Permit CITY OF TIGARD PLUMBING PERMIT
111 ' COMMUNITY DEVELOPMENT Permit #: PLM2013 00439
T t G A P J) 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 12/31/2013
Parcel: 2S 102 D 600800
Jurisdiction: Tigard
Site address: 13140 SW ASH AVE
Project: HARDWICK Subdivision: BURNHAM PARK Lot: 2
Project Description: Repairing 60 ft. of sanitary sewer.
Contractor: ROOT EXCAVATION Owner: HARDWICK, JEFFREY W & ERIN E
10824 E OAK ST 1809 AMBAS DR
MILWAUKIE, OR 97222 LAKE HAVASU CITY, AZ 86403
PHONE: 503 - 656 -6610 PHONE:
FAX: 503 - 656 -6625
FEES
Quantity Description Date Amount
60 If Sewer Service 12/31/2013 $62.54
Specifics: 1 12% State Surcharge - 12/31/2013 $8.70
Plumbing
10 ea Minimum Fee Adjustment - 12/31/2013 $9.96
Type of Use: SF 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: , •mittee 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 �� FOR OFFICE 1 SE ONLY
City of Tigard Received Permit No.:
h' g c ' � DateB id ) /1 3 q- ,ry/y�ao t 3 - ao
13125 SW Hall Blvd., Tigard, OR 972 % ✓ \� J / � ���
1 �O plan Review
I a Phone: 503.718.2439 Fax: 503.598. % 1 Date/By: Other Permit No.:
Inspection Line: 503.639.4175
T I G A R I? O PQ� Date Ready/By: tuns ® See Page 2 for
Internet: www.tigard or.gov O G `� 9 ot i fied/Method. '1" Supp Information
TYPE OF WORK G �� � (. M��`` + )` FEE* SCHEDULE
❑ New construction ❑ Dem 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 (l) bath 312.70
1- an 2-family dwelling SFR (2) bath 437.78
® y g ❑ Commercial/industrial
❑ Accessory building ❑ Multi- family SFR (3) bath 500.32
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: 13140 SW Ash Drive Catch basin or area drain 18.76
City /State /ZIP: Tigard Oregon Drywell, leach line, or trench drain 18.76
Footing drain (no. linear ft.: ) Page 2
Suite/bldg. /apt. no.: Project name: CA-ft- Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
Rain drain connector 18.76
Sanitary sewer (no. linear ft.: 611) 1 Page 2 Q .51A.
Storm sewer (no. linear ft.: __) Page 2
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
Repair the on property residentian sanitary sewer line Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
® PROPERTY OWNER I ❑ TENANT Expansion tank 12.51
Name: Maggie /' t ••et Fl 25.02
1 Floor drain/floor sink/hub 25.02
Address: 13140 SW Ash Druve
Garbage disposal 25.02
City /State /ZIP: Tigard Oregon Hose bib 25.02
Phone: ( ) Fax: ( ) Ice maker I 12.51
® APPLICANT ❑ CONTACT PERSON Interceptor /grease trap 25.02
Business name: Root Excavation Medical gas (value: $ ) Page 2
Primer 12.51
Contact name: Bridget
Roof drain (commercial) 12.51
Address: 10824 SE Oak Street # 322 Sink/basin/lavatory 25.02
City /State/ZIP: Milwaukie Oregon 97222 Solar units (potable water) 62.54
Phone: (503) 656-6610 I Fax: : (503) 656 -6625 Tub/shower /shower pan 12.51
E -mail: bridget @raglandsinc.com Urinal _ 25.02
CONTRACTOR Water closet 25.02
Water heater 37.52
Business name: Root Excavation Water P i to WV 56.29
Address: 10824 SE Oak Street # 322 Other: 25.02
City/State /ZIP: Milwaukie Oregon 97222 Subtotal
Phone: (503) 656 -6610 Fax: (503) 656 -6625 Minimum permit fee: 572.50 l 66
CCB Lic.: 134498 Plumbing Lic. no.: 3 -433pb Plan review (25% of permit fee)_
State surcharge (12% of permit fee) E1
Authorized signature:
TOTAL PERMIT FEE
Print name: Bridget Wilson Date: 12/26/2013 I This permit application expires if a permit is not obtained withi ti ( a� '-
after it has been accepted as complete.
*Fee methodology set by Tri - County Building Industry Service Board
Plum binE 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
62.54 3,601 to 7,200 $233.20
Sewer - 1st 100' 62
t 601.1i/ 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
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: ( 1
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/ d for review is required an of the following.
Performed: Capped Added Relocate q any flli
g'
Baptistry/Font Please 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 ❑ 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
Washer - Clothes *Note: If the fixture work under this permit results in an
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:
CITY OF TIGARD PLUMBING PERMIT
111 Permit #: PLM2013 -00439
» COMMUNITY DEVELOPMENT
Date Issued: 12/31/2013
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Parcel: 2S102CA00230
Jurisdiction: Tigard
Site address: 13140 SW ASH DR
Project: HARDWICK Subdivision: VIEWCREST TERRACE Lot: 15
Project Description: Repairing 60 ft. of sanitary sewer. 1/2/2014: REPRINT permit to correct site address from Ash Ave to ASH DRIVE.
Contractor: ROOT EXCAVATION Owner: HARDWICK, JEFFREY W & ERIN E
10824 E OAK ST 1809 AMBAS DR
MILWAUKIE, OR 97222 LAKE HAVASU CITY, AZ 86403
PHONE: 503 - 656 -6610 PHONE.
FAX: 503 - 656 -6625
FEES
Quantity Description Date Amount
60 If Sewer Service 12/31/2013 $62.54
Specifics: 1 12% State Surcharge - 12/31/2013 $8.70
Plumbing
Type of Use: SF 10 ea Minimum Fee Adjustment - 12/31/2013 $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 O NC b Ding 503.232.1987 or 1.800.332.2344.
Issued By: Permittee Signature: a(' 9 e- Q 7
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.
Location:
Record Type:
Inspection Type:
Result:
Comments:
Inspection Date:
Record ID:
Inspector:
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
13140 SW ASH DR, TIGARD, OR, 97223
Residential - Plumbing
399 Plumbing final
PASS - No C of O
April 16, 2015 at 8:26:05 AM
PLM2013-00439
George Heimos
Camera of repair provided to Plumbing Department and passed.
Violation Summary:
Inspector Contractor