Permit (46) 114 CITY OF TIGARD PLUMBING PERMIT
' COMMUNITY DEVELOPMENT Permit#: PLM2016-00399
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 08/01/2016
Parcel: 2S112CA03400
Jurisdiction: Tigard
Site address: 15270 SW 79TH AVE
Project: Trevor Subdivision: DURHAM ACRES Lot: 30
Project Description: Connect existing house to sewer service,less than 100'. -,
Contractor: ROYAL FLUSH PLUMBING Owner: TREVOR, BRETT&AMY JO
PO BOX 507 15270 SW 79TH AVE
BEAVERCREEK,OR 97004 TIGARD, OR 97224
PHONE: 503-657-3919 PHONE:
FAX: 503-657-3940
FEES
Quantity Description Date Amount
100 If Sanitary Sewer 08/01/2016 $62.54
Specifics: 1 12%State Surcharge- 08/01/2016 $8.70
Plumbing
Type of Use: SF 10 ea Minimum Fee Adjustment- 08/01/2016 $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 Notific 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 direc estions to-0,1NC by calling 503.232.1987 or 1.800.332.2344.
Issu d By: }k�` (-)1.44jua_L Permittee Signatu e: 1--/)/y//,,
Call 503.639.4175 by 7:00 a.m.for the next available inspection date./p
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
City of Tigard , , Received ,".
Permit No.: U--/014/ _0037?
. . 13125 SW Hall Blvd.,Tigard,OR 97123
IN i 2016 Date/By: / f -,,,
Plan Review
111 Phone: 503.718.2439 Fax: 503_5984960 ,. Date/By: Other Permit No.: i,,,od_.9.0/6••466 A49 g
Inspection Line: 503.639.4175 ..., k,_` ,---)f, ,'
TIGARD
Internet: Date Ready/By: kris Ed See Page 2 for
www.tigard-or.gov --.,,,,s ,,. ,,-, , ;,,, Notified/Method: Supplemental Information
TYPE OF WORK FEE* SCHEDULE
0 New construction Ei Demolition For special information use checklist.
Description Qty. Ea. I Total
El Addition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(1)bath 312.70
I=1 1-and 2-family dwelling I=1 Commercial/industrial SFR(2)bath 437.78
SFR(3)bath 500.32 I
0 Accessory building El Multi-family
Each additional bath/kitchen 25.02
C1,
0 Master builder 0 Other:
Fire sprinkler( sq.ft.) Page 2 )--1
JOB SITE INFORMATION AND LOCATION Site utilities:
(I)
A
Job site address: I S 2 7 0 5 i.AI 7 c.t.ii,\ ft ve. Catch basin or area drain 18.76
Drywell,leach line,or trench drain 18.76
City/State/ZIP: -75(--xrg , 0g, 9.7214-
, Footing drain(no.linear ft.:_) Page 2
Suite/bldg./apt.no.: (i I Project name: c1:41k fi
OU•SO-- Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
Rain drain connector 18.76
Sanitary sewer(no.linear ft.: ) Page 2
Storm sewer(no.linear ft.:_) Page 2
Water service(no.linear ft.:_) Page 2
Subdivision: I Lot no.: Fixture or item:
Backflow preventer 31.27
Tax map/parcel no.:
..,«.,' Backwater valve 12.51
.S'OEStitiPTION;OF WORK
C3
1 , 4. . ' ''' - ' Clothes washer 25.02
C.-tio it\v\es_1- -A-01 Cl."1 , SR, .A.1 er Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
qj PRokiltry OWNER '' 1 ' '0 1-6 -1 - -,,,, Expansion tank 12.51
Fixture/sewer cap 25.02
Name: Ere (I -T,,e,vo je-
Floor drain/floor sink/hub 25.02
Address: .s-ctl,,e cts. 00(4 1-7-1,e
Garbage disposal 25.02
City/State/ZIP:
Hose bib 25.02
Phone:( ) Fax:( ) Ice maker 12.51
0 APPLICANt 1j Cii" ACT PERSON':' Interceptor/grease trap 25.02
Medical gas(value:$ ) Page 2
Business name:
Primer 12.51
Contact name:
Roof drain(commercial) 12.51
Address:
Sink/basin/lavatory 25.02
City/State/ZIP: Solar units(potable water) 62.54
Phone:( ) Fax::( ) Tub/shower/shower pan 12.51
Urinal 25.02
E-mail:
-, -- Water closet 25.02
CMITRACknt
Waterheater 37.52
Business name: K0 .1 ct t fltA,S-L\ flAAVV\191 tAi
Address: Water piping/DWV 56.29
0 0 x. SC-2 Other: 25.02
City/State/ZIP: \ -)2 :' •0 ,_ 0.0.. C4 706C7 Subtotal
Phone:( 53) -.),5-7- Fax:( ) Minimum permit fee: $72.50 7c
CCB review (25%of permit fee) ----
CCB Lie.: t 2 4_22_ ii/3o/i Plumbing Lie,no.: 3- (123 Po cf.7 e.)-
State surcharge(12%of permit fee)
7/i it
Authorized signature: gy2ca k' L"- 77
TOTAL PERMIT FEE /•024)
Print name: ., ref-. T''-'e,vo i•-• Date: 12-1- k 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. .00
I:\Budding\Permits\PLMU-PermitApp doc 10/01/09 440-4616T(10/02/COM/WEB)
"7---.0:-.7-4 e-- j.5.-•, 1 1 I le•9-6
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' 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
Qty. Fee(en) Total
each additional$100.00 or fraction thereof,to
Other Inspections or Fees 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*. Plan RevieW for;flumbing I stallatio
Quantity by Fixture Type Plan review is required for any of the following.
Fixture Type forReplace/ Please check all that apply.
Work Performed: Capped Added Relocate
0 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
0 New exterior plumbing site utilities for any complex structure
Car Wash: -Each Stall as defined in OAR918-780-0040.
-Drive Thru
Cuspidor/Water Aspirator 0 Medical gas and vacuum systems for health care facilities.
El Any multipurpose fire sprinkler system.
Dishwasher: -Commercial
al
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"
3" Isonietric orRiser.Diagr m ,.
4"
0 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
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
Location:
Record Type:
Inspection Type:
Result:
Comments:
Inspection Date:
Record ID:
Inspector:
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
15270 SW 79TH AVE, TIGARD, OR, 97224
Residential - Plumbing
399 Plumbing final
PASS - No C of O
PLM2016-00399
Don Sylvester
1. Septic tank pump and fill - approved
Violation Summary:
Inspector Contractor