Permit (106) CITY OF TIGARD PLUMBING PERMIT
4 Permit#: PLM2017-00136
COMMUNITY DEVELOPMENT Date Issued: 04/17/2017
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 2S106DB24000
Jurisdiction: Tigard
Site address:
Project: River Terrace Northwest-Pocket Park Subdivision: RIVER TERRACE NORTHWEST Lot: M
Project Description: Plumbing for park at the NE corner of SW Forest Hollow Street and Apple Grove Terrace;(3)catch basins,191'of
footing drain and 281'of storm sewer.
Contractor: UNITED EXCAVATORS Owner: WILLIAM LYON HOMES
4804 NW BETHANY BLVD STE 1-2 PBM 361 109 EAST 13TH STREET
PORTLAND, OR 97229 VANCOUVER,WA 98660
PHONE: 360-695-7700
PHONE: 503-914-7166
FAX:
FEES
Quantity Description Date Amount
3 ea Catch Basin or Area Drain 04/17/2017 $56.28
Specifics: 191 If Footing Drain 04/17/2017 $87.55
281 If Storm Sewer 04/17/2017 $137.58
Type of Use: COM 1 Plan Review 04/17/2017 $70.35
Class of Work: OTR 1 12%State Surcharge- 04/17/2017 $33.77
Type of Const: Plumbing
Occupancy Grp:
Stories:
Total $385.53
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
theruleon
s
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
,d)
Issued By: Permittee Signature: �� /(
4-777'
771OA�
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.
Mk
IN
- Plumbing Permit Applicati CE1 E
Site Utilities FOR OFFICE I;SE ON1.1
APR 13 2017 Received �/
City of Tigard �} Date/By: 1//3//7 Permit No.:/�G j7e2ai 7- 7 )3(3
13125 SW Hall Blvd.,Tigard,OR 9�®�'TIGA�� Plan Review, /��f
II Phone: 503.718.2439 Fax: 503.5+) Date/By: y--(9-//7 L' Other Permit No.:
T I G A R D Inspection Line: 503.639.4175 BUILDING D Sip Date Ready/By: �/ / de Juris: H See Page 2 for
Internet: www.tigard-or.gov Notified/Method: �7//
r� Supplementallnformation
TYPE OF WORK �LG/ FEE* SCHEDULE
['New construction 0 Demolition For special information use checklist.
Description I Qty. I Ea. Total
❑Addition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION .71 SFR(1)bath 312.70
❑ 1-and 2-family dwelling 0 Commercial/industrial SFR(2)bath 437.78
SFR(3)bath 500.32
❑Accessory building 0 Multi-family
Each additional bath/kitchen 25.02
❑Master builder Erdther: ra�,1-, sprinkler
Fire ( sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: iio --Pry/1 Catch basin or area drain - 18.76 �(,,
t 1"" Drywell,leach line,or trench drain 48
18.76
City/State/ZIP: Footing drain(no.linear ft.: IiA1j I161 Page 2
7 Ss
Suite/bldg./apt.no.: Project name: Igit. ej r T2(Y ie MrWl anUfactured home utilitiesi11QY �L-�1 50.03
Cross street/directions to job site: Manholes 18.76
`1 �f 'NAt'
S war s� C-�
Rain drain connector 18.76
j� Sanitary sewer(no.linear ft.: ) Page 2
Co '� P ' ' /)L � 1 T Storm sewer(no.linear ft.:Z�O4 a E 1 1 Page 2 139,54:
t- Water service(no.linear ft.:_) Page 2
Subdivision: I Lot no.: Fixture or item:
Tax map/parcel no.: .2 S /0 46i3 E.Q 1/00 0Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 25.02
j\--i..)•C`rsC1 1./s r\'S No 1i an Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
0 PROP!ERTY.)WNER w` 1 0 TENANT Expansion tank 12.51
Name: Pitt,g.L--- Fixture/sewer cap 25.02
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
KAPPLICANT - :'5'''''' Ef CONTACT PERSON
Interceptor/grease trap 25.02
Medical gas(value:$ ) Page 2
Business name: WI\vice,f� or\ it
Primer 12.51
Contact name:
Roof drain(commercial) 12.51
Address: t J ci i- C ��.�
' k c e p A-"- Sink/basin/lavatory 25.02
City/State/ZIP: ik Solar units(potable water) 62.54
Phone:g(00) L911 A,,5 -,-ID(S Fax::( ) / Tub/shower/shower pan 12.51
E-mail:
Qty .G.,_,„--r.,,, C��1�4 25.02
Water closet 25.02
COCTOR 'k"
Water heater 37.52
Business name: tit V ' /C/I -tiffs Water piping/DWV 56.29
Address: y c d L J N t a t �i e,,k,�/1�,N bwa Other: 25.02
City/State/ZIP:P0 r.4 \ ,h a a 12_,„ Cr-i -� _ Subtotal a3 1t 4 i
Phone:( ) Fax:( ) Minimum permit fee: $72.50
O %g a.. I(l a* Plumbing Plan review (25%of permit fee) f� ,35CCB Lic.: Lic.no.: -
State surcharge(12%of permit fee) 33,17 7
Authorized signature: _..• i' i TOTAL PERMIT FEE 3S5,S3
/� rW ` This permit application expires if a permit is not obtained within 180 days
\` �
Print name: , Date: 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(l0/02/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 _Sc,O, 0 to 2,000 $121.90
Footing drain-each additional 100' 37.52 1'7 2 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 tee:
Storm&Rain Drain-1st 100' / 62.54 ' ,5 $1.00 to$5,000.00 Minimum fee$72.50
Storm&Rain Drain-each additional 100' Z 37.52 9S,(4 $5,001.00 to$10,000.00 $72.50 for the first$5,000.00 and$1.52 for
Other Inspections orFees Qty• Fee(�) Total 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 90.00/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: 13
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*.
