Permit 4
CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit#: PLM2014-00003
r 1 Date Issued: 01/08/2014
TIGARD 13125 SW Hall Blvd..Tigard OR 97223 503.718.2439 Parcel: 25111 BCO2700
Jurisdiction: Tigard
Site address: 10380 SW CANTERBURY LN
Project: Miller Subdivision: TIGARDVILLE HEIGHTS Lot: 5
Project Description: Connect existing house to sewer service,under 200'of line work Septic tank to be properly decommissioned.
Reimbursement District#50 fee paid. 3/11/14,reprinted to add(1)catch basin. (1)drywell.(1)rain drain connector
&60'of storm sewer line.
Contractor: TIGHT ACCESS EXCAVATING LLC Owner: MILLER, PAUL& JUDITH LIVING TRU
5400 SE 101ST AVE 10380 SW CANTERBURY LN
PORTLAND. OR 97266 TIGARD,OR 97224
PHONE. 503-287-4836 PHONE 503 684-8513
FAX: 503-296-2846
FEES
Quantity Description Date Amount
1 ea Catch Basin or Area Drain 03/11/2014 518 76
Specifics: 1 ea Drywell.Leach Line or Trench 03/11/2014 $18.76
Drain
Type of Use: SF 1 ea Rain Drain Connector 03/11/2014 518 76
Class of Work: ALT 200 If Sewer Service 01/08/2014 $100.06
Type of Const: 60 If Storm and Rain Drain 03/11/2014 562 54
Occupancy Grp: 1 12%State Surcharge- 03/11/2014 526.27
Stories: Plumbing
Total 5245 15
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 S -.in
Utility Notification Center. Those rules are set forth in UAR 952-001-0010 through OAR 952-001-0090. You may obtain a c.• • the rules
or direct que ' OUNC by calling 503.232 1987 or 1 800 332.2344.
Issued By `��2'e---1-4^ y' 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.
Plum bins Permit Application
Building Fixtures RECEIVED
Received ' 3
City of Tigard y J/ /y Pei nut No.:
-
. 13125 SW Hall Blvd.,Tigard,OR 97223 Date/B
Iii
Phone: 503.718.2439 Fax: 503. 1601 1 2 014
Plan Review
Date/By: Other Permit No.:
T I G A R D Inspection Line: 503.639.4175 Date Ready/By: turfs 0 See Page 2 for
Internet: www.tigard-or.gov Notified/Method: Supplemental Information
TYPE OF OF 1 LAR/D� FEE* SCHEDULE
❑New construction II, [ �r t I i��rfi41UN For special information use checklist.
Description I Qty. I Ea. 1 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
❑ 1-and 2-family dwelling ❑Commercial/industrial SFR(2)bath 437.78
building SFR(3)bath 500.32
❑Accesso ry g ❑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: Catch basin or area drain 18.76 / t
f 3��� �� ��`�l� `,0 brywell,leach line,or trench drain l 18.76 /�j 7 t,
City/State/ZIP: C/ Footing drain(no.linear ft.:_) Page 2
Suite/bldg./apt.no.: Project name: ML " Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
Rain drain connector
/ 18.76 /' 7(
Sanitary sewer(no.linear ft.:_) Page 2
Storm sewer(no.linear ft.: 60) Page 2 ;2,S Y
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
Dishwasher 25.02
Drinking fountain 25.02
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
Medical gas(value:$ ) Page 2
Business name: -
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:( ) I Fax: :( ) Tub/shower/shower pan 12.51
E-mail: Urinal 25.02
Water closet 25.02
CONTRACTOR •
/� Water heater 37.52
Business name: e 1 7 -f --1 r / [-Ali/ 17 k6w r piping/DW V 56.29
Address: Other: 25.02
City/State/ZIP: Subtotal
Phone:( ) Fes;( ) Minimum permit fee: $72.50 •
Plan review (25%of permit fee)
CCB Lic.: Plumbing Lic.no.: State surcharge(12%of permit fee)
Authorized signature: TOTAL PERMIT FEE
Print name: (V_K (Ai /7-21 1/2_) r_ Date:3---//,_ /Li permit application expires if a permit is not obtained within 180 days
11 after it has been accepted as complete.
