Permit CITY OF TIGARD PLUMBING PERMIT
- 2 ' COMMUNITY DEVELOPMENT Permit#: PLM2015-00339
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 10/07/2015
Parcel: 2S114AA00500
Jurisdiction: Tigard
Site address: 16375 SW 85TH AVE
Project: Clean Water Services Subdivision: 1993-078 PARTITION PLAT Lot: 2
Project Description: Interior plumbing:Modifying(2)manholes and altering 100 ft.of sanitary sewer for Primary Treatment&Hydraulic
Capacity Improvements Project.
Contractor: 2KG CONTRACTORS INC Owner: CLEAN WATER SERVICES
4917 NE 185TH DR 2550 SW HILLSBORO HWY
PORTLAND, OR 97230 HILLSBORO, OR 97123
PHONE: 503-489-2020 PHONE:
FAX:
FEES
Quantity Description Date Amount
2 ea Manholes 10/07/2015 $37.52
Specifics: 100 If Sanitary Sewer 10/07/2015 $62.54
1 12%State Surcharge- 10/07/2015 $12.01
Type of Use: COM Plumbing
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
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: '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
Building Fixtures FOR OFFICE USE ()\I.\
City of Tigard 1` ' Received 331 Er
`J g V '� DateBy: (j 4.� Permit No.: /our) ()(S-00
• 13125 SW Hall Blvd.,Tigard,OR 97AC
°� • Phone: 503.718.2439 Fax: 503.59 Plan Review Other Permit No.:
Inspection Line: 503.639.4175 15 Date Ready/By: ge 2 j_-(,�Y�,j�
T I G n R D
2O Date ReadyBy: ruri: ® See Page 2 for
Internet: www.tigard-or.gov C� Notified/Method: Supplemental Information
TYPE OF WOR
❑New construction ❑j� G For special information use checklist
j Description I Qty. I Ea. I Total
[Addition/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 ta 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
1 I ! .i , , • . Site utilities: _
t 31 S S 954-K 1\J Catch basin or area drain 18.76
Job site address: 10 {„1
Drywell,leach line,or trench drain 18.76
City/State/ZIP: .-
Footing drain(no.linear ft.:_) Page 2
Suite/bldg./apt.no.: I Project name: C W Manufactured home utilities 50.03
Cross street/diredions to job site: Manholes 2 18.76 .� sa
Rain drain connector 18.76 ,
Sanitary sewer(no.linear ft.: [ Page 2 6'2 _sy
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
Backwater valve 12.51
Clothes washer 25.02
S S. iMAPA)If 41 titti4 PiPiA6 Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
❑ PROPERTY OWNER I ❑ TENANT Expansion tank 12.51
Name: "C 02 ())f� 4 2.'J1 CAI Fixture/sewer cap _ 25.02
f Floor drain/floor siat/hub 25.02
Address: I IQ() bh 5w &r+t Garbage disposal 25.02
City/State/ZIP: Ti 6 1 b a, al i z 4 Hose bib 25.02
Phone:( 1j 4) rj 41 fo 1 i c Fax:( ) Ice maker 12.51
""J❑ APPLICAIIM ❑ CONTACT PERSON Interceptor/grease trap 25.02
Medical gas(value:$ ) Page 2
Business name: 2.1L4 eJATip A t?Il-S
Primer 12.51
Contact name: 141210 tu'tt t
L�; Roof drain(commercial) 12.51
Address: T`I(1 µCi 1 i,5*k t>0_ Sink/basin/lavatory 25.02
City/State/ZIP: publi qk{p (0 Q 1 i Z. 0 Solar units(potable water) 62.54
Phone:(t'j]) ) 401 ZCLO Fax::(j ■3 ) 4.61 Oleo Tub/shower/shower pan 12.51
E-mail: PIrke,d O CO 2 V C 111.• : S, ' tm Urinal 25.02
Water closet 25.02
CONTRACTOR
Water heater 37.52
Business name: �14�►� Q5 4 ,.,, - Water piping/DWV 56.29
Address: `v Other: 25.02
City/State/ZIP: Subtotal 10() .()(o
Phone:( ) Fax:( ) Minimum permit fee: $72.50
CCB Lic.: $b�,51 Plumbing Lic.no.: 3-s�p Plan review (25%of permit fee)
State surcharge(12%of permit fee) /�, V I
Authorized signatures-7// t TOTAL PERMIT FEE (( a. .07
Print name: Mk
1210 1.1 lP Aa. I Date: /p., 1 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\Pennits\PLMU-PermitApp.doc 10/01/09 440-4616T(10/02/COM/WEB)
Plumbin! 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-1st 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 S stems:
Water Service-each additional 100' 37.52 ValUatl
Storm&Rain Drain-1st 100' 62.54 $1.00 to$5,000.00 Minimum fee$72.50
Storm&Rain Drain-each additional 100' i 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*. t i( , 1(11::j' t1. lij!i.l )(i 11 l �1; ; , .
by Type ty 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
engineer.
Car Wash: -Each Stall ❑ New exer.
terior plumbing site utilities for any complex structure
as defined in OAR918-780-0040.
-Drive Thru
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 Dia ram
❑ Isometric or riser diagram is required for new buildings
-Car Wash Drain that meet the •ualifications above.
Garbage -Domestic non-food
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
Water Closet-Toilet plumbing permit can be issued.
Urinal
Other Fixtures:
I:\Building\Permits\PLMF_PermitApp.doc 08/04/2011 2