Quantity by Fixture Type Ilan"Review fdt Plumbing Installations ,
Fixture Type for Plan review is required for anyof the following.
Work Performed: Capped Added Relocate. ._ �1
Baptistry/Font Please check all that apply.
Bath Tub/Shower
0 Any new commercial building with water service 2"and
Jacuzzi/Whirlpool greater,except systems designed and stamped by licensed
Car Wash -Each Stall engineer.
-Drive Thru 0 New exterior plumbing site utilities for any complex structure
Cuspidor/Water Aspirator as defined in OAR918-780-0040.
Dishwasher -Commercial ❑ Medical gas and vacuum systems for health care facilities.
-Domestic 0 Any multipurpose fire sprinkler system.
Drinking Fountain 0 Any complex structure as defined in OAR918-780-0040.
Eye Wash
Floor Drain/sink -2" Submit 2 sets of plans with any of the above.
Car Wash Drain ISpmetric car er Diagram
Garbage Domestic-non-food
0 Isometric or riser diagram is required for new buildings
Disposal -Domestic-food related that meet the qualifications above.
-Commercial-food related
-Industrial-food related
Ice Mach./Refrig.Drains
Oil Separator(Gas Station) Comments regarding fixture work:
Rec.Vehicle Dump Station
Shower -Gang
-Stall
Sink/Lav -Non-food related
-Bradley
-Commercial-food related
-Service
Swimming Pool Filter *Note: If the fixture work under this permit results in an
Washer-Clothes
Water Extractor increase of sewer EDUs,a sewer permit will be issued and
Water Closet-Toilet fees assessed for the sewer increase must be paid before the
Urinal plumbing permit can be issued.
Other Fixtures:
I:\Building\Permits\PLMU PermitApp.doc 2
illi Site Utilities — Plumbing Permit Application
r Plan Submittal Requirements
TIGARD
A plumbing permit for site utility plumbing work is required for sanitary sewer, storm sewer
and potable water systems on private property.
1. SITE PLAN and vicinity map showing the geographic location (fully dimensional, drawn
to scale) labeled with:
A. El map&tax lot# El project name ❑ site address ❑ suite number
❑ zoning El applicant name El phone number
B. North arrow.
C. Scale (architectural or engineering only).
D. Street names.
E. Building pads with project location.
2. PLUMBING PLANS-Two (2) complete sets, civil only.
All details listed below shall be incorporated into the plumbing plans:
A. Storm drainage plan showing:
1) Finish elevations throughout the developed site.
2) Grade breaks determining area serving each catch basin.
3) Location of catch basins.
4) Pipe size.
5) Type of material.
6) Slope of piping.
7) Manholes and field drains.
8) Cleanouts provided for each 100 feet or fraction thereof.
9) Roof drain laterals specifying cleanouts at each upper terminal.
10) Location of existing or proposed connection to a public sewer line.
B. Utilities plan showing:
1) Sanitary sewer line location,pipe size, type of material, slope of piping,manholes
and cleanouts provided as required for storm.
2) Size and location of domestic water piping and drainage.
3) Proposed location of connection to a public water or sanitary sewer line.
I:\BuildingPermits\PLMF-PermitApp.doc 12/30/05