Permit (10) CITY OF TIGARD PLUMBING PERMIT
14 • COMMUNITY DEVELOPMENT Permit ft: PLM2016-00502
UI C;;t I=.h 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 10/03/2016
Parcel: 2S109DB01701
Jurisdiction: TIGARD
Site address: 13100 SW SUMMIT RIDGE ST
Project: Zeider Annexation Subdivision: Lot:
Project Description: Sewer connection for existing house,approximately 100'. Septic tank to be pumped and removed.
Contractor: NORTHWEST EARTHMOVERS INC Owner: JANET ZEIDER
PO BOX 1609 13100 SW SUMMIT RIDGE ST
SHERWOOD, OR 97140
PHONE: 503-625-3100 PHONE: 503-620-2428
FAX: 503-625-3108
FEES
Quantity Description Date Amount
100 If Sanitary Sewer 10/03/2016 $62.54
Specifics: 1 12%State Surcharge- 10/03/2016 $8.70
Plumbing
Type of Use: SF 10 ea Minimum Fee Adjustment- 10/03/2016 $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 q oris to OUNC by calling 503.232.1987 or 1.800.332.2344. f
Issu By: ie„,,,,.._1)22":„.„,0A...4....A Permittee Signature:
Call 503.639.4175 by7:00 a.m.for the next available inspection date.
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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 OFFICE. USE ONL1
City of Tigard Received // 1, ^
Date/By: /0/5(/4 ( j Permit No.: All, 50 A
III • 13125 SW Hall Blvd.,Tigard,OR �Z
= Plan Review �l .�y
Phone: 503.718.2439 Fax: 503.598.1960 �}� Date/By: Other Permit No.: o/c��//O-66.3n./
Inspection Line: 503.639.4175 Z`
T I G A R I� 'C t `i Date Ready/By: Juris: EI See Page 2 for
Internet: www.tigard-or.gov t' e y{�t`a° Notified/Method: Supplemental Information
v
TYPE OF WORD- ' 1 y\( ILS • FEE* SCHEDULE
'' 'r c,"s l 7 4� For special information use checklist
❑New construction 0 Dei P
+"' Description Qty. Ea. Total
[Addition/alteration/replacement ❑ t er: New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION :� SFR(1)bath 312.70
al-and 2-family dwelling 0 Commercial/industrial SFR(2)bath 437.78
buildingSFR(3)bath 500.32
❑Accessory 0 Multi-family
Each additional bath/kitchen 25.02
0 Master builder 0 Other:
Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMATIQN AND LOCATI
aN Site utilities:
Job site address: (3 100 Catch basin or area drain 18.76
S W t C ovt+�t R-(�(r-t Drywell,leach line,or trench drain 18.76
City/State/ZIP: --I((4>A Q tb 0(1 2-2.. Footing drain(no.linear ft.:_) Page 2
Suite/bldg./apt.no.: I Project name: Z e ( bele. Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
Rain drain connector 18.76
Sanitary sewer(no.linear ft.:l if d) Page 2 4,2_5q/
Storm sewer(no.linear ft.:_) Page 2
Water service(no.linear ft.:_) Page 2
Subdivision: c;2 /659-06/70 /0 I Lot no.: Fixture or item:
Tax map/parcel no.: I 7.-4)t7.-4)tZ t cf(sPj
C�1L Backflow preventer 31.27
�-T tio
DESCRIPTION OE !ORK
Backwater valve 12.51
AW
' Clothes washer 25.02
.�2 evU e- S e 9"fC c- 0& U i- Lc-00K_ Gy Dishwasher 25.02
`-`l`1AA.r.; j SL:3C,3 E12-- Drinking fountain 25.02
Ejectors/sump 25.02
❑:.PROPERTY OWNER " { 0 .TENANT", Expansion tank 12.51
Fixture/sewer cap 25.02
Name: .,/l 't- -L- l6 c.i2.
f Floor drain/floor sink/hub 25.02
Address: O 2 0 9 L.LS c&14 IAA�T" R.((�
( Garbage disposal 25.02
City/State/ZIP: -7-t 6i Ji R 6 d a - ot 1 Z2,4 Hose bib 25.02
Phone: ) okev*rFax:( ) Ice maker 12.51
0 AP.PLIC 0 CONTACT PERSON Interceptor/grease trap 25.02
Business name: , �,j,``; V'O. (?d'�.� Tl eek AlC Medical gas(value:$ ) Page 2
V
Contact name: c� A 6 Primer 12.51
C -` ' . e L (erYvt 15-e-' Roof drain(commercial) 12.51
Address: /i -7 (DA\e C s 1 CC Sink/basin/lavatory 25.02
City/State/ZIP: L....A(ce C)S(Ala -(_.:.,(..._To C -1,0.1.' Solar units(potable water) 62.54
Phone:(5t;-ra) eisci„5._ 0 SlO Fax::( ) Tub/shower/shower pan 12.51
E-mail: L 1. v e0-1,4e04-04-t p _ GN Urinal 25.02
r Water closet 25.02
CONTRACT R
Water heater 37.52
Business name: 0,P1-?��(�e57- (A L7-Alla/)C)�c Water piping/DWV 56.29
Address: 7(-) (� " c) (0 0 Cj Other: 25.02
City/State/ZIP: ! (4-%.7..1Q14.) \(,�-�
Of
Cl 7 ( '40 Subtotal 6 ri
Phone:(5C)3) to 2 c.-; 3 t 0 U Fax:( ) I Minimum permit fee: $72.50 �4 $
Plan review (25%of permit fee) i�
CCB Lic.: Lo1 -1 b 1 Plumbing Lic.no.: -12.;\lei 3 '
State surcharge(12%of permit fee) Q_70
Authorized signature: /1_ tl.Alk ' TOTAL PERMIT FEE )-)
��
Print name: 1 , \' Date: /77/LL2_ This permit application expires if a permit is not obtained within 180 days
L C �! tPd(Jl� ( D after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
I:A Building\Permits APLMU-PermitApp.doc 10/01/09 440-4616T(I0/02/COM/WEB)
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-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 Systems:
Water Service-each additional 100' 37.52
Storm&Rain Drain-1st 100' 62.54 Valuation Permit Fee:
$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
h 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 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 '
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
Car Wash: -Each Stall 0 New exterior plumbing site utilities for any complex structure
as defined in OAR918-780-0040.
-Drive Thru
Cuspidor/Water Aspirator 0 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"
3" Isometric or Riser Diagram
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:
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