Permit (29) CITY OF TIGARD PLUMBING PERMIT
� + Permit#: PLM2017-00372
COMMUNITY DEVELOPMENT Date Issued: 09/12/2017
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 2S104AD07700
Jurisdiction: Tigard
Site address: 12882 SW PARKDALE AVE OLSON WOODS Lot: 13
Project: Olson Woods,Lot 13 Subdivision:
Project Description: New SF.
Contractor: CONTOUR LANDSCAPING Owner: WINDWOOD CONSTRUCTION INC
12485 SW TOOZE RD 12655 SW NORTH DAKOTA ST
SHERWOOD, OR 97140 PORTLAND, OR 97223
PHONE:
PHONE: 503-682-1302
FAX: 503-682-1302
FEES
Quantity Description Date Amount
1 ea Backflow Preventer 09/12/2017 $31.27
1 12%State Surcharge- 09/12/2017 $8.70
Specifics: Plumbing
41 ea Minimum Fee Adjustment- 09/12/2017 $41.23
Type of Use: SF Plumbing
Class of Work: OTR
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 1.800.332.2344.
Issued By: Permittee Signature:
(5110-2
, :
AA;I/t
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 t SE ONE)
City of Tigard �' Received / ) � Permit No.: /f ' �} /7.-'
• 13125 SW Hall Blvd.,Tigard, 1): ... Date Review ,}/] N ' p[ 3
g Plan Review
1 Phone: 503.718.2439 Fax: '13. §'60 Q� Other Permit No.:/� ��}
Date/By: / /���I 7'L�4��' 7
1 It,
G ARD Inspection Line: 503.639.4175 ,) ''� Date Ready/By: Duds: ® See Page 2 for
Internet: www.tigard-or.gov f6 Notified/method: 0 Supplemental Information
TYPE OF W Y or `I C.k0 _ FEE I use .,
k
construction (' t J ll For special information use checklist
v v.. n Description Qty. I Ea. I. Total
❑Addition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
SFR(1)bath 312.70
y CATEGORY OF CONSTRUCTION � �{:
SFR(2)bath 437.78
and 2-family dwelling 0 Commercial/industrial
Al'''.- SFR(3)bath 500.32
0 Accessory building 0 Multi-family Each additional bath/kitchen 25.02
❑Master builder 0 Other: Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION : Site utilities:
Catch basin or area drain 18.76
Job site address: 1 01 Cg g S -p, rL(,,
Drywell,leach line,or trench drain 18.76
City/State/ZIP: 'T
11 (JAa Footing drain(no.linear ft.:_) Page 2
Suite/bldg./apt.no.: Project name: 0 (T/YJ ( cyi `tel 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
Subdivision: I Lot no.: ( 3 Fixture or item:
Backflow preventer1 31.27
Tax map/parcel no.:
4 Backwater valve 12.51
DESCRI TIQN OF WORK/ , ,�. z . 25.02
`z. __ !, Clothes washer
7fe-ytlGl / # Dishwasher 25.02
J
.6 Drinking fountain 25.02
r
Ejectors/sump 25.02
a " , 0 rlo'ERTY OWNER ❑''TENANT .{'
Expansion tank 12.51
Fixture/sewer cap 25.02
Name: C 140,1,-- Floor drain/floor sink/hub 25.02
Address: 6'/3 /06 117:1\- 1 " Garbage disposal 25.02
City/State/ZIP: 7'Ol,�„n r l (,D. Hose bib 25.02
(RFax:( ) Ice maker 12.51
Phone:( )
0 APPLICANT 0 ,CONTACT{PERSON Interceptor/grease trap 25.02
Medical gas(value:$ ) Page 2
Business name:
Primer 12.51
Contact name: 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
Urinal 25.02
E-mail:
Water closet 25.02
CONTRACTOR Water heater 37.52
Business name: 60 'J I V U 2. U Uhk I\"v ' ' $,\) C Water piping/DWV 56.29
Address: ) D- LJ Too-- Other: 25.02
City/State/ZIP: S, n 0 s77 J Yl7 Subtotal
"`'= 'l� } Minimum permit fee: $72.50
[ Fax: �p
Phone:(.S t' / C) - (3�7 ( ) Jc 1 m. -
a Plan review (25%of permit fee)
CCB Lic.: S Plumbing Lic.no.: - °
State surcharge(12%of permit fee)
Authorized signature: (2,1/y l 6,1(t_ ✓ TOTAL PERMIT FEE O(.„LC)
( Co YOL)a 0 Date: i1( (Z Oq- This permit application expires if a permit is not obtained within 180 days
Print name: �lk-0 L. )'"
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 9t3c. Fee(et° Total Square Footage: Permit Fee:"'
Footing drain-l'100' 50.03 0 to 2,000 $121.90
Footing drain-each additional 100' 37.52 2,001 to 3,600 $169.69
Sewer-1st 100' 62.54 3,601 to 7,200 $233.20
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
Storm&Rain Drain-1st 100' 62.54 ;1<11fRt10II: r Permit leer
$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
OtCrilSpecti4IIS or Fees ' Fge ICotaf each additional$100.00 or fraction thereof,to
Inspection of existing plumbing or for and including$10,000.00.
which no fee is specifically indicated 90.00/hr $10,001.00 to$25,000.00 $148.50 for the first$10,000.00 and$1.54 for
(minimum charge 1/2 hour) each additional$100.00 or fraction thereof,to
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 Revjew for Fjumgring InsllafionT `"�`
Quantic,by Fixture Tjpe
Fixture Type forReplace/ Plan review is required for any of the following.
rmed: Capped Added Relocate Please check all that apply.
Workry/Font ❑ Any new commercial building with water service 2"and
Bath: Tub/Shower greater,except systems designed and stamped by licensed
-Jacuzzi/Whirlpool engineer.
Car Wash: -Each Stall 0 New exterior plumbing site utilities for any complex structure
Ve Tall 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"
3„ Isometric or Riser Diagram
4
0 Isometric or riser diagram is required for new buildings
-Car Wash Drain
Garbage -Domestic non-food that meet the qualifications above.
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, permit will be issued and
Washer-Clothes a sewer
Water Extractor fees assessed for the sewer increase must be paid before the
Water Closet-Toilet plumbing permit can be issued.
Urinal
Other Fixtures:
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