Permit CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit#: PLM2015-00181
T I G A R p 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 06/04/2015
Parcel: 1S 136 DD07601
Jurisdiction: Tigard
Site address: 11905 SW 69TH AVE
Project: Parsa LLC Subdivision: WEST PORTLAND HEIGHTS Lot: 36
Project Description: Connect existing house to sewer service,approx..60'. Septic tank must be pumped and filled or removed.
Contractor: TEAM TITAN LLC Owner: PARSA LLC
PO BOX 1803 1510 6TH ST
CLACKAMAS, OR 97015 WEST LINN, OR 97068
PHONE: 503-477-8117 PHONE:
FAX:
FEES
Quantity Description Date Amount
60 If Sanitary Sewer 06/03/2015 $62.54
Specifics: 1 12%State Surcharge- 06/03/2015 $8.70
Plumbing
Type of Use: SF 10 ea Minimum Fee Adjustment- 06/03/2015 $9.96
Plumbing
Class of Work: OTR
Type of Const:
Occupancy Grp:
Stories:
Total 581.20
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 • uspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Noti . ion Center. hose 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 OUNC by - • 5' 232.1987 or 1.800.332.2344.
Issu d By: / /pi; Permittee Signature:
Call 503.639.4175 by 7:00 a.m.for the next available in-.ection 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.
PlumbingPermit Application
Building Fixtures FOR OFFICE, USE ONI.1
RECEIVED
City of Tigard Received
Date/By: 115 14,, gi) Permit No.: 4 41-0/ -e.egy
NI . • 13125 SW Hall Blvd.,Tigard,OR-
,1 if ^ 20 15 Plan Review
Phone: 503.718.2439 Fax: 50318i1960rj L Date/By: Other Permit No.:&c:96,045-QX:e2?//
Inspection Line: 503.639.4175
TIGARD Date Rea d B y kris: 10 See Page
2 for
Internet: www.tigard-or.gov CITY OF TIGARD
Notified/Method: Supplemental Information
-
TYPE'i (J
❑New construction ❑Demolition For special information use checklist. E
Description I Qty. I Ea. I Total
❑Addition/alteration/replacement ❑Other: New 1-2-family dwellings(includes 100 ft.for each utility correction) n`
i CATEGORY OF CONSTRUCTION SFR(1)bath f 312.70 Gov
1-and 2-family dwelling ❑Commercial/industrial SFR(2)bath t 437.78
SFR(3)bath 500.32
❑Accessory building ❑Multi-family
Each additional bath/kitchen 25.02 LA
❑Master builder ❑Other: Fire sprinkler( sq.ft.) Page 2
R.
INFORMATION AND LOCATION AI. Site utilities: _ O
Job site address: /.7 90 S o / (a )e/ Catch basin or area drain 18.76
City/State/ZIP � �� Drywell,leach line,or trench drain 18.76 O
1 , a Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: I Project name: PA Q60 Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
Rain drain connector 18.76
Sanitary sewer(no.linear ft.41 0 ) (ot) Page 2 /„a ,��
Storm sewer(no.linear ft.: ) Page 2 (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
e_c:,N/V W ---t--,;,- 0.....4( S 42��*� Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
❑ PROPERTY OWNER I ❑ TENANT Expansion tank 12.51
Name: if L 1 �1, Fixture/sewer cap 25.02
1 1 Floor drain/floor sink/hub 25.02
Address: 1 61 0 (0
Garbage disposal 25.02
City/State/ZIP: L�E G21 Li iJ jJ i C)/2 9 70/0r6 Hose bib 25.02
Phone:( ) Fax:( ) Ice maker 12.51
APPLICAN ❑ CONTACT PERSON Interceptor/grease trap 25.02
Business e: 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:( ) I Fax::( ) Tub/shower/shower pan 12.51
E-mail: 1 C Cl a - �� Urinal 25.02
. _. -- �.-. Water closet 25.02
CONTRACTOR
Water heater 37.52
Business name: / 2,1/4( l 7 it A C • Water piping/DW V 56.29
Address: ��t3 p� 5s--(., Other: 25.02
City/State/ZIP: C...„6ja C-dC� yrnA 5 (f CL. 7(21 S" Subtotal
Phone:(j i 3) L ")1 r- ' (( 1 Fax:( ) Minimum permit fee: $72.50 IV-541)
'CCB Lie.: z...0 S 'S'CZ Q`� , Plumbing Lic. Plan n review (25%of permit fee)
/71State surcharge(12%of permit fee)
■Authorized signatu'. --. '� 'rr1 �`.
`� ■
TOTAL PERMIT FEE
Print name: e---- �j-471.---,..V-.4311.42-.. 6�01'j Date: e. :-'zj/`-y.J This permit application expires if a permit is not obtained within 180 days
after it has been accepted as complete.
"Fee methodology set by Tri-County Building Industry Service Board.
I:\Building\Permits\PLMU-PermitApp.doc 10/01/09 440-46I6T(10M2/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- 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 permltS
$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. 'Wes) lag 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:
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.
I Work Performed: Capped Added Relocate
❑ Any new commercial building with water service 2"and
Baptistry/Font _. greater,except systems designed and stamped by licensed
Bath: -Tub/Shower
-Jacuzzi/Whirlpool engineer.
Stall
❑ New exterior plumbing site utilities for any complex structure
Car Wash: -Each
Drive tall 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"
Isometric or Riser Aiagr&m
❑ 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 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
WaterCloset-Toilet plumbing permit can be issued.
Urinal _
Other Fixtures:
I:\Building\Petmits\PLMF_PermitApp.doc 08/04/2011 2
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
11905 SW 69TH AVE, TIGARD, OR, 97223
Residential - Plumbing
399 Plumbing final
PASS - No C of O
October 4, 2016 at 11:26:34
AM
PLM2015-00181
Don Sylvester
Septic tank has been pumped and removed
Violation Summary:
Inspector Contractor