Permit CITY OF TIGARD i��"'" ! PLUMBING PERMIT
COMMUNITY DEVELOPMENT � Permit#: PLM2015-00183
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 06/08/2015
TIGARD Parcel: 2S 102AB03900
Jurisdiction: TIGARD
Site address: 12370 SW MAIN ST
Project: Tigardville Station Subdivision: KINGSTON Lot: 2
Project Description: Repair 120'of sanitary sewer and install(1)interceptor/grease trap. Reprinted 6/18/15 to add 120'of storm drain
•
work,(2)catch basins and(1)area drain.
Contractor: DRAINAGE MASTERS LLC Owner: CAPISTRANO, NICOLAS III REV LIV
PO BOX 818 BY CAPISTRANO, NICOLAS III TR
RIDGEFIELD,WA 98642 6646 SW 35TH
PORTLAND, OR 97221
PHONE: 360-694-5847 PHONE:
FAX:
FEES
Quantity Description Date Amount
3 ea Catch Basin or Area Drain 06/18/2015 $56.28
Specifics: 120 If Sanitary Sewer 06/08/2015 $100.06
120 If Storm Sewer 06/18/2015 $100.06
Type of Use: COM 1 ea Interceptor/Grease Trap 06/08/2015 $25.02
Class of Work: ALT 1 12%State Surcharge- 06/18/2015 $33.77
Type of Const: Plumbing
Occupancy Grp:
Stories:
Total $315.19
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 • a ion • er. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
or dir-ct questions to OU • by c. g 503.232.1987 or 1.800.332.2344.
Iss ed By: ��,�� / 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.
Plumbing Permit Application
Fixtures RECEIVED FOR OFFICE USE ONLY
City of Tigard Received 1J^ �y
IIg 24VN 18 2015 Date/By: l.(� l b /'E �„� Permit No.:ral U/Cj- 6j/93
r • 13125 SW hall Blvd.,Tigard,OR 97 Plan Review
■ Phone: 503.718.2439 Fax: 503 9 bF TIGARD Date/By: Other Permit No.:
Inspection Line: 503.639.4175 Date Ready/By: luris See Page 2 for
I Ili;\Itl) Internet: www.tigard-or.gov BUILDING DIVISION Notified/Method: Supplemental Information
TYPE OF WORK FEE* SCHEDULE
❑New construction ❑Demolition For special information use checklist.
Description I Qty. I Ea. I Total
❑Addition/alteration/replacement R Other: Stc„M D r,,,,-;,„.1 y 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:
Catch basin or area drain 18.76
Job site address: I Z'1 l O S W Y Ne\ O ,-, clk
Drywell,leach line,or trench drain 18.76
City/State/ZIP: ^ fir. 0 r °) 1 -L2
°J 1 Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: I Project name:►'t aY-dly \ x r Manufactured home utilities 50.03
Cross street/directions to job site: 1 Manholes 18.76
G\.1 L I sr c !^
S A Rain drain connector 18.76
Sanitary sewer(no.linear ft.: Page 2
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
i Clothes washer 25.02
fir► Q \ c.(-t. S '}-o r ■_■ C� t^ 0. v ' I, Dishwasher 25.02
Drinking fountain 25.02
Ah)-D TO G y/5 j/N.)d Ejectors/sump 25.02
I PROPERTY OWNER I ❑ TENANT Expansion tank 12.51
Name: P vA...4... ��
Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address: 1 •Z'\^-k 0 S �I y-"-\ c, ..,.
Garbage disposal 25.02
City/State/ZIP: --.7' t o•.4- 0 C)1 - 1. 3 Hose bib 25.02
Phone:(S c ) ytjt 's.,\ o L Fax:( ) Ice maker 12.51
❑ APPLICANT ❑ CONTACT PERSON Interceptor/grease trap 25.02
Business name: 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:( ) Fax: :( ) Tub/shower/shower pan 12.51
E-mail: Urinal 25.02
Water closet 25.02
CONTRACTOR
Water heater 37.52
Business name: r `� •.�� m S\ f Water piping/DWV 56.29 oN
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: -' Date: 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.
1:\Building\Permits\PLMU-PermitApp.doe 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-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
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:
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
❑ 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.
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: 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"
3" 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: -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 Filter 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-Toilet plumbing permit can be issued.
Urinal
Other Fixtures:
I:\Building\Permits\PLMF_PermitApp.doc 08/04/2011 2
CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit#: PLM2015-00183
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 06/08/2015
Parcel: 2S 102AB03900
Jurisdiction: TIGARD
Site address: 12370 SW MAIN ST
Project: Tigardville Station Subdivision: KINGSTON Lot: 2
Project Description: Repair 120'of sanitary sewer and install(1)interceptor/grease trap.
