Permit n
CITY OF TIGARD PLUMBING PERMIT
11111 5 ' COMMUNITY DEVELOPMENT Permit#: PLM2015-00421
T LGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 12/15/2015
Parcel: 1 S134DC03001
Jurisdiction: Tigard
Site address: 11130 SW TIGARD ST
Project: Dirkson Nature Park-Educational Center Improvement Subdivision: CHERRY HILL ACRE TRACTS Lot: 6
Project Description: Installation of 12'of culvert pipe,71'of storm sewer&(1)area drain(overflow structure).
Contractor: LEE CONTRACTORS LLC Owner: TIGARD, CITY OF
PO BOX 896 13125 SW HALL BLVD
BATTLEGROUND,WA 98604 TIGARD, OR 97223
PHONE: 360-852-2317 PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Catch Basin or Area Drain 12/15/2015 $18.76
Specifics: 83 If Storm Sewer 12/15/2015 $62.54
1 12%State Surcharge- 12/15/2015 $9.76
Type of Use: COM Plumbing
Class of Work: ALT
Type of Const:
Occupancy Grp:
Stories:
Total $91.06
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 questi to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued y: _LICI____&,f/ S21„," Permittee Signature:
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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.
Irfr
Plumbing Permit Application
Site Utilities RECEIVED FOR OFFICE USE ONI.I
City of Tigard Received
.111 11 y: n �<S cot/.
- Date/By: / �S/S `/`.d(rJ Permit No.: /' (�
13125 SW Hall Blvd.,Tigard,ORi� 1 5 2015 ,/
Plan Review / i-J
Phone: 503.718.2439 Fax: 503.598.1960 Date/By: Other Permit No.:AuP� J [f
TIGARD Inspection Line: 503.639.4175 CITY OF TIGARD Date Ready/By: luris: ® See Page 2 for
Internet: www.tigard-or.gov t Notified/Method: Supplemental Information
®New construction 0 Demolition For special information use checklist.
Description j Qty. I Ea. I Total
®Addition/alteration/replacement ❑Other: New 1-2-family dwellings(includes 100 ft.for each utility connection) _
CATEGORY OF CONSTRUCTION114SFR(1)bath 312.70
❑ I-and 2-family dwelling ®Commercial/industrial SFR(2)bath 437.78
0 Accessory building 0 Multi-family SFR(3)bath 500.32
Each additional bath/kitchen 25.02
D Master builder D Other:
Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: 11136 SW TIGARD ST Catch basin or area drain 1 18.76 18.76
Drywell,leach line,or trench drain 18.76
City/State/ZIP:TIGARD OR 97223
t ev,SoN 1. r++. PS e k Footing drain(no.linear ft.:_) Page 2
Suite/bldg./apt.no.: I Project name: r Manufactured home utilities 50.03
Cross street/directions to job site:Tigard Street at SW Twin Park Place Manholes 18.76
Rain drain connector 18.76
Sanitary sewer(no.linear ft.:_) Page 2
Storm sewer(no.linear ft.:83) 1 Page 2 62.54
Water service(no.linear ft.: ) Page 2
Subdivision: I Lot no.: Fixture or item:
Tax map/parcel no.: 1S134DC03001,03000 Backflow preventer 31.27
DESCRIPTION OF WORKBackwater valve 12.51
Clothes washer 25.02
Installation of 12'culvert pipe. Dishwasher 25.02
Installation of 71 'of drainage pipe Drinking fountain 25.02
Installation of Overflow structure Ejectors/sump 25.02
® PROPERTY OWNER I 0 TENANT Expansion tank 12.51
Name:City of Tigard Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address: 13125 SW Hall Blvd
Garbage disposal 25.02
City/State/ZIP:Tigard,OR.97223 Hose bib 25.02
Phone:(503)718-2466 Fax:( ) Ice maker 12.51
Z APPLICANT 0 CONTACT PERSON Interceptor/grease trap 25.02
Business name:City of Tigard Medical gas(value:$ ) Page 2
Primer 12.51
