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Permit (67) CITY OF TIGARD PLUMBING PERMIT 11, 1 COMMUNITY DEVELOPMENT Permit#: PLM2016-00224 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 04/25/2016 7 I Ain) l� 9 Parcel: 2S111AD05900 Jurisdiction: Tigard Site address: 8540 SW PINEBROOK ST Project: CROSS Subdivision: PINEBROOK TERRACE Lot: 85 Project Description: Replacing 40 ft.of sanitary sewer. Contractor: NW HOME SERVICES LLC Owner: CROSS, LAURA 6941 SE BIXEL WAY PO BOX 1051 MILWAUKIE, OR 97267 TUALATIN, OR 97062 PHONE: 503-722-9599 PHONE: FAX: 503-722-9779 FEES Quantity Description Date Amount 40 If Sanitary Sewer 04/25/2016 $62.54 Specifics: 1 12%State Surcharge- 04/25/2016 $8.70 Plumbing Type of Use: SF 10 ea Minimum Fee Adjustment- 04/25/2016 $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 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 o18A94324344,_ 11111" \ � Issued By: / Permittee Signature: / /9 Call 503.639.4175 by 7:00 a.m.for the next availab ' pection date. This permit card shall be kept in a conspicuous place on the jo ite until completion of the project. Approved plans are required on the job site at the time of each inspection. Plumbing Permit Application Building Fixtures Received 3125 of Tigard q t Permit No.: 1-�q /' /` ,a 9jj gi 13125 SW Hall Blvd.,Tigard,OR 97223 . Date/By: I�� I �}� p1rbKJj`� 'V�V�`t i Plan Review Phone:IN p 503.718.2439 Fax: 503.59 . ` 16 Date/By: Other Permit No.: Inspection Line: 503.639.4175 �"/ Date Read /B Juris: ® See Page 2 for I I(' \It I) Internet: www.ti and-or. ov v, �0 Ready o g g J : Notified/Method: Supplemental Information • � gir� � ' $Fi' >t di rz " r <j.x 'IPs4444;x { 1=- "x i °T n ,yra.c. �Js �� , 0 x , „ ; 3 "fir > 4-t a < sM» n0 h �i6E4,sils.,,x dxg- '. z 0 New construction 0 Dp i . c , For special information use checklist VVI' � Description • Total Addition/alteration/replacement 0 0, 9 New 1-2-family dwellings(includes 100 ft.for each utility connection) it£ t e't:s } ,40.41.4.2e-., ,,;t * r 'x 4 SFR(1)bath 1 VS I-and 2-family dwelling ❑Commercial/industrial SFR(2)bath 437.78 SFR(3)bath 500.32 0 Accessory building 0 Multi-family Each additional bath/kitchen 25.02 ❑Master builder 0 Other: Fire sprinkler( sq.ft.) Page 2 x t*� was 'f +�->^, x r, t 4$ � tl�� 'r b t 4 Site utilities: /� -- / Catch basin or area drain 18.76 Job site address: 557/0 yw / e_S5-r took ��. �� Drywell,leach line,or trench drain 18.76 City/State/ZIP: �z R a Footing drain(no.linear ft.:_) Page 2 Suite/bldg./apt.no.: v 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.: 4/0) / Page 2 /_111!ll��� S4 Storm sewer(no.linear ft.:_) Page 2 1 Water service(no.linear ft.:_) Page 2 Subdivision: I Lot no.: Fixture or item: Tax map/parcel no.: Backflow preventervalv31.27 "T J Ti �11P�4;i1�1 1�' WC>ikK Fx. Backwater e 12.51 Clothes washer 25.02 /,/ c -e 5?.✓e/ /yr-t 49yl ��Y' Dishwasher 25.02 Drinking fountain 25.02 Ejectors/sump 25.02 , r p d I L ® �� nExpansion tank 12.51 Name: / L�f^t"4 cross Fixture/sewer cap 1 L Floor drain/floor sink/hub 25.02 Address: Garbage disposal 25.02 City/State/ZIP: Hose bib 25.02 Phone:( ) Fax:( ) Ice maker 12.51 , � - t:(lll•I 'ACT P (1AI Interceptor/grease trap 25.02 Business name:/// /f es llv's /J Medical gas(value:$ ) Page 2 12.51 Contact name:/�-5-:,14 / Primer �j Roof drain(commercial) 12.51 Address: 69t7 l S �J/X e'/�jv t4 Sink/basin/lavatory 1 City/State/ZIP: l a,,,Gxt,�ilE © g( Solarunits(potablewater) 62.54 Phone:( Z) 7Z'-95r7 I Fax: :(5,5-)727- 777 Tub/shower/shower pan 12.51 E-mail:/7„,/,‘,,,,,,e Urinal 1 5�/Yice e-rpiylcctg7.?PT 1i. ig to SS^ ,rs y `tr 'x re^ ,..,a �. v T$r°-i,,': Water closet 1 1,d;._- . l• �� .•t� v= .a" ti, f 7tak,,,.. r... .r. , �A,,W... ,K'n:,. .,. Water heater 37.52 Business name: 0�e ..i/v, v `, Waterpiping/DWV 56.29 Address: Gi 9y/ 54- g- / fie, Other: 25.02 City/State/ZIP:/ '/.a`_p ad 9.72‘y Subtotal 6A �'1 Minimum pennit fee: $72.50 7A ) Phone:(��;)�2_.15��i' Fax:(�'�)�Z-/C�/y7f - CCB Lie.: /77, ? g Plumbing Lic.no.: /ro, ?../‘ Plan review (25%of permit fee) State surcharge(12%of pennit fee) -70 Authorized signature: i/ TOTAL PERMIT FEE ' This permit application expires if a permit is not obtained within 180 days Print name: // Tr /4"--.)_. Date: Fe-,...:---/,‘ GH�'7 /'rafter it has been accepted as complete. *Fee methodology set by Tri-County Building Industry Service Board. Ir Building Permits Pi.M11-PermitApp.doc 10 01 09 440-4616T(10 02 COM WEB) Plumbing Permit Application - City of Tigard Page 2 - Supplemental Information Fee Schedule: Residential Fire Su. s ression S stems: 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' 62.54 7,201 and greater $327.54 Sewer-each additional 100' 37.52 Water Service- 1st 100' 62.54 Medical Gas S stems: Water Service-each additional 100' 37.52 g',Ss �� � a c�✓u,Y$'#m w2.n .mka...E t^,. 4rn :. x 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 c4 1 Ir* : 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 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 90.00Mr $50,001.00 and up $742.00 for the first$50,000.00 and$1.20 for (minimum charge I/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*. p1 ,teywfl01 ;1I g C >1oll s 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 0 Any new commercial building with water service 2-and greater,except systems designed and stamped by licensed Bath: -Tub/Shower -Jacuzzi/Whirlpool engineer. Car Wash: Each Stall ❑ New exterior plumbing site utilities for any complex structure Drive tall as defined in OAR918-780-0040. 111Cuspidor/Water Aspirator Medical gas and vacuum systems for health care facilities. Dishwasher: Commercial ❑ Any multipurpose fire sprinkler system. Domestic 0 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•• 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./Refiig.Drains Comments regarding fixture work: Oil Separator(Gas Station) Rec.Vehicle Dump Station Shower: -Gang -Stall Sink: -Lav/Bar non-food related -Bradley -Coin/Sere/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:ABuilding\Permits\PLMF_PennitApp.doc 08/04/2011 2