Permit (51) CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit#: PLM2017-00424
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 10/16/2017
[t �tO 9 Parcel: 2S103DA02400
Jurisdiction: Tigard
Site address: 10820 SW DERRY DELL CT
Project: HINES Subdivision: DERRY-DELL NO.2 Lot: 26
Project Description: 50 ft.of footing drain.
Contractor: OWNER Owner: HINES, DAVID B&SANDRA
GARY HINES 5845 SW GLENBROOK RD
10820 SW DERRY DELL CT BEAVERTON, OR 97007
TIGARD, OR 97223
PHONE: 503-807-8185 PHONE:
FAX:
FEES
Quantity Description Date Amount
50 If Footing Drain 10/16/2017 $50.03
Specifics: 1 12%State Surcharge- 10/16/2017 $8.70
Plumbing
Type of Use: SF 22 ea Minimum Fee Adjustment- 10/16/2017 $22.47
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. 9�u 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: Av.
'
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
City of Tigardi Received
Date/B /1 Permit No.: ,01,4n�AI 7. it j ( ,1
lig
� 13125 SW Hall Blvd.,Tigard,OR 9 2 Plan Review `� �� � s N _r tJ (_al_(�`
S Phone: 503.718.2439 Fax: 503.598.1960 OCT1 Date/By: Other Permit No.• 577. _ "14'b
6 2017
T I(i A R D Inspection Line: 503.639.4175 I Date Ready/By: Juris: H See Page 2 for t
Internet: www.tigard-or.gov �+ Notified/Method: Supplemental
TYPE OF WO TY ( � = = FEE* SCHEDULE
❑New construction D14tNO NISI m
For special information use checklist
Description Qty. Ea. I Total
f 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
0 Accessory building ElMulti-family
SFR(3)bath 500.32
0 Master builder r Each additional bath/kitchen 25.02
Other: hR�� sQ Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: X f� Catch basin or area drain 18.76
`�� �` C Drywell,leach line,or trench drain 18.76
City/State/ZIP: i A.4/
Footing drain(no.linear ft.:alpPage 2 r,7).
Suite/bldg./apt.no.: Project name: GA lQj Manufactured home utilities 50.03
Cross street/directions to job site: M s 7 2.0 1 '1 - o 0 3 S--/. 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: ; c..;,V1"1 b. ( I I Lot no.: Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
a "_ x
DES( N OF v ORIS { € K, Backwater valve 12.51
$PTI
,.t� - Clothes washer 25.02
` ` c -1 Ee 12-A - r1 U-i-1 Id Dishwasher 25.02
a 12 A I Al Drinking fountain 25.02
Ejectors/sump 25.02
TY OWNER .`j" df�"ItNAN't .x., z Expansion tank 12.51
� / t Fixture/sewer cap 25.02
Name:
6r g t i s
/� -7-
Floor drain/floor sink/hub 25.02
C0
Address: ( 0 8 Z Sit/ OF y 6J E LC C ( Garbage disposal 25.02
City/State/ZIP: 1 &" KO 61 1'Z-2--2 Hose bib 25.02
-
Phone:( . ) S 0 .-g(8 S Fax:( ) Ice maker 12.51
AS-Lick-4T t' ClNCONTACT pERSON Interceptor/grease trap 25.02
ti`: ' w
Business name: {.,4 Medical gas(value:$ ) Page 2
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
E-mail: ( f'eSIGC�! AOL 0 Urinal 25.02
Water closet 25.02
CONTRACTOR
Water heater 37.52
Business name: G'P ` Waterpiping/DWV 56.29
Address: `J Other: 25.02
City/State/ZIP: Subtotal 45-0".43
Phone:( ) Fax:( ) Minimum permit fee: $72.50 7.4.
CCB Lic.: ' \ Plumbing Lic.no.:
Plan review (25%of permit fee) a--_.
State surcharge(12%of permit fee) T.,-7;;.,
Authorized signature: TOTAL PERMIT FEE g t,).-0
Print name: c (2 l(� ( tt/�5 Date:�"y 7L 0
_/7 This permit application expires if a permit is not obtained within 8days
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(l0/02/COM/WEB)
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site Utilities i'1rkotY. Fee(ea) Total Square Footage: ; Permit Fee:
Footing drain-1st 100' t 50.03 57) 0 to 2,000 $121.90
2,001 to 3,600 $169.69
Footing drain-each additional 100' 37.52 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
each additional$100.00 or fraction thereof,to
Fede
Other Inspections or Fees } ' o
p 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
Pfees*.
accurately report fixtures could result in increased sewer 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
Car Wash: -Each Stall 0 New exterior plumbing site utilities for any complex structure
as defined in OAR918-780-0040.
-Drive Thru
0 Medical gas and vacuum systems for health care facilities.
Cuspidor/Water Aspirator
Dishwasher: Commercial ❑ 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 Wiser Diagram fir'
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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