Contact name:Jeff Peck
Roof drain(commercial) 12.51
Address: 13125 SW Hall Blvd
Sink/basin/lavatory 25.02
City/State/ZIP:Tigard,OR 97223 Solar units(potable water) 62.54
Phone:(503)718-2466 Fax::( ) Tub/shower/shower pan 12.51
E-mail:jeffp@tigard-or.gov Urinal 25.02
Water closet 25.02
CONTRACTOR
Water heater 37.52
Business name: I--.IrE C.tp".rr-r1,4c_rtv_<, LLL'_ Water >�t m DWV 56.29
P P
Address: p P.30 y
g y(p Other:
25.02
City/State/ZIP: 7-jTLE 4Qp�i.,5?6 L)f1 11/coq Subtotal 81.30
Phone:(34 o) C65a_A31 7 Fax:( ) Minimum permit fee: $72.50
CCB Lic.: tile 5 3z Plumbing Lic.no.:
Plan review (25%of permit fee) '
Authorized signator n /!;_� State surcharge(12%of permit fee) q.7
R.
(' L_- TOTAL PERMIT FEE 9/.D(P,
Print name:Jeff Peck Date:8/27/15 This permit application expires if a permit is not obtained within tau days
after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
I:Building'Permits'PLMU-PermitApp.doc 10/01/09 440-4616T(I0/02/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-I" 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
Valuation: Permit Fee:
Storm&Rain Drain- 1st 100' 1 62.54 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
Other Inspections or Fees Qty Fee(ea) Total
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:
Other Fixtures:
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*.
Quantity by Fixture Type
Fixture Type for Replace/ Plan Review for Plumbing Installations
Work Performed: Capped Added Relocate b- -
Baptisuy/Font Plan review is required for any of the following.
Bath -Tub/Shower Please check all that apply.
Jacuzzi/whirlpool ❑ Any new commercial building with water service 2"and
Car Wash -Each Stall greater,except systems designed and stamped by licensed
-Drive Thru engineer.
Cuspidor/Water Aspirator ❑ New exterior plumbing site utilities for any complex structure
Dishwasher -Commercial as defined in OAR918-780-0040.
-Domestic ❑ Medical gas and vacuum systems for health care facilities.
Drinking Fountain ❑ Any multipurpose fire sprinkler system.
Eye Wash ❑ Any complex structure as defined in OAR918-780-0040.
Floor Drain/sink -2"
3„ Submit 2 sets of plans with any of the above.
4"
Car Wash Drain
Isometric or Riser Dia ram
Garbage -Domestic-non-foodg
Disposal -Domestic-food related ❑ Isometric or riser diagram is required for new buildings
-Commercial-food related that meet the qualifications above.
-Industrial-food related
Ice Mach./Refrig.Drains
Oil Separator(Gas Station)
Rec.Vehicle Dump Station Comments regarding fixture work:
Shower -Gang
-Stall
Sink/Lav -Non-food related
-Bradley
-Commercial-food related
-Service
Swimming Pool Filter
Washer-Clothes
Water Extractor *Note: If the fixture work under this permit results in an
Water Closet-Toilet increase of sewer EDUs,a sewer permit will be issued and
Urinal fees assessed for the sewer increase must be paid before the
1:\ENG\l -Active Projects\92016 Dirksen Nature Park(Summer Creek Palk)\Permits\Applications\CITY OF TIGARD\SITE
UTILITIES\PLMU_PermitApp.doc
Location:
Record Type:
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Result:
Comments:
Inspection Date:
Record ID:
Inspector:
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
11130 SW TIGARD ST, TIGARD, OR, 97223
Commercial - Plumbing
399 Plumbing final
PASS - No C of O
PLM2015-00421
Don Sylvester
Violation Summary:
Inspector Contractor