Contractor: DRAINAGE MASTERS LLC Owner: CAPISTRANO, NICOLAS III REV LIV
PO BOX 818 BY CAPISTRANO, NICOLAS III TR
RIDGEFIELD,WA 98642 6646 SW 35TH
PORTLAND, OR 97221
PHONE: 360-694-5847 PHONE:
FAX:
FEES
Quantity Description Date Amount
120 If Sanitary Sewer 06/08/2015 $100.06
Specifics: 1 ea Interceptor/Grease Trap 06/08/2015 $25.02
1 12%State Surcharge- 06/08/2015 $15.01
Type of Use: COM Plumbing
Class of Work: ALT
Type of Const:
Occupancy Grp:
Stories:
Total $140.09
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: L�j"�/ Permittee Signature: (9_
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 Applicatio """"VEP
Building Fixtures JUN - 8 2015 FOR OFFICE I til: O\l l
City Tigard Received / p ,` M/.
Date/By: ca,"a N lr , Permit No.�
lig �/Yo2a�s�/�3
• 13125 SW Hall Blvd.,Tigard,OR 97221IV Of fIGAtU
Plan Review
Phone: 503.718.2439 Fax: 503.598.1960, Date/By: Other Permit No.:
I I Ci A K U Inspection Line: 503.639.4175 INC 1 DIVISION
t Date Ready/By: Jurir. ® See Page 2 for
Internet: www.tigard-or.gov Notified/Method: Supplemental Information
Milt ' TYPE OF WORK
❑New construction ❑Demolition 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 CONSTRUCIIO 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: 1 'Z 3 7 ( (O c42",‘ S Catch basin or area drain 18.76
City/State/ZIP: p,1 ZZ� Drywell,leach line,or trench drain 18.76
l r-� d Footing drain(no.linear ft.: Page 2
Suite/bldg./apt.no.: Project name: -T-I c. a�d�.I\1 p Manufactured home utilities 50.03
Cross street/directions to job site: X (�(1�; 'T 63 u.-A S-t Manholes 18.76
1 Rain drain connector ‘',....0 S34 18.76
tw r h h G`" N c c-\ti it v.rte••• s' •c3
Sanitary sewer(no.linear ft.: Page 2
Storm sewer(no.linear ft.: ) Page 2
Water service(no.linear ft.: ) Page 2
Subdivision: Lot no.: Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 25.02
��c-o ti-11-e- u,-∎s \...c1 'l O r'e.■•• k o Dishwasher 25.02
Se l.r•-•,�t \ %:4's Q Drinking fountain 25.02
Ejectors/sump 25.02
1-PROPERTY OWNER 1 ❑ TENANT Expansion tank 12.51
Fixture/sewer cap 25.02
Name: ?St 1 L.p tn,,t, (-1-‘,.,1 wc.Avt\\< S ••)tkn \..,c._
5 Floor drain/floor shit/hub 25.02
Address: 1 -Z-'s 1 0 S U YY1 h\r siv
Garbage disposal 25.02
City/State/ZIP: c ' cc.k O f .} .'13 Hose bib 25.02
Phone:60 1) -\4 L. -3\O (;) Fax:( ) Ice maker 12.51
❑ APPLICANT ❑ CONTACT PERSON lk Interceptor/grease trap ( 25.02
Business name: - 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:( ) Fax::( ) Tub/shower/shower pan 12.51
E-mail: Urinal 25.02
CONTRACTOR Water closet 25.02
` Water heater 37.52
Business name: 't)4-.01/4 t 19‘.‘0.J� In Pi ;. L L L Water piping/DWV 56.29
Address: ?,Ct s x 9 % $ Other: 25.02
City/State/ZIP: `71 r(}G t.1-, Subtotal
Phone:(3(,4 ) (1®j 4 - ri 4'L\.1 Fax:( ) Minimum permit fee: $72.50
Plan review (25%of permit fee)
CCB Lic.: 1 82 - 2,3 /A/`1/_Plumbing Lic.no.: fp g 4 i 0
-•7 j State surcharge(12%of permit fee)
Authorized signature:44 J/� �� /! �l� 7 TOTAL PERMIT FEE �y�, 09
Print name: S ��1 �� %� Date: - S This permit application expires if a permit is not obtained within 180 days
after it has been accepted as complete.
*Pee methodology set by Tri-County Building Industry Service Board.
I:\Building\Permia\PLMU-PermitApp.doe 10/01/09 440-4616T(l0/02/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 � On' Permit Fee;,t
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
each additional$100.00 or fraction thereof,to
ether n pTons 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-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 Plumbin 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
❑ 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.
Car Wash: Each Stall ❑ New exterior plumbing site utilities for any complex structure
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" _
3'' ( ; r , . . . !i,
4" ❑ Isometric or riser diagram is required for new buildings
-Car Wash Drain
Garbage Domestic non-food that meet the •ualifications 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 fees assessed for the sewer increase must be paid before the
Water Extractor
WaterCloset-Toilet plumbing permit can be issued.
Urinal
Other Fixtures:
I:\Building\Permits\PLMF_PermitApp.doc 08/04/2011 2