Permit (45) CITY OF TIGARD PLUMBING PERMIT
" �°.. COMMUNITY DEVELOPMENT Permit#: PLM2017 00399
TI GARE) 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 09/28/2017
Parcel: 1 S135BD00400
Jurisdiction: Tigard
Site address: 10895 SW 95TH AVE
Project: Ash Creek Village Subdivision: MEADOW VIEW Lot: 8
Project Description: Private water line installation for Ash Creek Village:2,025 ft.of water service.
Contractor: GREEN MOUNTAIN PLUMBING Owner: CTH INVESTMENTS LLC
PO BOX 402 1800 NW 167TH PL STE 150
BANKS, OR 97106 BEAVERTON, OR 97006
PHONE: 503-969-8298 PHONE:
FAX:
FEES
Quantity Description Date Amount
2025 If Water Service 09/28/2017 $812.94
Specifics: 1 12%State Surcharge- 09/28/2017 $97.55
Plumbing
Type of Use: SF
Class of Work: ALT
Type of Const:
Occupancy Grp:
Stories:
Total $910.49
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.232 987 or .:::. 2.2344.
Issued By: •-rmittee Signature: =`
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Call 503.639.4175 by 7:00 a.m,for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion o -e—project.
Approved plans are required on the job site at the time of each inspection.
y
t Plumbing Permit Application
Site Utilities • -, `
' r &,� ..
w , FOR OFFICE I;SF ONI.I
City of Tigard Received
- Permit No.:
13125 SW Hall Blvd.,Tigard,OR 97223 sy 1% Date/By: r7`9 �C/� /7,.. )-NI
�+ C5 ?t'F Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 SE Date/By: Other Permit No.: �j � i /rx} t'�1
Inspection Line: 503.639.4175 ►/"'/> 7_iv/
T l G A R D ,3p,9} ate Ready/By: ,,jyq$; WI See Page 2 for
Internet: www.tigard-or.gov t`5 '*z' Ii(�
;,-,x, Notified/Method: Supplemental Information
TYPE OF WO i 1 1S 01
�� ��'t��".�# i� FEE* SCHEDULE
KNew construction 0 Demolition For special information use checklist
Description Qty. Ea. 1 Total
❑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-family dwelling 0 Commercial/industrial SFR(2)bath 437.78
❑Accessory building 0 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: 10 8 75"
..C,.) 95 -14't�Alit
2, Catch basin or area drain 18.76
Dryty -g-j(7��9 o Cr---re,
t w ✓ Footing
1,leach line,or trench drain 18.76
City/State/ZIP: I
Footing drain(no.linear ft.:_) Page 2
Suite/bldg./apt.no.: I Project name:A1, G U 91\16,L Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
cis A U- Rain drain connector 18.76
Sanitary sewer(no.linear ft.:_) Page 2
Storm sewer(no.linear ft.:_) Page 2
Water service(no.linear ft.ZOZ,.1- Pae 2
s1� r e (j 1 t e_ Lot no.: Fixture or item: g ��� '�
Subdivision:
Tax map/parcel no.: Backflow preventer 31.27
r: Backwater valve 12.51
= riESCRIPTION,91(tt ` `WORD4. L
} "� Clothes washer 25.02
�Y`\_,\tom.\ \�A) 0 F Pr)\,,�*c� CQJ>- Dishwasher 25.02
1 V 1e Drinking fountain 25.02
Ejectors/sump 25.02
`" P OPERTY,O R +„ L j:10 TENANT- Expansion tank
12.51
Fixture/sewer cap25.02
Name: f y_ ,A/, \\- kN �e� c �c, y�, h Floor drain/floor ink/hub 25.02
Address: /8/5- /V&) /6y ftt ��le JvIJC, i®�v
JJ q Garbage disposal 25.02
City/State/ZIP: I lver-fo�I C C pc co Hose bib 25.02
Phone:(933)
O 2!2 Fax ( ) Ice maker
12.51
' t
APPLICANT ''',:i--: }. - jtCONT;A;LT PERSON Interceptor/grease trap 25.02
Business name: SA vV) : Above Medical gas(value:$ ) Page 2
Contact name: �I P 011 ,y
(17APrimer 12.51
l 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
Water closet
25.02
s .< Water heater 37.52
Business name: oree,A) ma,V o l vt. e �vv+v�0 v. Water piping/DWV 56.29
Address: p0 50U (.'o� Other: 25.02
City/State/ZIP: ( vN:s i ®E 97 70 6 Subtotal ri j.q 4
Phone:(50 3 61/7 _ 2¶51 Fax:( ) Minimum permit fee: $72.50
d Plan review (25%of permit fee)
CCB Lic.: l 3 g9C c Ci Plumbing Lic.no.:
y ni 1ell
State surcharge(12%of permit fee) 7,
Authorized signature: . ....,,..e- 7 E Nf! TOTAL PERMIT FEL 4/0,'11
Print name: C/A /E- G Date: /57Z,'18/2(C/7 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 tea) Total SquareaFootage: Permit Fee:
M
Footing drain-l't 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 T�i,,e 1 Medical Gas Systems:
Water Service-each additional 100' 37.52 ,f
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
(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*.
Quantity by Fixture Type s; Review for
P limping i> taIla ons
Fie Type for Re Plan review is required for any of the following.
Work Performed: Capped Added Relocate
Baptistry/Font Please check all that apply.
0 Any new commercial building with water service 2"and
Bath -Tub/Shower
Jacuzzi/Whirlpool greater,except systems designed and stamped by licensed
Car Wash -Each Stall engineer.
Drive Thru ❑ New exterior plumbing site utilities for any complex structure
Cuspidor/Water Aspirator as defined in OAR918-780-0040.
Dishwasher -Commercial 0 Medical gas and vacuum systems for health care facilities.
-Domestic ❑ Any multipurpose fire sprinkler system.
Drinking Fountain ❑ 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.
-3"
Isometric or.RiserRiser:1)=gram
Car Wash Drain
Garbage Domestic-non-food ❑ 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
increase of sewer EDUs,a sewer permit will be issued and
Water Extractor
Water Closet-Toilet fees assessed for the sewer increase must be paid before the
Urinal plumbing permit can be issued.
Other Fixtures:
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