SCHWAHN Owner: KACHELMEYER, DONNA KAY
16111 S REDLAND RD 2637 S GLEN MORRIE DR
OREGON CITY,OR 97045 LAKE OSWEGO, OR 97034
PHONE: 503-869-0152
HONE: 503-631-3957
FAX:
FEES
Quantity Description Date Amount
1 ea Catch Basin or Area Drain 09/12/2013 $18.76
Specifics: 55 If Storm and Rain Drain 09/12/2013 $62.54
1 12%State Surcharge- 09/12/2013 $9.76
Type of Use: SF Plumbing
Class of Work: OTR
Type of Const:
Occupancy Grp:
Stories:
Total $91.06
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:
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 .
Building Fixtures RECEIVE') FOR OFFICE USE ONLY
1 2 013 Received 9/a C3 "G�yo2t9�3 OG
City of Tigard -Permit No
114 D Date/By:
J
v 13125 SW Hall Blvd.,Tigard,OR 97223 S C i Plan Review }�
Phone: 503.718.2439 Fax: 503.598.1960 Other Permit N9 o,2O/3_1103x,
p CITY OF TIGARD-Date Re
Ins
Inspection Line: 503.639.4175 Date Read B m See Page 2 for
T IGARD Ready/By: g
Internet: www.tigard-or.gov BUILDING DNISIONIotified/Method: Supplemental Information
TYPE'OF WORK FEE* SCHEDULE
❑New construction ❑Demolition For special information use checklist:
Description 1 Qty. 1 Ea. .1 Total
❑Addition/alteration/replacement ❑Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
•
CATEGORY OF CONSTRUCTION SFR(I)bath 312.70
y 1-and 2-family dwelling ❑Commercial/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: /17 ‘.5.-- AVE i gi S/ Catch basin or area drain j 18.76 /f•76
q Drywell,leach line,or trench drain 18.76
City/State/ZIP:
Y I ! ez-rd, OR 9 7 Z Z 3 Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: Project name: Manufactured home utilities 50.03 '
-Cross street/direbtions to job site: - Manholes 18:76
Rain drain connector 18.76
Sanitary sewer(no.linear ft.: ) Page 2
Storm sewer(no.linear ft.: 20�� Page 2 (p..59
Water service(no.linear ft.: ) Page 2
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
C),:NNe- 7 A e0 C'97 e fi i3 4- i/j f'2O At Dishwasher 25.02
p -y To 01-10-11 / r-5/4J /•l4 57teer Drinking fountain 25.02
Ejectors/sump 25.02
❑ P.ROPERTY.OWNER i I ❑ TENANT . Expansion tank 12.51
Name: Fixture/sewer cap 25.02
net h� k cLc.k e,l rn e y.� V Floor drain/floor sink/hub 25.02
Address:
f 1 1 ot,j' S w L'f/ S /4 vz. Garbage disposal 25.02
City/State/ZIP: T/y' '_v' 0 i? 9 7 2-13 Hose bib 25.02
Phone:(-s-o ) V(,' - O/,..s.---2, Fax:( ) Ice maker 12.51
❑ APPLICANT ❑ 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,,
.. t Water heater 37.52
Business name: /�.o ,4 - j/r .1 44-I c-e as rl,t_..c.CiZ,... Water piping/DW V 56.29
Address: /(p/(f 51 ;tee -4.12 4,6 Other: 25.02
City/State/ZIP: j,f -/7 O 2 970`116 - Subtotal ot/• 50
Phone:(cLb1)103(''- 3/ 957n Fax:( )
Minimum permit fee: $72.50
CCB Lic.: -7!s`r-� c9/3A5 Plumbing Lic.no.: Plan review (25%of permit fee) ��
State surcharge(12%of permit fee) 9. 7,6
Authorized signature: dl TOTAL PERMIT FEE 9/ Co
This permit application expires if a permit is not obtained within'IEB days
Print name: � ��� L���r/f J Dale: 9%..7/-/ after it has been accepted as complete.
*Fee methodology set by Tri-County pBuilding Industry Service Board.
1:\Building\Permits\PLMU-PermitApp.doc 10/01/09 • 440-4616T(10/02/COM/WEB)
fit 7 �
39/. 0 6
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-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
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) I_ 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 ❑ Any new commercial building with water service 2"and
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 Thru 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 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
Water Extractor fees assessed for the sewer increase must be paid before the
Water Closet-Toilet plumbing permit can be issued.
Urinal
Other Fixtures:
I:\Building\Permits\PLMF_PermitApp.doc 08/04/2011 2
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
11795 SW 91ST AVE, TIGARD, OR, 97223
Record Type: Record ID:
Commercial - Plumbing PLM2013-00316
Inspection Type: Inspector:
399 Plumbing final Don Sylvester
Result:
PASS - NoCofO
Comments:
1 . Note: inspected and approved by George H on 9-17-2013, this inspection is a final to
close permit.
Violation Summary:
Inspector Contractor