Permit CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit #: PLM2013 -00430
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 12/12/2013
Parcel: 1 S134CA00515
Jurisdiction: Tigard
Site address: 11820 SW MANZANITA ST
Project: LEIGLAND Subdivision: PANORAMA NO.2 Lot: 27
Project Description: Replacing 30 ft. of water service. Electrical permit may be required if house grounding is affected.
Contractor: MR ROOTER OF PORTLAND Owner: LEIGLAND, MICHAEL A & KEIKO F
PO BOX 789 11820 SW MANZANITA ST
GLADSTONE, OR 97027 TIGARD, OR 97223
PHONE: 503 - 653 -5301 PHONE:
FAX: 503- 653 -5376
FEES
Quantity Description Date Amount
30 If Water Service 12/12/2013 $62.54
Specifics: 1 12% State Surcharge - 12/12/2013 $8.70
Plumbing
Type of Use SF 10 ea Minimum Fee Adjustment - 12/12/2013 $9.96
Plumbing
Class of Work: ALT
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: � y►--,
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.
Dec. 11. 2013 11:44AM 'VED No. 8026 P. 3
Plumping rermir Appli
Building Fixtures SE C 11 2013 I (lit OH. U. L l'SL ONLl
Cl of Ti and Received
* 13125 SW Hall il TIGARD Dale/B : / // Aar! Blvd., Tigard, O 9 Plan Review
l I Phone: 503.639.4171 Fax: 503. /± oivISI Date/B : Other Penni' Wm;
Inspection Line: 503.639.4175 3 Dale Read B Sr
h 1 RiAltr) Y Y See Page 2 for
InIcmc(, www.ligard- or,gov Notified/Method: 7. - Supplemental Informs lion
TYPE OF WORK SCHEDULE
■ ❑ New construction ❑ Demolition Pedal
^ Dcscri1lion NM Ea. Total
y LAddition /alteration /replacement ❑ Other: New 1 - 2•fnntlly dwellings (includes 100 R. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (1) bath 312.70
S 11i.l I- and 2- family dwelling 11 Commerelal/industrial SFR (2) bath �-. 437.78
SFR (3) bath 500.32
❑ Accessory building ❑ Multi - family
Each additional bath/kitchen 25.02
a ❑ Master builder ❑ Other: Fire sprinkler ( sq. ft.) Page 2
JOB SITE INFORMATION AND LOCATION She utilities:
lob site address: / 1 P ZQ .SW M an Z an it& Si Catch basin or area drain 15.76
Drywell, leach line, or trench drain 18.76
City/Statc/ZIP: -ri and OR q7 Z2.3
Footing drain (no. linear (t.: ) Page 2
Suite/bldg./apt - no.: l Project name: Manufactured home utilities 50.03
Cross street/directions to job site. I , Si, 0,4 - C j - , o S Manholes 18.76
Rain drain connector 18.76
F PfYy Paget Water service (no. linear Saniiary sewer (no. linear 11.: ) , - Storni sewer (no. linear R.: ____) Page, 2
Y CL
Subdivision: Lot no.: Fixture or
Tax map /parcel no.:
'• Backwater valve 12.51
DESCRIPTION OF WORK
t Rol acs. Pp -cc7t ID-C L•3tzto --r Scry i tQ . Dishwasher 25.02
Drinking , 25.02
1 w. Ejechns/sump ®
i t PROPERTY O lY
❑ TENANT ILt
a Name: M tc hci Lei a 02
ir \ Fixture/sewer cap 25.02
� Floor , „ , 25 .
