Permit 1 CITY OF TIGARD PLUMBING PERMIT
I ! g COMMUNITY DEVELOPMENT Permit#: PLM2013 00322
Date Issued: 09/16/2013
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 2S104DC06100
Jurisdiction: Tigard
Site address: 13094 SW MORNINGSTAR DR
Project: Rojas Subdivision: MORNINGSTAR Lot: 2
Project Description: Replacement 20'of sanitary sewer line
Contractor: T C EXCAVATING INC Owner: ROJAS, CARLOS A& PATRICIA A
PO BOX 1733 13094 SW MORNINGSTAR
SANDY, OR 97055 TIGARD,OR 97223
PHONE: 503-407-0503 PHONE:
FAX:
FEES
Quantity Description Date Amount
20 If Sewer Service 09/16/2013 $62 54
Specifics: 1 12%State Surcharge- 09/16/2013 $8.70
Plumbing
Type of Use: SF 10 ea Minimum Fee Adjustment- 09/16/2013 $9.96
Class of Work: ALT
Plumbing
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 Notifi - '•n e : . Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
or direc •uestions to OUN •y = 03 232 1987 or 1.800.332.2344
Issu:d By: Permittee Signature:
/-(, / l I1/t 1-� at/r
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
City of Tigard Received ?/6, / h Permit No.: CJ./A/3_On 3
1114
U 13125 SW Hall Blvd.,Tigard,OR 97223 Date/By:
C Phone: 503.718.2439 Fax: 503.598.1960 Plan Review Date/By: Other Permit No.:
T I G A R D Inspection Line: 503.639.4175 Date Ready/By: Juris: ® See Page 2 for
Internet: www.tigard-or.gov Notified/Method: Supplemental Information
TYPE OF WORK FEE* SCHEDULE
❑New construction ❑Demolition For special information use checklist
Description I Qty. 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
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: i 3 o 9 Li_ Sly l i `D(-n `�„-.. �/` Catch basin or area drain 18.76
City/State/ZIP: ✓`� Drywell,leach line,or trench drain 18.76
Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: I Project name: --RCS7y_, Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
Rain drain connector 18.76
Sanitary sewer(no.linear ft.:. ) Page 2
Storm sewer(no.linear ft.: ) Page 2
Water service(no.linear It.: ) 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
PI-Q f LC[_� - --"C)\ A-T Dishwasher 25.02
"1 Drinking fountain 25.02
Ejectors/sump 25.02
❑ PROPERTY OWNER I ❑ TENANT Expansion tank 12.51
Name: Pfc 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
Medical gas(value:$ ) Page 2
Business name: ---"
r C`VC / Primer 12.51
Contact name:
l )ly\ 600 K Roof drain(commercial) 12.51
Address: Po 43,3.i ? Li-7 ( Sink/basin/lavatory 25.02
City/State/ZIP: E s- Q-(la 0 9-20?.... Solar units(potable water) 62.54
Phone:(S,3) 9-0-7-O SO .5 Fax::( ) Tub/shower/shower pan 12.51
E-mail:-f--L�(G0,V��-t„. 0 xta:a` �"--1 Water 25.02
CbNTRCTOR Water closet 25.02
Water heater 37.52
Business name: 0,-1"ti32.-- Water piping/DWV 56.29
Address: Other: 25.02
City/State/ZIP: Subtotal
Phone:( ) Fax:( ) Minimum permit fee: $72.50
CCB Lic.: r S Plumbing Lic.no.: ii)e. 3 Plan review (25%of permit fee)
State surcharge(12%of permit fee)
Authorized signature / � �j/ L le TOTAL PERMIT FEE1.��
Print name: J K ( Date:9-/ I This permit application expires if a permit is not obtained within 180 days
Wl / after it has been accepted as complete.
"Fee methodology set by Tri-County Building Industry Service Board.
1:\Building\Permits\PLMU-PermitApp.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-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 Ins ections 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 requiied 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: Commermercial ❑ Any multipurpose fire sprinkler system.
Comc CI 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 •
❑ Isometric,or riser,diagram is;required;fornew-buildings
;Car Wash Drain
Garbage Domestic non-food that,meet the qualifications above.
• Disposal: -Domestic food related
•
-Commercial food related •
-Industrial food related
Ice MachJRefrig.Drains Comments regarding fixture work:
Oil Separator(Gas Station)
Rec.Vehicle Dump Station
Shower: -Gang
-Stall
Sink: -Lav/Bar non-food related
-Bradley
-Com/Serv/Util food related
-Service *Note: If the fixture work under this permit results in an
Swimming Pool Filer - 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:
IABuilding\Permits\PLMF PermitApp.doc 08/04/2011 2