Permit (53) CITY OF TIGARD PLUMBING PERMIT
S COMMUNITY DEVELOPMENT
Permit#: PLM2017-00250
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 06/22/2017
T f �� �- Parcel: 25111 BA01700
Jurisdiction: Tigard
Site address: 14325 SW 97TH AVE
Project: Mitchell Subdivision: TIGARDVILLE HEIGHTS Lot: 32
Project Description: Connect existing house to sewer service,approximately 100'. Septic tank is to be pumped and filled or removed.
Contractor: OWNER Owner: MITCHELL, MICHAEL W&PATRICIA T
PATRICIA&MICHAEL MITCHELL 14325 SW 97TH AVE
TIGARD, OR 97224 TIGARD, OR 97223
PHONE: 971-777-4043
971-777-4043
FAX:
FEES
Quantity Description Date Amount
100 If Sanitary Sewer 06/22/2017 $62.54
Specifics: 1 12%State Surcharge- 06/22/2017 $8.70
Plumbing
Type of Use: SF 10 ea Minimum Fee Adjustment- 06/22/2017 $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 ' - . -- '•n 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•erect questions • •UNC = calling 503.232.1987 or 1.800.332.2344.
ssued By: 1 / Permittee Signature: /
__ _ 4_ ./..i.at-Ait A , . ./ AAdAft&od4 dAadaNiAl
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.
Plumbin Permit A lic tion
Building Fixtures ., , '' FOR OFFICE USE ()NEN'
City of Tigard Received /_ n n7
c / Permit No.: ,(.H�`7���
Date/By:nR ((/OSO`
NI . 13125 SW Hall Blvd.,Tigard,OR 97,x,23+` Plan Review �e.,,,,,„,,,,,,,g`�
I Phone: 503.718.2439 Fax: 503.598.19t0m f"17 Other Permit No.:
Date/By:
Inspection Line: 503.639.4175 -.
T I G A R D h Date Read/BY Jur s: ® See Pagee 2 for
Internet: www.tigard-or.govt,,/ F t ? � Notified/Method: Supplemental Inf
ormation
TYPibip.ua qqr
FEE* SCHEDULE
❑New construction ❑Demolition For special information use checklist.
Description I Qty. Ea. I Total
ddition/alteration/replacement ❑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 ❑Commercial/industrial SFR(2)bath 437.78
SFR(3)bath 500.32
❑Accessory building ❑Multi-family
Each additional bath/kitchen 25.02
❑Master builder ❑Other: Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
6it4
Job site address: / i_/3 A 5 S 9-7 >'` Catch basin or area drain 18.76
/ Drywell,leach line,or trench drain 18.76
City/State/ZIP: -1) +e) 01L 9 1 Z 2.cT
/ / 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
9 77' w.t 41 ota24/6 ' k1 P_6 M L) Rain drain connector 18.76 'r
Sanitary sewer(no.linear ft.:/f7 0 Page 2 CO,5
Storm sewer(no.linear ft.:_) Page 2 J
Water service(no.linear ft.:_) Page 2
Subdivision: Lot no.: Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
Mgr Backwater valve 12.51
DESCRIPTION OF WORK ,f.
:x .. �.
s€P r(Ci ro gf 4dClothes washer 25.02
Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
0 PROPERTY OVs£ I 0TENANTk' ! Expansion tank 12.51fix
Name: eAr/-(C/#1- ' ili IC/*A / /nrre frig' Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address: /c./j sc f i f ) Pl` 4-1,4-e.,
'/ Garbage disposal 25.02
City/State/ZIP: / /6�j f) 02 .97 7 2 Hose bib 25.02
Phone:i9 2() 77 7 4/D'3 Fax:( /) Ice maker 12.51
n
` "" Interceptor/grease 25.02
�❑ APPLICANT �;F ' N S, t NTACT PERSONtrap
s '
Business name: tri GC ifect4 A T�lfGvv Medical gas(value:$ ) Page 2
CiPrimer 12.51
Contact name: l^ h
4. Roof drain(commercial) 12.51
Address: /eg 3 2-S Ski /'`-- / Sink/basin/lavatory 25.02
City/State/ZIP: �/64k.,) OCL 97 Z ze Solar units(potable water) 62.54
Phone:(97/) 777 yD t{1 Fax::( / ) Tub/shower/shower pan 12.51
Urinal 25.02
E-mail: /c L//V (L.2 e Cr/r'^`-
Water closet 25.02
7 CONTRACTOR ,/,/ ,TM>
/ _ 5„.. .155
Water heater 37.52
Business name: 9 / '[�n( C‘171-1 t rre-t � Water piping/DWV 56.29
Address: 5fr-,1,(• /��(� £,� Other: 25.02
City/State/ZIP: C/ Subtotal
Phone:( ) Fax:( ) Minimum permit fee: $72.50
CCB Lic.: Plumbing Lic.no•
Plan review (25%of permit fee)
State surcharge(12%of permit fee)
Authorized signature: c/� � TOTAL PERMIT FEE gi�O
Print name: /C/ eL j i-ll/ Date: Z Z.- �(/4- / A This permit application expires if a permit is not obtained within 180 days
// /I 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/CAM/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. 2,001 to 3,600 $169.69
3,601 to 7,200 $233.20
Sewer-1st 100' 62.5 7,201 and greater $327.54
Sewer-each additional 100' .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
each additional$100.00 or fraction thereof,to
Other Inspections or Fees Qty. Fee(ea) Total
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 Plumlib..g'Installations m'
Quantity by 1F'Yture Type. Plan review is required for any of the following.
Fixture Typeor Replarel Please check all that apply.
Work Performed: Capped Added' Relocate
Baptistry/Font ❑ Any new commercial building with water service 2"and
greater,except systems designed and stamped by licensed
Bath: -Tub/Shower
-Jacuzzi/Whirlpool engineer.
Car Wash: Each Stall
0 New exterior plumbing site utilities for any complex structure
Drive Thru as defined in OAR918-780-0040.
Cuspidor/Water Aspirator 0 Medical gas and vacuum systems for health care facilities.
Dishwasher: Commercial
0 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"
; , a exp e
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 beaid before the
Water Extractor p
Water Closet-Toilet plumbing permit can be issued.
Urinal
Other Fixtures:
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