- Address; 1 1820 St_ an . .IrY
disposal t
City /State /ZIP: 1 . a-d OR .9722 Hoc bib ■ 25.02
Phone: (,)) 351 - 12. 1 Fax: ( ) Ice maker 12.51
yi APPLICANT ❑ CONTACT PERSON Interceptor/grease t
Business name: My-, ( r liI�py) Paget
s Primer 12 51
Contact name Re.bg-1 vaal l5hr, Roof drain = 12.51
Address; pp 6 1S9 Sinkfbasinhavatory 25.02
City /State /ZIP: 61 a "'102 Solar units (potable M 62.54 -
Fax: , , 12.51 A. Phone: ( ) ID 53 . 5 � F 25.02
E -mail: rebe IV & rnrrccs'th,Ypbri , em nil
Water closet 25.02
CONTRACTOR
Water healer
Business name; Water piping/DWV '
Address: • t 0._S • ..a . Other: ~ � 25 A2
City /State/ZIP: Subtotal rma
Phone: ( ) Fax ( ) Minimum permit fee: $72.50 -72.57)
CCB Lie.: t 1 Plumbing Lie. no.: 343 p� Plan review (25% of permit fee)
t State surcharge (12% ofpvnnit fee) b. 7o
Authorized signature: Q O , ^- 4 ^*.- TOTAL PERMIT FEE =�
Print name: e,be.,` ` f wag hat j pale: 1 This permit epplicalion expires it permit le not obtained within 180 days
C V after it has been accepted es complete_
'Fee methodology NI by Tri- County Building Indusuy Semwce Board.
I:Uluildis \PermiIAP1M11- PermiLApp.doc 10!01!09 -14O- 16167( 10:'02ICOMIWPB)
Dec. 11. 2013 11:44AM No. 8026 P. 4
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site Utilities Qty. Bee (ea) Torsi Square Footage: Permit Fee:
Fooling drain - 1'100' 50.03 0 to 2,000 $121.90
Fooling drain - each additional 100' 37.52 2,001 to 3,600 $169.69
Sewer - 1st 100' 62.54 3 to 7,200 $233.20
7,201 and greater $327.54
Sewer - cach additional 100' 37.52
Water Service -1st 100' 62.54 C �y Medical Gas Systems:
Water Service - each additional 100' 37.52
Storm & Rain Drain - lst 100' 62.54 Valuation, Permit Fee:
$1.00 to $5,000.00 Minimum fee $72.50 —
Storm & Rain Drain - cach 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, Bee (ea) Total each additional $100.00 or fraction thereof, to
p and includin: $10 000.00.
Inspection of exisling 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 nomial 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 haction thereof.
Subtotal:
Commercial Fixture Work:
Are you capping, adding or replacing fixtures? If "yes ", Plan Review for Plumbing Installations
please indicate work performed by fixture. Failure to Plan review is required for any of the following.
accurately report fixtures could result in Increased sewer fees. Please check all that apply.
Quantity by (Fixture) Work Performed ❑ Any new commercial building with water service 2" and
Fixture Type: Replace greater, except systems designed and stamped by licensed
Previous Capped Added &Wog engineer.
Baptistry/Font
Q ]d
I1al[t = lltb/Shower ew exterior plumbing site utilities for any complex stricture
as defined in OAR918- 780.0040.
- Jacuzzi/Whirlpool ❑ Medical gas and vacuum systems for health care facilities.
Car Wash - Each Stall
- Drive Tltnt ❑ Any multipurpose fire sprinkler system.
- D
Cuspidor/Waier A ri a Tltr ❑ Any complex structure as defined in OAR918- 780 -4040.
rator
Dishwasher - Commercial
Domestic Submit 2 sets of plans with any of the above,
Drinking Fountain
Eyc Wash Isometric or Riser Diagram
Floor Drain/sink - 2" ❑ Isometric or riser diagram is required for new buildings
- 3" that meet the qualifications above.
-4 „
Car Wash Drain
Garbage - Domestic
Disposal - Commercial
- Industrial Comments regarding fixture work:
Ice Mach./Refrig. Drains
Oil Separator (Gas Station)
Rec. Vehicle Dump Station
Shower -Gang
-Stall
Sink -Ear/Lavatory --
- Bradley
- Co,iunercial "Note; If the fixture work wider this permit results in an
- Service increase of sewer EDUs, a sewer permit will be Issued and
Swimming Pool Filter fees assessed for the sewer increase must be paid before the
Washer Clothes plumbing permit can be issued.
Water Extractor
Water Closet - Toilet
Urinal
Otter Fixtures:
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