Permit (26) CITY OF TIGARD PLUMBING PERMIT
111 COMMUNITY DEVELOPMENT Permit#: PLM2017-00024
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 01/24/2017
TIG;1 I<.i) 9 Parcel: 2S112CA12100
Jurisdiction: Tigard
Site address: 15511 SW 76TH AVE
Project: Higginbotham Subdivision: RENAISSANCE WOODS NO.2 Lot: 45
Project Description: Replace 1"water service from meter to house,approximately 45'.
Contractor: PLUMBING CRAFTSMAN AND DRAIN SERVICE LLC Owner: HIGGINBOTHAM, KENT&LINDA LIV T
13300 SW BUTNER RD 15511 SW 76TH AVE
BEAVERTON, OR 97005 TIGARD, OR 97224
PHONE: 503-810-3250 PHONE:
FAX:
FEES
Quantity Description Date Amount
45 If Water Service 01/24/2017 $62.54
Specifics: 1 12%State Surcharge- 01/24/2017 $8.70
Plumbing
Type of Use: SF 10 ea Minimum Fee Adjustment- 01/24/2017 $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 it:y obtain a copy of the rules
or direc es ion 4 UNC by calling 503.232.1987 or 1.800.332.2344.
Issu d By: i 0 , Permittee Signature: r
Call 503.639.4175 by 7:00 a.m.for the next available inspection da .
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 FOR OFFICE USF OyLI'
City of Tigard Received
IIII ll y r Date/By: /7 (---)1), Permit No.:
SW Hall Blvd.,Tigard,O (a! F f' '111-40,91y7.- �
IIPhone: 503.718.2439 Fax: 503.598 1960 Plan Review
Date/By: Other Permit No.:
T I G A R D Inspection Line: 503.639.4175 JAN G A 4 2017
017 Date Ready/By: Juris: 0 See Page 2 for
Internet: www.tigard-or.gov Notified/Method: Supplemental Information
TYPE OF liCKIY OF 1 IuARD FEE* SCHEDULE
Ne construction r3I �t R r �� J "�
0 `"�'ttDertiki tM,i F 1 ,•ry' For special information use checklist
Description Qty. I Ea. Total
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
1-and 2-family dwelling 0 Commercial/industrial SFR(2)bath 437.78
ElAccessory building 0 Multi-family - SFR(3)bath 500.32
❑Master builderEach additional bath/kitchen 25.02
0 Other: Fire sprinkler( sq.ft.) Page 2
JOB SITE iINFORM?jT
1 ION AND' LOCATION" Site utilities:
Job site address: 1 S S S l._,L.) "I vI ck e Catch basin or area drain 18.76
City/State/ZIP: t I C,y••(.ir�i" U i�__Drywell,leach line,or trench drain 18.76
1 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
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 6„2.57
Subdivision: 1 Lot no.: Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
DESCRIPTION OF,WORKt-
.c., Backwater valve 12.51
" Clothes washer 25.02
LA-,
r " Dishwasher 25.02
S t Cr.) V`OA-2 J-r' Drinking fountain 25.02
Ejectors/sump 25.02
0 PROPERTY OWNER i i 0 TENAkr ; Expansion tank 12.51
Name: Fixture/sewer cap 25.02
Address: �`^j l( S 1 L Floor drain/floor sink/hub 25.02
`--1 (r'�-A4 CA.v.{'
Garbage disposal 25.02
City/State/ZIP: i a-1-c.-(, CA__ Hose bib
525.02
Phone:( ) Fax:( ) Ice maker 12.51
,` " APPLICANT " Interceptor/grease� ❑ CONTACT PERSON, ��E trap 25.02
Business name: �' vbI L71,y Medical gas(value:$ ) Page 2
" C. t 1N1 La.14
Contact name: TV v-- c c ;, L,., .-C-? mer 12.51
�T Roof drain(commercial) 12.51
Address: (-3 V_u ,--c ig L 'A,c ti Sinlc/basin/lavatory 25.02
City/State/ZIP: • v-Ni, . 0 (. (ct-)o) S- Solar units(potable water) 62.54
Phone: )" --CC.,i'- 3 - C Fax::( ) Tub/shower/shower pan 12.51
E-mail: Urinal 25.02
CONTRACTOR Water closet 25.02
Water heater 37.52
Business name: P VVI w i,,S 'C. "V'Lai ti."P1 .ti Ji;J.,Water piping/DW�V 56.29
Address: I '3 , ;�- (`3.e'li e w ti'L/ 14-0Other: 25.02
City/State/ZIP: V5Cc-e V-4,V p/i , Gag_ j )1,A)r Subtotal
Phone:6---)3 "-cC4,-, - 3D.. S- Fax:( ) Minimum permit fee: $72.50 7a,So
�p,��.�"�• p Plan review (25%of permit fee)
CCB Lie.: -
C,(4,,Z L., ?silo(? Plumbing Lic.as t --1 ti v
7
!� /,/t 7 State surcharge(12%of permit fee) T.70
Authorized signature: ,�'7v -90
�7' TOTAL PERMITFEE
�`
Print name: V c:-�3--, L,-)A-? Date: 1-2 L'i- tr
i 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 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-15'100' 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(ea) 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
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*. 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 0 New exterior plumbing site utilities for any complex structure
Car Wash: -Each Stall as defined in OAR918-780-0040.
-Drive Thru
❑ Medical gas and vacuum systems for health care facilities.
Cuspidor/Water Aspirator
0 Any multipurpose fire sprinkler system.
Dishwasher: -Commercial ❑ Any complex structure as defined in OAR918-780-0040.
-Domestic
Drinking Fountain
Eye Wash Submit 2 sets of plans with any of the above.
Floor Drain/sink: -2"
...,,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/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
Water Closet-Toilet plumbing permit can be issued.
Urinal
Other Fixtures:
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