Permit CITY OF TIGARD PLUMBING PERMIT
1111 11 •: COMMUNITY DEVELOPMENT Permit#: PLM2016 00067
T LGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 02/08/2016
Parcel: 2S102CD02300
Jurisdiction: Tigard
Site address: 9440 SW EDGEWOOD ST
Project: Johnson Subdivision: EDGEWOOD Lot: 18
Project Description: Installation of 135'of 1'water service.Note: Electrical permit may be required if replacement piping effects house
grounding.
Contractor: STANDARD PLUMBING&HEATING Owner: JOHNSON, CLARENCE DEAN
8318 SW SPRUCE 9440 SW EDGEWOOD ST
PORTLAND, OR 97223 TIGARD, OR 97223
PHONE: 503-246-3338 PHONE: 503-620-3636
FAX:
FEES
Quantity Description Date Amount
135 If Water Service 02/08/2016 $100.06
Specifics: 1 12%State Surcharge- 02/08/2016 $12.01
Plumbing
Type of Use: SF
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 Notifi . '. -- . Tho - rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
or direc .uestions to OUN b ailing 503.232.1987 or 1.800.332.2344.
Iss ed By: /1 / 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 Applic ti
Building Fixtures _ : � lita Folz orFlt h: tsi: ()NIA
City of Tigard Received
a- $ leo I Permit No.: 2 / Y3(P'7
13125 SW Hall Blvd.,Tigard,Og 0'423 8 J h Date
Plan By:Review
Phone: 503.718.2439 Fax: 503.598.1960 Date/By: Other Permit No.:
I I t ,1 ILD 11
Inspection Line: 503.639.4175 t/ Q ,i, Date Ready/By: Juris. ® See Page 2 for
Internet: www.tigard-or.gov( 1 `ii iL�l:"AKt) Notified/Method: Supplemental Information
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4 P 1'& ^r':'.r t q ^�d••au+n�l.S a 4 't t " "'k ata k, ,.� s d k 7` .k f ', 3
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0 New construction 0 Demolition For special information use checklist.
Description Qty. Ea. Total
•ddition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
""( is a r`i" r a€ k: t �" �b,��yy SFR(1)bath 312.70
fi < ^' “,,,447,4; "k'.. .yv34 y-,i s , ,LL. '...--,'`e,,,:,a,.,x..4,. - a�+wItitdti uaA„£a.3 .°-
-and 2-family dwelling ❑Commercial/industrial SFR(2)bath 437.78
SFR(3)bath 500.32
❑Accessory building 0 Multi-family
Each additional bath/kitchen 25.02
❑ Master builder 0 Other:
Fire sprinkler( sq.ft.) Page 2
r '"-o a Baa ' 5'a ,. � ,�
S/ QiiiiiATION D itOCATION JJl" . Site utilities:
Job site address: ,1 4 0 5 a f, c s, ,�E9,tr�S/c,tc(/lam Catch basin or area drain 18.76
�V"`y `bf' Drywell,leach line,or trench drain 18.76
City/State/Z1P: �16447
/ .
16�4 ?7 ZZ'3 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
_"- ./1/t / e t i J/C Rain drain connector age 2
V` J Sanitary sewer(no.linear ft.:_) Page 2
Storm sewer(no.linear ft.:_) Page 2
Water service(no.linear ft.:13 Page 2 !off
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
J pJ� ; . 0 i,, Expansion tank 12.51
Name: at, A / __ 1 j Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address: i
Air
Garbage disposal 25.02
City/State/ZIP: -r b�j, Hose bib 25.02
Phone: ) 5-) 4 ab `f Fax:( ) Ice maker 12.51
:2,t7 ms`s „°�a i, i s t''F`St ' 4 if-3,-,- :1, � '= Interceptor/grease trap 25.02
C+0)V'll'A+�7'
max. .,- ,.,. _�,,..'",
Medical gas(value:$ ) Page 2
Business name: 3-7-41t/d tyle phiG/r,4,,t/d 4 Ic1.,�A -iiiiCS
Primer 12.51
Contact name: � -,c
C-'� �/^t.7 Roof drain(commercial) 12.51
Address: T.5 3 / 9-- c ' Sink/basin/lavatory 25.02
City/State/ZIP: pe;,,.7"- /e- q 7.ZZ Solar units(potable water) 62.54
Phone:( 7) a,1.-6`-I.... 3--..z1.--Z Fax::/St ) -7.,9%Y.._ /R7(It Tub/shower/shower pan 12.51
E-mail: Urinal 25.02
rr hi 'f =i'��'k , w ,,,,,,t-.„,„0,‘, r, 1 -;04,,,,,,,, Water closet 25.02
,F „x..,,:..r'' ''' '' '''w+r, ;'''"•'''''''''''4"`. a ,..T., sdi r 'ff ` '''". -"r
"" Water heater 37.52
Business name: 57"�a/o P(WN,t4.)€ V- -g t Water piping/DWV 56.29
Address: t 7) I $ ��el 5 Other: 25.02
City/State/ZIP r 72Z Subtotal /00,(4
�1 _.
Phone:(03 ` 33g Fax:�3 ) eJ-yy JZ� Minimum permit fee: $72.50t�
CCB Lie.: [ 3 b 9 ,/q/1(4Plumbing Lic.no.: , .7a fto Plan review (25%of permit fee)
( l State surcharge(12%of permit fee) /2.8/Authorized signatur � al.-441&c, �l f i7 TOTAL PERMIT FEE /101,O7
Print name: c),,,,„0/....%) /94` 4) Date: 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.
I:',Building Permits PLMU-PermitApp.doc 10OI 09 440-4616T(1002COM WEB)
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Su' s ression S stems:
e'4Z.s x. ,c't, .A_`9kk. .,'x'. t" ",aw_.'tb.. E . ". °^ ''
Footing drain-1'1100' 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 a F,: "Rt r , ,
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
each additional$100.00 or fraction thereof,to
e anspi $�t IN�r�cAj txi;
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 S742.00 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
Baptistry/Font ❑ Any new commercial building with water service 2' and
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
Drive tall as defined in OAR918-780-0040.
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" " �]flCt�*tlCi+ 'r �1Ck111i1, t. ,. 1
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
-Coin/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:
1:\Building\Permits\PLMF_PermitApp.doc 08/04/2011 2