"Fee methodology set by Tri-County Building Industry Service Board.
I:\BuildingTermies\PLMU•PennitApp.doc 10/01/19 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- 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 _ 5327.54
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 R 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) 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
Haptislry/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 tall as defined in OAR91 8-780-0040.
•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"
Isometric or Riser Diagram
4" ❑ Isometric or riser diagram is required for new buildings
-Car Wash Drain
Garbage Domestic non-food that meet the qualifications above.
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 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
WaterCloset-Toile[ plumbing permit can be issued.
Urinal
Other Fixtures: _
1:1Building\PermitslPLMF_PermitApp.doc 08/04/2011 2
I, CITY OF TIGARD PLUMBING PERMIT IN I' COMMUNITY DEVELOPMENT Permit#: PLM2014-00003
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 01/08/2014
Parcel: 25111 BCO2700
Jurisdiction: Tigard
Site address: 10380 SW CANTERBURY LN
Project: Miller Subdivision: TIGARDVILLE HEIGHTS Lot: 5
Project Description: Connect existing house to sewer service,under 200'of line work. Septic tank to be properly decommissioned.
Reimbursement District#50 fee paid.
Contractor: TIGHT ACCESS EXCAVATING LLC Owner: MILLER, PAUL&JUDITH LIVING TRU
6400 SE 101ST AVE 10380 SW CANTERBURY LN
PORTLAND,OR 97266 TIGARD,OR 97224
PHONE: 503-287-4836 PHONE: 503 684-8513
FAX: 503-296-2846
FEES
Quantity Description Date Amount
200 If Sewer Service 01/08/2014 $100.06
Specifics: 1 12%State Surcharge- 01/08/2014 $12.01
Plumbing
Type of Use: SF
Class of Work: ALT
Type of Const:
Occupancy Grp:
Stories:
Total $112.07
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
Ut" Notifica i• Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
r direct questions to■UNC b calling 503.232.1987 or 1.800.332.2344.
Issued By: • # ,,, J , 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.
P4umbing Permit Application
Building Fixtures VENED FOR:OFFICE USE ONLY- .
' City of Tigard Received /�J /j _ }//� //��� 2
g •:: r Date/By: I ` 1 fJ ., ,,' Permit No. G1(O`v[7 rrGtzJ
'� 13125 SW Hall Blvd.,Tigard,OR 9`�t :> 4 Plan Review
III
Phone: 503.718.2439 Fax: 503.59:.1960 0 �Q\
Date/By. Other Permit No.: tQ go!(k /
n��\\ Y
Inspection Line: 503.639.4175 . 1\\ Q
.T1 GARD (� ) Date Ready/By: lu See Page 2 for
Internet: www.tigard-or.gov ®�l1G S` „p' Notified/Method: Supplemental Information
TYPE OF WORK-ej ��'�Q`�` \�' FEE* SCHEDULE 3
❑New construction ❑ ,,Frt�n i• For special information use checklist.
