Permit CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit#: PLM2015-00431
p 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 12/29/2015
Parcel: 1 S134CD08500
Jurisdiction: Tigard
Site address: 11865 SW SUMMER CREST DR
Project: SAJA Subdivision: BURLWOOD NO.4 Lot: 35
Project Description: Replacing water piping to all existing fixtures.
Contractor: TRUE BLUE PLUMBING LLC Owner: SAJA LIVING TRUST
17940 NW ARACADIA ST BY SAJA, EDWARD J & ROSE M TRS
PORTLAND, OR 97229 11865 SW SUMMER CREST DR
TIGARD, OR 97223
PHONE: 503-747-9989 PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Water Piping/DWV 12/29/2015 $56.29
Specifics: 1 12%State Surcharge- 12/29/2015 $8.70
Plumbing
Type of Use: SF 16 ea Minimum Fee Adjustment- 12/29/2015 $16.21
Class of Work: ALT Plumbing
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 Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You m obtain a opy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: rmittee 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 ONLY
City of Tigard 2p15 Received Permit No.:
Date/f3y: p� 1 S-
n 13125 SW Hall Blvd.,Tigard,OR 97223 `F C.
_ Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 Other Permit No.:
Date/13y:
Inspection Line: 503.639.4175 tv Y 0�' q,��� tc Ready/13y: ® See Page 2 for
Internet: www.tigai-d-ot-.gov D ��J Notified/Method: Supplemental Information
TYPE OF WORK, FEE* SCHEDULE
❑ New construction ❑ Demolition For special inforutation use checklist.
Description I Qt Ea. I Total
Addition/alteration/replacement ❑Other: New I-2-family dwellings(includes 100 fl.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(1)bath 312.70
I-and 2-family dwelling ❑Commercial/industrial SFR(2)bath 437.78
SFR(3)bath 500.32
ElAccessory building ElMulti-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: 6 S(J sGt 1 d]01 ev-- G Ce,0 C- Catch basin or area drain 18.76
1
city/state/ZIP: '�'' Drywell-leach line,or trench drain 18.76
�ra � �` 9 7Z2,�
7 Footing drain(no.linear III.:_) Page 2
Suite/bldg./apt.no.: Project name: Manufactured hone utilities 50.03
Cross street/directions to job site: Manholes 18.76
Rain drain connector 18.76
Sanitary sewer(no.linear It.:_) Page 2
Storm sewer(no.linear ft.:_) Page 2
Water service(no.linear It.:_) 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
Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
EJ PROPERTY OWNER ❑ TENANT Expansion tank 12.51
Name: Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address:
Garbage disposal 25.02
City/State/ZIP: Hose bib 25.02
Phone:( ) Fax:( ) Ice make- 12.51
❑ APPLICANT ❑ CONTACT PERSON Interceptor/grease trap 25.02
Business name: T rLte, D Medical gas(value:S ) Page 2
Primer 12.51
Contact name: Ta ) Sw Rot,,)j S/
' Roof drain(commercial) 12.51
Address: 179LIO /A) Ga ` -f
L Sink/basin/lavatory 25.02
City/State/ZIP: -))ef g?�-2-/p Solar units(potable water) 62.54
Phone:(tjf) ) '7 g� Fax: :( ) Tub/shower/shower pan 12.51
E-mail: Urinal 25.02
Water closet 25.02
CONTRACTOR
Water heater 37.52
Business name: Water piping/DW V ! 56.29
Address: Other: 25.02
City/State/ZIP: Subtotal -olq
Phone:( ) Fax:
( ) Minimum permit fce: 572.50
CCB Lic.: 7 0 Plumbing Lic.no.: 1 2- `9 Plan review (25%ol-pennit fee)
State surcharge(12%of pennit tee)
Authorized signature:
TOTAL PERMIT FEE �
1 his permit application expires if a permit is nut obtained within 180 days
Print name: 73-5151-A4-- 13CA Date: -Z �� after it has been accepted as complete.
"Fee methodology set by"Fri-County Building Industry Service Board.
I:ABuildingAPermits\PLx1U-PermnApp.doc 10001)09 440-4616T(10,02?C0N1/N'1i13)
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression S stems:
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- I st 100' 62.54 7,201 and greater $327.54
Sewer-each additional 100' 37.52
Water Service- I st 100' 62.54 Medical Gas Systems:
Water Service-each additional 100' 37.52
Valuation: Permit Fee:
Storm&Rain Drain- I st 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 thereol,to
(minimum charge-1/2 hour) and including$25,000.00.
Inspections outside of'nornal business 90.00/111- $25,001.00 to$50.000.00 $379.50 for the first$25.000.00 and 51.45 for
howl(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/hi $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
engineer.
-Jacuzzi/Whirlpool
Car Wash: -Each Stall ❑ New exterior plumbing site utilities for any complex structure
as defined in OAR918-780-0040.
-Drive Thru
Cuspidor/Water Aspirator El 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
4„ ❑ Isometric or riser diagram is required for new buildings
-Car Wash Drain
that meet the qualifications above.
Garbage -Domestic non-food
Disposal: -Domestic food related
-Commercial food related
-Industrial food related
lee 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/Sery/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:
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