Permit (55) CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit#: PLM2017-00253
F FGAR D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 06/26/2017
Parcel: 2S102AB02401
Jurisdiction: Tigard
Site address: 12511 SW MAIN ST
Project: ANKELE Subdivision:ELECTRIC ADDITION TO TIGARDVILLE Lot: 15
Project Description: Replacing 50 ft.of water service.
Contractor: BRUNER PLUMBING Owner: ANKELE, BRIAN
PO BOX 23985 3570 SW RIVER PKWY UNIT 1703
TIGARD, OR 97281 PORTLAND, OR 97239
PHONE: 503-484-5105(CELL) PHONE:
FAX: 503-624-2173
FEES
Quantity Description Date Amount
50 If Water Service 06/26/2017 $62.54
Specifics: 1 12%State Surcharge- 06/26/2017 $8.70
Plumbing
Type of Use: COM 10 ea Minimum Fee Adjustment- 06/26/2017 $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 may obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or = a .2344.
Issued By: - 'tee Signature: --
AIPP
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 FOR OFFICE USE ONLI'
City of Tigard Received
- �m
Permit No.: _crows
Date/B
13125 SW Hall Blvd.,Tigard,OR 9726om ��� - ' Plan Review �'� �L ��7
Phone: 503.718.2439 Fax: 503.598.1960 Date/By: Other Permit No.:
T I G A R D Inspection Line: 503.639.4175 JUN 2 6 2017 Date Ready/By: Juris: ® See Page 2 for
Internet: www.tigard-or.gov et�� {� p Notified/Method: t. Supplemental Information
TYPE OF WO1UCITY OF TIGARD
FEE*Wt..
[ U
❑New construction Ib1G OIVISION For special information use checklist.
Description Qty. 1 Ea. Total
of ddition/alteration/replacement ❑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 Commercial/industrial SFR(2)bath 437.78
❑Accessory 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 INFORMATION AND LOCATION Site utilities:
(Z S !/ S%l� . C Catch basin or area drain 18.76
Job site address: Ma, 7
� Drywell,leach line,or trench drain 18.76
.-L -
City/State/ZIP: !
Jr ' ( Footing drain(no.linear ft.:_) Page 2
Suite/bldg./apt.no.: I Project name: f<ee(� VPho I y Manufactured home utilities 50.03
Cross street/directions to job site: gV r� L1G1V\ �r / 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.:Std) so Page 2 6,2 ,511.
Subdivision: Lot no.: Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
4.' r; `' . s�� Backwater valve 12.51
1N1 DESCRI OF'F'WORK''
Clothes washer 25.02
Y'C'J GL/'t_ . Se/y«-- Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
ems,^ 0 PROPERTY WNER ., ''TENANT Expansion tank 12.51
Name: 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
APPLICANT ., -00itiTAcTPERSONS Interceptor/grease trap 25.02
Business name: Medical gas(value:$ ) Page 2
Contact name:
Primer 12.51
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
E-mail: Urinal 25.02
w; r*led e x Water closet
25.02
Aw Water heater 37.52
Business name: try �t
4r P(V 1 J i Ki ( c--- Waterpiping/DWV 56.29
Address: 4) 0 a cr../.. 2....3 et 'fr Other:
25.02
City/State/ZIP: T 01„4-34 i oe)171-1-1- F!31 Subtotal Cd2
Phone:(.5-6 3)6,2}it CrLs-e'd Fax:(�0 11) a ( Minimum permit fee: $72.50 .74,z,ye
CCB Lic.: e/g 3-7 Plumbing Lic.no.: .. 7 T S Pe Plan review (25%of permit fee)
State surcharge(12%of permit fee) b!-„1
Authorized signature:
-' TOTAL PERMIT FEE n�
Print name: lj(J � 4 Z rice.-- Date:6,/jam//2 This permit application expires if a permit is not obtained within S0 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 (02,sy 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 Tluu
0 Medical gas and vacuum systems for health care facilities.
Cuspidor/Water Aspirator
0 Any multipurpose fire sprinkler system.
Dishwasher: -Commercial
-Domestic
❑ Any complex structure as defined in OAR918-780-0040.
Drinking Fountain
Submit 2 sets of plans with any of the above.
Eye Wash
Floor Drain/sink: -2"
3" ec o"r RRiiser, iagrai ;
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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