Permit (66) CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENTt.
Permit#: PLM2017-00278
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 07/13/2017
Parcel: 1 S 134AB02000
Jurisdiction: Tigard
Site address: 11325 SW BASSWOOD CT
Project: Bryant Subdivision: ENGLEWOOD Lot: 77
Project Description: Replace 20'of sanitary sewer line via burst.
Contractor: TCJ CONSTRUCTION Owner: BRYANT, BRADY B
19750 SW PAGE CT DINH, HUONG
BEAVERTON, OR 97007 3802 SE 2ND AVE
CAPE CORAL, FL 33904
PHONE: 503-320-7831 PHONE:
FAX: 503-259-2432
FEES
Quantity Description Date Amount
20 If Sanitary Sewer 07/13/2017 $62.54
Specifics: 1 12%State Surcharge- 07/13/2017 $8.70
Plumbing
Type of Use: SF 10 ea Minimum Fee Adjustment- 07/13/2017 $9.96
Class of Work: ALT Plumbing
Type of Const:
Occupancy Grp:
Stories:
Total $81.20
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
or direct. - 'ins to OUNC by calling 503.232.1987 or 1.800.332.2344.
Iss ed By: 01,
i
... Permittee Signature:
. q____,.....„)
Call 503.639.4175 by 7:00 a.m.for the next available inspection date
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Plumbing Permit Application
Building Fixtures RECEIVED
City of Tigard Eiew
13125 SW Hall Blvd.,Tigard,OR 97L 13 2017 D '7 /3 If PermitNo.: !7_
- `'r
Phone: 503.718.2439 Fax: 503.598.1960 Date/By: Other Permit No.:
T I c ARD Inspection Line: 503.639.4175 CITY OFT$GARS r Date Ready/By: Jur s: ® See Page 2 for
Internet: www.tigard-or.gov BUILDING DIVISION.. Notified/Method: Supplemental Information
TYPE OF WORK '+ ^` FEE* SCHEDULE
0 New construction 0 Demolition For special information use checklist
Description Qty. Ea. Total
21 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-famil y dwellin SFR(2)bath 437.78
g ❑Commercial/industrial
❑Accessory building 1:1 Multi-family SFR(3)bath 500.32
Each additional bath/kitchen 25.02
❑Master builder 0 Other:
Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: I ( a" `�� �✓r , }�',.p� tt Catch basin or area drain 18.76
w 1�"' Drywell,leach line,or trench drain 18.76
City/State/ZIP: _� Gu2J
Footing drain(no.linear ft.:_) Page 2
Suite/bldg./apt.no.: Project name: ,/2. /,.pJ 1 Manufactured home utilities 50.03
Cross street/directions to job site: �( Manholes 18.76
Rain drain connector 18.76
Sanitary sewer(no.linear ft.:420) Page 2
Storm sewer(no.linear ft.: ) Page 2
Water service(no.linear ft.:_) Page 2
Subdivision: I Lot no.: Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
Ile-:'DES PTION -WO - Backwater valve 12.51
j
` a Clothes washer 25.02
a o pt,A 1. e' ✓A \-i1)T4)`l TO 111 (U Dishwasher 25.02
4/1 CfiJ %j)p. &QV.5.1 Drinking fountain 25.02
Ejectors/sump 25.02
{
0 PROPERTY owNER a TENANT Expansion tank 12.51
Name: �1f 4 0-7--- j Fixture/sewer cap 25.02
I 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
APPLICNT 0ONTA14ERSON Interceptor/grease trap 25.02
Medical gas(value:$ ) Page
Business name: /a
TC CU''iv 0.VL�I � >, h\-t--C-- 2
Contact name: 4.`� Primer 12.51
Address: rigSly P L Roof drain(commercial) 12.51
�` ' A 1 Sink/basin/lavatory 25.02
City/State/ZIP: f J (A n tSolar units(potable water) 62.54
Phone:t; )`SZ. ` ' L �--'"),31 Fax::( ) Tub/shower/shower pan 12.51
Email:(...' 60,,"5�0-vt Tt> 0/�44.-i" 4,t14.)\41\ Urinal 25.02
7:.;x, : ;og - RA (5; ( x Water closet 25.02
' .. ,. ',
�� ' Water heater 37.52
Business name: L R'S (h n...s.,d f.--- Water piping/DWV 56.29
Address: Other: 25.02
City/State/ZIP: Subtotal
Phone:( ) Fax:( ) Minimum permit fee: $72.50 '7 .5D
CCB Lic.: ri Li q 9 Plumbing Lic.no.:
Plan review (25%of permit fee) /-
1 State surcharge(12%of permit fee) t
Authorized signature: ✓ TOTAL PERMIT FEE
,,,,
Print name: Date: 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 dram-1' 100' 50.03 0 to 2,000 $121.90
Footing dram-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
Other Inspections or Fees Qty. Fee(ea) Total each additional$100.00 or fraction thereof,to
pand 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 ReV ew 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
❑ 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.
CW
C Dishwasher: -Commercialirator ❑ 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"
Isolclletrie r 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 MachiRefrig.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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