Description I Qty. I Ea. I Total
®Addition/alteration/replacement ❑Other: New I-2-family dwellings(includes 100 II. for each utility connection)
CATEGORY OF CONSTRUCTION SFR(I)bath 312.70
•® I-and 2-family dwelling ❑Commercial/industrial SFR(2)bath 437.78 W
❑Accessory building ❑Multi-family SFR(3)bath 500.32
• Each additional bath/kitchen 25.02
Ot
❑Master builder 0 Other: Fire sprinkler( sq.ft.) Page 2
. JOB SITE INFORMATION AND LOCATION , Site utilities: (JI
Job site address: 10380 SW Canterbury Ln Catch basin or area drain 18.76 V)
' Drywell,leach line,or trench drain 18.76
City/State/ZIP:Tigard,OR 97224 Footing drain(no.linear ft.:_) Page 2
Suite/bldg./apt.no.: Project name: Miller Residence Manufactured home utilities 50.03
- ---Cross street/directions to job site; 103rd St-and-Canterbury Ln - Manholes - - -- --18:76-- -
Rain drain connector 18.76
Sanitary sewer(no.linear ft.:atiL) a Page 2 if1 ..06
Storm sewer(no.linear ft.: ) Page 2
Water service(no.linear R.: ) Page 2
Subdivision: 1 Lot no.: Fixture or item:
fax map/parcel no.: Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 25.02
Sewer connection for addition
Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
® PROPERTY OWNER. ❑ TENANT . Expansion tank 12.51
Name: Paul and Judy Miller
Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address: 10380 SW Canterbury Ln
Garbage disposal 25.02
City/State/ZIP:Tigard,OR 97224 • Hose bib 25.02
Phone:(503)684-8513 Fax:( ) lee maker 12.51
❑ APPLICANT ❑ CONTACT PERSON Interceptor/grease trap 25.02
Business name:Neil Kelly Company Medical gas(value:$ ) Page 2
Primer 12.51
Contact name: Dan Moore
Roof drain(commercial) 12.51
Address:804 N Alberta St Sink/basin/lavatory 25.02
City/State/ZIP: Portland,OR 97217 Solar units(potable water) • 62.54
Phone:(503)335-9240 Fax: :(503)288-7461 Tub/shower/shower pan 12.51
E-mail:danm@neilkelly.com Urinal 25.02
Water closet 25.02
CONTRACTOR
Water heater 37.52
Business name:Tight Access Water piping/DWV 56.29
Address:6400 SE 101st Ave Other: 25.02 i
City/Stale/ZIP: Portland,OR 97266 Subtotal 7/[!).0‘,
Phone:(503)287-4836 • Fax:( ) Minimum permit fee: $72.50
�S394, Plan review (25%of permit fee)
CCB Lic.: /A-45/5"-- Plumbing Lic.no.:
State surcharge(12%of permit fee) 0 0/
uthorized signature: TOTAL PERMIT FEE /J). 07
...)0
Print name: Date: This permit application expires if a permit is not obtained within 180 days
after it has been accepted as complete. 11,, f�
*Fee methodology set by Tri-County Building Industry Service oar.
I:\Building\Permits\PLNIU-PermitApp doc 10/01/09 440-4616T(10/02/CO\I/WEB) 11 I qy 7 4'7
•
•
Plufnbing 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
3,601 to 7,200 $233.20
Sewer- 1st 100' j 62.54 Ci2.5 7,201 and greater $327.54
Sewer-each additional 100' ' 37.52 3-7.5-,k
Water Service- Ist 100' 62.54 Medical Gas Systems:
Water Service-each additional 100' 37.52 Valuation:. Permit Fee:
Storm&Rain Drain- 1st 100' 62.54 $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
Qty. 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--I/2-hour) each additional.$100.00-or-fraction-thereof. --
Subtotal: a /as.c)(,
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/ Plan review is required for any of the following.
Work Performed: Capped Added Relocate
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 OAR9I8-780-0040.
Eye Wash
Floor Drain/sink -2" Submit 2 sets of plans with any of the above.
Isometric or Riser Diagram
Car Wash Drain ❑ s
Isometric or riser diagram is required for new buildings
Garbage -Domestic-non-food g q g
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:
\\albina\UserProfiles\DanM\Documents\Current Clients Folders\Miller 2023\Miller Tight Access-PcrmitApp.doc
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
10380 SW CANTERBURY LN, TIGARD, OR,
97224
Residential - Plumbing
399 Plumbing final
PASS - No C of O
May 28, 2014 at 11:46:22 AM
PLM2014-00003
Chip Barnett
Sewer corrections have been completed
Violation Summary:
Inspector Contractor