Permit „”
in 1114CITY OF TIGARD PLUMBING PERMIT
` 31' . COMMUNITY DEVELOPMENT Permit#: PLM2016-00433
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 08/11/2016
Parcel: 2S104CA00700
Jurisdiction: Tigard
Site address: 13339 SW ESSEX DR
Project: WEGENER Subdivision: HILLSHIRE Lot: 7
Project Description: Replacing 5 ft.of sanitary sewer.
Contractor: TC EXCAVATING INC Owner: WEGENER FAMILY TRUST
PO BOX 2471 BY WEGENER, MICHAEL W&
ESTACADA, OR 97023 FARRAR-WEGENER, LOUISE TRS
13339 SW ESSEX DR
TIGARD, OR 97223
PHONE: 503-407-0503 PHONE:
FAX:
FEES
Quantity Description Date Amount
5 If Sanitary Sewer 08/11/2016 $62.54
Specifics: 1 12%State Surcharge- 08/11/2016 $8.70
Plumbing
Type of Use: SF 10 ea Minimum Fee Adjustment- 08/11/2016 $9.96
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 952-001-009 ou may obtain a co. of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: -ermittee 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
co
City of Tigard Received
13125 S W Hall Blvd.,Tigard,OR 9 Y3 Date/By: i i
i 4,7,7_
Permit No.:
t 11 Phone: 503.718.2439 Fax: 503.59: 1'.0' Plan Review
Inspection Line: 503.639.4175 ,`� i `to� Date/By: Other Permit No.:
T I G A R D N 1 Date Ready/By: Juris: ® See Page 2 for
Internet: www.tigard-or.gov F'� � Notified/Method: -
A ►�'C.� Supplemental Information
TYPE OF WORT{ C' OF CI 5i®N $ I}IJLE
At FEE*
❑New construction ❑ C ��`�G 1..)1Y'
For special information use checklist
'�ddition/alteration/replacementCts Description Qty. Ea. Total
0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(1)bath 312.70
-and 2-family dwelling 0 Commercial/industrial SFR(2)bath 437.78
SI
❑'1Accessory building 0 Multi-family SFR(3)bath 500.32
ID Master builderEach additional bath/kitchen 25.02
0 Other: Fire s
- prinkler( sq.ft.) Page 2
JOB Silt,,INFORMATION AND LOCATION, Site utilities:
Job site address: r 3 �-)Ci _3(A-) CS P!2 Catch basin or area drain 18.76
City/State/ZIP: / > /r Drywell,leach line,or trench drain 18.76
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
A 18.76
.. 1 Rain drain connector 18.76
Sanitary sewer(no.linear ft.:,4 ) Page 2 ?,r% 5-1.7
Storm sewer(no.linear ft.:_) Page 2
Water service(no.linear ft.:_) Page 2
Subdivision: I Lot no.:
Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
. ; ,g:. D Q,,ON F.WORK . ,: , .1 Backwater valve 12.51
1 . ' ` Y 3 Clothes washer 25.02
L11 ez_ `c 't,'. .kr Dishwasher
25.02
Drinking fountain 25.02
Ejectors/sump 25.02
w r.:-J p#9. OWNER ,ry ,x .:,, ❑ TENAI F Expansion tank
12.51
Name: Fixture/sewer cap 25.02
Address: Floor drain floor sink/hub 25.02
Garbage disposal 25.02
City/State/ZIP:
Hose bib 25.02
Phone:( ) Fax:( ) Ice maker 12.51
"APPLICANt :1' 14 ,: ❑ 'CONTACT PERSON Interceptor/grease trap 25.02
Business name: ` f, Medical gas(value:$ ) Page 2
x �v(..� n
Contact name. r� � Primer 12.51
( ( � l )Cp_ Roof drain(commercial) 12.51
Address: fb _1'S,_), Zi _..-7
�f Sink/basin/lavatory 25.02
City/State/ZIP: S Cr-t if
� ( � �`:� �>3'Z.. 5 Solar units(potable water) 62.54
`
Phone:(c_. .. ( L' ,r t 50 3 I Fax::( ) Tub/shower/shower pan 12.51
E-mail:14 L.P. t-,, //_ Urinal 25.02
CONTRACTOR Water closet 25.02
Business name: Water heater 37.52
___S
Water piping/DWV 56.29
Address:
Other: 25.02
City/State/ZIP:
Subtotal
Minimum permit fee: $72.50 "7;-TLt
Phone:( ) Fax:( )
CCB Lic.: /;c."--0 (;^•7 Plumbing Lic.no.: Plan review (25%of permit fee)
C, ' State surcharge(12%of permit fee)
Authorized signature. 'tiAL., d(!
TOTAL PERMIT FEE /„ )
I Print nam . ,' t C i I Date: ?--/( ,--/6I
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 10/01/09 440-4616T(10/02/COM/WEB)
Plumbing
2 - Supplemental Permit ApplicationInformation- City of Tigard
Fee Schedule: Residential Fire Suppression Systems:
Y. Fee(ea) $otat Square Footage: Permit Fee:
Site�'t>ilities`
Footing drain-1 s`100' 50.03 0 to 2,000 $121.90
37.52 2,001 to 3,600 $169.69
Footing drain-each additional 100' 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
al each additional$100.00 or fraction thereof,to
Other Inspections or Fees Qt'• Fee�) Tot
t 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.
90.00/hr $50,001.00 and up $742.00 for the first$50,000.00 and$1.20 for
Additional plan review for revisions each additional$100.00 or fraction thereof.
(minimum charge-1/2 hour)
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*. PlanRe'V env„for Plumbing ns a la 'MS
„ .
Quantity by Fixture Type Plan review is required for any of the following.
Fixture Type for RePla 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 0 New exterior plumbing site utilities for any complex structure
Car Wash: -Each Stall as defined in OAR918-780-0040.
-Drive Thru 0 Medical gas and vacuum systems for health care facilities.
Cuspidor/Water Aspirator 0 Any multipurpose fire sprinkler system.
Dishwasher: -Commercial 0 Any complex structure as defined in OAR918-780-0040.
-Domestic
Drinking Fountain Submit 2 sets of plans with any of the above.
Eye Wash
Floor Drain/sink: -2"
3" 1sojnet1'i4C 01140er'l agraw. ry
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 Comments regarding fixture work:
Ice Mach./Refrig.Drains
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 plumbing permit can be issued.
Water Closet-Toilet
Urinal
Other Fixtures:
I:\Building\Permits\PLMF PermitApp.doc 08/04/2011 2