Permit IN q CITY OF TIGARD PLUMBING PERMIT
t;' COMMUNITY DEVELOPMENT Permit#: PLM2015-00347
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 10/13/2015
Parcel: 1 S136AD04900
Jurisdiction: Tigard
Site address: 6601 SW PINE ST
Project: LENTZ Subdivision: VILLA RIDGE Lot: 2
Project Description: Replacing 25 ft.of sanitary sewer.
Contractor: S&S SEARS INC Owner: LENTZ, CAROL J
PO BOX 446 20385 S NOBLE LN
GLADSTONE, OR 97027 WEST LINN, OR 97068
PHONE: 503-650-8200 PHONE:
FAX: 5023-650-8203
FEES
Quantity Description Date Amount
25 If Sanitary Sewer 10/13/2015 $62.54
Specifics: 1 12%State Surcharge- 10/13/2015 $8.70
Plumbing
Typo of Use: SF 10 ea Minimum Fee Adjustment- 10/13/2015 $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 N tifirati Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. Y.0 may obta'a copy of the rules
z. ______.o irect questions to # NC by .fling 503.232.1987 or 1.800.332.2344.
I sued By: 01, / Permittee Signature: - ----
V
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 USE ONLY
City of Tigard Received ' MIMS
• 13125 SW Hall Blvd.,Tigard,OR'97223 1`j
Date/By: . Permit No.: V ■ - _ 7
Illii : Plan Review
Phone: 503.718.2439 Fax: 503.598.19(` -\.%�O Other Permit No.:
r� Date/By:
Inspection Line: 503.639.4175 V Date Read B t�ris: VI Page 2 for
TIGARD O �`N> Ready/By: B
Internet: www.tigard-or.gov Y� Y43 ��1 . Q' Notified%Method: ?fir Supplemental information
TYPE OF WOR ! FEE* SCHEDULE
❑New construction [y � iionn For special information use checklist
�3° Description I Qty. I Ea. I Total
Addition/alteration/replacement ❑Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
Addition/alteration/replacement
CATEGORY OF CONSTRUCTION SFR(I)bath 312.70
4-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
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: �'J x f Catch basin or area drain 18.76
�9 t/ „ �Q�� Dtywell,leach line,or trench drain 18.76
City/State/ZIP: 111 / �I
/ Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: I Project name: Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
Rain drain connector 18.76
Sanitary sewer(no.linear ft.:2_,,, --) ZSPage 2
Storm sewer(no.linear ft.:_) 11�� Page 2
Water service(no.linear ft.: ) Page 2
Subdivision: I Lot no.: Fixture or item:
Tax map/parcel no.: Backtlow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
1 s Clothes washer 25.02
�,� -a - //6ZO .4 - tiullltallill Dishwasher 25.02
ce./1./--e/C__ PK
/'2.t4_1. Drinking fiiuntain 25.02
Ejectors/sump 25.02
❑ PROPERTY OWNER I ❑ TENANT Expansion tank 12.51
Name: Fixture/sewer cap 25.02
Floor drain/tloor sink/hub 25.02
Address:
Garbage disposal 25.02
City/State/ZIP: Hose bib 25.02
Phone:( ) Fax:( ) Ice maker 12.51
0 APPLICANT ❑ CONTACT PERSON Interceptor/grease trap 25.02
Business name:
Medical gas(value:$ ) Page 2
Contact name: Primer 12.51
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
': ;'.iii, ` CONTRACTOR Water heater 37.52
Business name:2�-- C�-,ate„ /- t)( n ,�� , f Water piping/DWV 56.29
Address: / e / v.y J✓ /y } �������, CGG.- Other: 25.02
Ciry/State/ZIP: (� /yl, ' 70z_'__/7 Subtotal
Phone:( ) f_ 5J_ Z r VFaax::( ) �5 g'w3 Minimum permit fee: $72.50
CCB Lie.: / C c.„ 5�5 Plumbing Lic.no.:pQ/�� Plan review (25%of permit fee)
J 1�� tJ State surcharge(12%of permit fee)
Authorized signature: / - -7///1 7 TOTAL PERMIT FEE g`.01-0
Print name: 3 a n e •,oti/ Date:/12 /7_ /5.-- 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 PLMt-PennitApp.doc 10 01 09 440-46161110 02 COM WFn)
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
erignrTIV , guare 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' Eiji 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
n. IMMO
Permit
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 Ins actions or Fees s. Fee(ea) Total each additional$100.00 or fraction thereof,to
and including$10,000.00.
Inspection of existing plwnbing 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 cha e-1/2 hour) and including$25,000.00.
Inspections outside of normal business 90.00/111 $25,001.00- $25,001.00 to$50,000.00 $379.50 for the first$25,000.00 and$1.45 for
hours(minimum char_e-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/hi $50,001.00 and up $742.00 for the first$50,000.00 and$1.20 for
(minimum cha e-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
rent'+C'u' y 44 1Y at Kk§ P{u,
accurately report fixtures could result in increased sewer fees*. ` „' 'Ian Review for Plu i s t Le:,i ;; ?1 4
•
QuindI by ire Tyr Plan review is required for any of the following.
*future orlt Performed:d: Gapped Added Rad Please check all that apply.
Baptistry/Font ❑ Any new commercial building with water service 2"and
Bath: -Tub/Shower
greater,except systems designed and stamped by licensed
-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 111 Any multipurpose fire sprinkler system.
Domestic CI 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 Diagra
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 P
Water Closet-Toilet plumbing permit can be issued.
Urinal
Other Fixtures:
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