Permit CITY OF TIGARD PLUMBING PERMIT
V
COMMUNITY DEVELOPMENT Permit#: PLM2015-00321
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 09/23/2015
Parcel: 2S109DA06800
Jurisdiction: Tigard
Site address: 15067 SW GREENFIELD DR
Project: Gill Subdivision: SUMMIT RIDGE Lot: 45
Project Description: Replace 70'of water service
Contractor: PAUL'S PLUMBING Owner: GILL, CRAIG D&SEVILLA
5516 SE FOXFIRE WAY 15067 SW GREENFIELD DR
MIKWAUKIE, OR 97222 TIGARD, OR 97224
PHONE: 503-793-9803 PHONE: 206-972-2226
FAX:
FEES
Quantity Description Date Amount
70 If Water Service 09/23/2015 $62.54
Specifics: 1 12%State Surcharge- 09/23/2015 $8.70
Plumbing
Type of Use: SF 10 ea Minimum Fee Adjustment- 09/23/2015 $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 Notir - enter. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
or dire, questions to O i'C b - I • 503.232.1987 or 1.800.3322344.
Issued By: �\ / Permittee Signature:
cuLLQ:A.44"3._„,...0...efC
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 �NtV FOR OFFICE USE ON1.1
City of Tigard 1�� Received Q 23 /s Permit No.: �G� S����
13125 SW Hall Blvd.,Tigard,OR 9722 Plan Review /
Plan Re
I Phone: 503.718.2439 Fax: 503.598.1960 p 3��1
Date/By:
Other Permit No.:
T I G A R D Inspection Line: 503.639.4175 S�.. D ate Ready/By: lugs: ® See Page 2 for
Internet: www.tigard-or.gov Ev . ed/Method: Sup lemental Information
❑New construction ❑De For For special information use checklist
vv���"' Description Qty. I Ea. I Total
Klddition/alteration/replacement ❑Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
SFR(1)bath 312.70
1-and 2-family dwelling ❑Commercial/industrial SFR(2)bath 437.78
SFR(3)bath 500.32
❑Accessory building ❑Multi-family
Each additional bath/kitchen 25.02
❑Master builder ❑Other: Fire sprinkler( sq.ft.) Page 2
MEVJOB SITE INFON AND LOCAT _Site utilities:
Job site address: Jt S0(Q 7 5,..3 6rie ,v Fie it Catch basin or area drain 18.76
r Drywell,leach line,or trench drain 18.76
City/State/ZIP: 11 Ere C 7adl Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: IjPtoiect name: tnj-I LI Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
Rain drain connector 18.76
Sanitary sewer(no.linear ft.: ) Page 2
Storm sewer(no.linear ft.: ) Page 2
Water service(no.linear ft.: 7D) 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
r`�F/tom' w t"" 1A4$ �' Dishwasher 25.02
II Drinking fountain 25.02
Ejectors/sump 25.02
❑ PROPERTY OWNER I ❑ TENANT Expansion tank 12.51
Fixture/sewer cap 25.02
Name: (71
Floor drain/floor sink/hub 25.02
Address:
Garbage disposal 25.02
City/State/ZIP: Hose bib 25.02
Phone:(a(j D -/-74)., aa6. Fax:( ) Ice maker 12.51
❑ APPLICANT ❑ CONTACT PERSON Interceptor/grease trap 25.02
Business name: Au)! S ' t,) ia� (o Medical gas(value:$ ) Page 2
41.2 Primer 12.51
Contact name:
Roof drain(commercial) 12.51
Address: tc S 1,(0 S x(tZ<E til-ku � Sink/basin/lavatory 25.02
City/State/ZIP: -�p'-(� 61 q-7?-447, l! ` Solar units(potable water) - 62.54
Phone:(,�2)7 q3,l br 3 Fax::(5D.3),5(3( , e Tub/shower/shower pan 12.51
E-mail: �k++ '' Urinal 25.02
Water closet 25.02
CONTRACTOR
Water heater 37.52
Business name: (&lftp Water piping/DWV 56.29
Address: Other: 25.02
City/State/ZIP: Subtotal 7 ,.St)
Phone:( ) Fax:( ) Minimum permit fee: $72.50
CCB Lic.: lD 0 Plumbing Lic.no.: 3-13 7 pi,
review (25%of permit fee) �"
L State surcharge(12%of permit fee) e 76
Authorized signature. ( - TOTAL PERMIT FEE g/.,2-6
Print name: DLL,Li( )(Jet e � fJ Date: ? 1 This permit application expires if a permit is not obtained within 180 days
/`�I I+�l f J after it has been accepted as complete.
"Fee methodology set by Tri-County Building Industry Service Board.
I:\Building\Permiu\PLMU-PermitApp.doc 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-15'100' 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 - Valuation: Permit Fee:
$1.00 to$5,000.00 Minimum fee$72.5()
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
1 l er i .''etions O j , j •' 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 Stall as defined in OAR918-780-0040.
Cuspidor/Water Aspirator ❑ Medical gas and vacuum systems for health care facilities.
Dishwasher: Commercial El Any multipurpose fire sprinkler system.
Domestic El 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
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 Staion)
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
Water Closet-Toilet plumbing permit can be issued.
Urinal
Other Fixtures:
I:\Building\Permits\PLMF_PermitApp.doc 08/04/2011 2