Permit (40) CITY OF TIGARD PLUMBING PERMIT
II ' COMMUNITY DEVELOPMENT Permit#: PLM2018-00203
13125 SW Hall Blvd.,Ti Date Issued: 04/30/2018
TIC AI<.17 and OR 97223 503.718.2439 9
Parcel: 2S104BC00500
Jurisdiction: TIGARD
Site address: 14065 SW FERN ST
Project: Loesche Subdivision: HANDY ACRES Lot: 9
Project Description: Connecting existing house to 100 FT of sanitary sewer.
Contractor: G&B PLUMBING&SONS INC Owner: LOESCHE, JOSH&JENNIFER N
PO BOX 92 14065 SW FERN ST
ST PAUL, OR 97137 TIGARD, OR 97223
PHONE: 503-868-1417 PHONE:
FAX:
FEES
Quantity Description Date Amount
100 If Sanitary Sewer 04/30/2018 $62.54
Specifics: 1 12%State Surcharge- 04/30/2018 $8.70
Plumbing
Type of Use: SF 10 ea Minimum Fee Adjustment- 04/30/2018 $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 questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: i ALL- Permittee Signature:
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 bk.
\-f!7:-
BuildingFixtures ,
FOR OFFICE USE ONLY
of u•+ Received
141 III
13125 SW HallllBlvd.,Tigard,OR 97223 APRt,i Date/By: �1�/>� Permit No.:�`� 1.l F'C%�.,,�'j
IC Phone: 503.718.2439 Fax: 503.598.1960 Plan Review �/`- iCIJ O ' tJ
Date/By: Other Permit Noe!Cb/��i�k�i ao,
T I G A R D Inspection Line: 503.639.4175 �, r /''!G i(27
Ue ,I,,,., e a,,) :: Date Ready/By: Jwis: ® See Pae 2 for
Internet: www.tigard-or.gov g
Notified/Method:
� Supplemental Information
TYPE OF WORK _
FEE* SCHEDULE
❑New 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
0 1-and 2-family dwelling ❑Commercial/industrial SFR(2)bath 437.78
❑Accessory building 0 Multi-family SFR(3)bath 500.32
❑Master builderEach additional bath/kitchen 25.02
0Other: Fire sprinkler( sq.ft.) Page 2
. = JOB SITE INFORMATION AND LOCATION . Site utilities:
Job site address: p./06:,5 Fern ft Catch basin or area drain 18.76
City/State/ZIP: 'Tigard Drywell,leach line,or trench drain 18.76
O2 91 2Z5 Footing drain(no.linear ft.:_) Page 2
Suite/bldg./apt.no.: I Project name: tern free? ,ftcbdri4516,0 Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
Rain drain connector 18.76
Sanitary sewer(no.linear ft.: sot)) ( Page 2 6:)..3--t7
Storm sewer(no.linear ft.: ) Page 2
Water service(no.linear ft.:_) Page 2
Subdivision: icev ii.- I Lot no.: Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
D f' 0 O f' =x Backwater valve 12.51
x.'., ,?:3 -,1 m ''''''b'.. .' r 4.3' k.§: l''''
� ,,,
CoY9n[0'7/7ex fah gDa� � Clothes washer 25.02
9 tie 1=C Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
.. 'ii PRUDE `'Y WNER ;,. -' K , `] T N Expansion tank 12.51
Name: Fixture/sewer cap 25.02
Address:
Floor drain/floor sink/hub 25.02
Garbage disposal 25.02
City/State/ZIP: Hose bib 25.02
Phone:( ) Fax:( ) Ice maker 12.51
' APPLICANT ❑m CONTAc Interceptor/grease trap 25.02
Business name: k‹. (Arbon n,,,�,,,^,_� ? �I wy�rn� Medical gas(value:$ ) Page 2
Contact name: f '`� �' Primer 12.51
Cara P ('ii 1lOrrif
Q Roof drain(commercial) 12.51
Address: 153y ski 3--g t a(,e #20 Sink/basin/lavatory 25.02
City/State/ZIP:t ,1-iand, G(I/ (potable
Q� 7Ze/ Solar units water) 62.54
Phone:(S3 )Z QZ-Cl3G#y ax::( ) Tub/shower/shower pan 12.51
E-mail: Ca r'>�R'c praoer1 ' �'1'xlne'uneri f; Urinal 25.02
.; Water closet 25.02
' -. ,NTRACTOR ; a, 'n
2� " Water heater 37.52
Business name: .. �x f1J
1 G t(,l(�'1�I nV Water piping/DW 56.29
Address: pa
/ Other: 25.02
City/State/ZIP 0704,4e( 477/17 Subtotal G �j-
Phone: ! tj 3 i,1,11_, l {I Fax:( ) 2 4/6 Minimum permit fee: $72.50 -70) sv
CCB Lic.: E I Plumbing Lic. IF: ?D -
Plan review (25%of permit fee)
�� State surcharge(12%of permit fee) p
Authorized signature: : a "��
'1 ,/ V TOTAL PERMIT FEE8,,
Print name: E/ l n R prri Date: 4130 kg This permit application expires if a permit is not obtained wit in 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:
' ;. Qt „ Nee lea) Total Square F+ otage: Permit Fee
Sit','Utillties �,. r.
Footing drain-1"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' i 62.54 6,•
A-P1 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
al Lon., Permit dee;
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
,,, 2 ReeaT1 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
each additional$100.00 or fraction thereof.
(minimum charge-1/2 hour)
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 R i lr' i c a urs In tallatib iS ;__~
Quitjhtity 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 Relaea e' 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 0 New exterior plumbing site utilities for any complex structure
Car Wash: -Each Stall as defined in OAR918-780-0040.
-Drive Than 0 Medical gas and vacuum systems for health care facilities.
Cuspidor/Water Aspirator
0 Any multipurpose fire sprinkler system.
Dishwasher: -Commercial
0 Any complex structure as defined in OAR918-780-0040.
-Domestic
Drinking Fountain Submit 2 sets of plans with any of the above.
Eye Wash
Floor Drain/sink: -2"
; ",,'js' S` ;Diag
4" ❑ 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 plumbing permit can be issued.
Water Closet-Toilet
Urinal
Other Fixtures:
I:\Building\Permits\PLMF PermitApp.doc 08/04/2011 2
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
14065 SW FERN ST, TIGARD, OR, 97223 May 9, 2018 at 12:34:40 PM
Record Type: Record ID:
Residential - Plumbing PLM2018-00203
Inspection Type: Inspector:
399 Plumbing final David Young
Result:
PASS - NoCofO
Comments:
Septic tank removed from property.
Violation Summary:
Inspector Contractor