Permit Support Document Plumbing Permit Applica 'O n
1 0
Building Fixtures FOR OFFICE USE ()NEN
City of Tigard Received
Date/B Permit No.: -�
i 13125 SW Hall Blvd.,Tigard,OR L�� . 4 y' �G �V ,, Jam- �Lr� ��>>y�
S I, Plan Review
Phone: 503.718.2439 Fax: 503, 9 Other Permit No 4r ��"7_a`y
Date/By: �/ /'[f4 J
.7
Inspection Line: 503.639.4175T1GARD JUL 1 6 2018 Date Ready/ y.
Juds: 0 See
e
Page 2 for www.tigard-or.gov Notified/Method: Supplemental
Information
`' TYPE ':4'W'1'; '4. f: TyIG _ F ' SCHED LE r:=, .u':
0 New construction BMOINGPOiVISION For special information use checklist
Description I Qty. Ea. Total
0 Addition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
''7 ' ATEGO 11' O1F ONST 6 TIOl%z SFR(1)bath 312.70
0 1-and 2-family dwelling 0 Commercial/industrial SFR(2)bath 437.78
0 Accessory building 0 Multi-family SFR(3)bath 500.32
Each additional bath/kitchen 25.02
0 Master builder 0 OtherFire sprinkler( sq.ft.) Page 2
Q :SITE INFOR 'TI4I D LOCATI t
O ��^ - "�' Site utilities:
Job site address: Catch basin or area drain 18.76
Drywell,leach line,or trench drain 18.76
City/State/ZIP: I 6.4,-v ,0 / 0(2-/ '7'2-12-4
Footing drain(no.linear ft.:_) Page 2
Suite/bldg./apt.no.: 1 Project name: 14-ikl' £201) 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: 1 Lot no.: f Fixture or item:
Tax map/parcel no.: r' Backflow preventer / 31.27 -//)_7
i' �i , . 4 146 ;: Backwater valve 12.51
'' "ri S� i sir s ' t
��' .
Clothes washer 25.02
/'l 711J,-/ki.i. AStr /inid /kill CW (/u- :' Dishwasher 25.02
AC-1.55z,r-E' !'44.4.4%,-1A/Cj lies. a- ikv J lts?ii Gw,/ Drinking fountain 25.02
1 Ejectors/sump 25.02
❑ Pl, I E - O - a 4 ,; Expansion tank 12.51
Name: J. Fixture/sewer cap 25.02
� �, /' Floor drain/floor sink/hub 25.02
Address: +oe if-o S t,1/ 14161/JE L,AIN)2 (V
, Garbage disposal 25.02
City/State/ZIP: Hose bib 25.02
Phone:( ) Fax:(1' ) Ice maker 12.51
Al PLIC L" f'tit ' 'ok Interceptor/grease trap 25.02
$
Business name: Medical gas(value: ) Page 2
' Primer 12.51
Contact name: r'r'NUS 5(44-1
Roof drain(commercial) 12.51
Address: 21 Zq ��v w,y� (�2�� f, Sink/basin/lavatory 25.02
k
City/State/ZIP:FcaTL ND `0 r¢_/ GI') 2__/ v Solar units(potable water) 62.54
Phone:qI+) /l-1i-�� 'I r :`x Fax::( ) Tub/shower/shower pan 12.51
Urinal 25.02
E-mail: Ff2.A�C-(S 03 SIAN(tee-1(S op-c
c4., t „ ? -,r' ;44 .,v Water closet 25.02
n
��, ',"t"- "<-,� '" '�' . , 02 Water heater 37.52
Business name:
_ Water piping/DWV 56.29
Address: Other:keiksire, ��.av� 6/ 1 25.02 �5,G
City/State/ZIP: Subtotal
-
•
Phone:(I ; / ' Fax:( ) Minimum permit fee: $72.50 -7„7,5i)
CCB Lic,: Plumbing Lic,no.:
Plan review (25%of permit fee)
State surcharge(12%of permit fee) .70
Authoriz signature: 1 - TOTAL PERMIT FEE S
Print name: ' 7 ' v v S SL'((.4 Date:'7 . /�- t�1' 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\PLMO-PermitApp.doe 10/01/09 440-4616T(10/02/COM/WEB)
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression S stems:
Site U ;itiies Qty Fee{ea $ se / °; 101'erm>t
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' 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 "' P
aluat n. rnut ° e:
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 .-rF Fee(eat Total each additional$100.00 or fraction thereof,to
Other In: L'tions Or 'S *s 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*. lan � .,.e1K' Or Pltitmb gInstall ons
4 Quantity by Fire TyePlan review is required for any of the following.
s" w
Fixture Typ'CCor ' Replace/ Please check all that apply.
Work Performed: 'tapped:_, 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
Cuspidor/Water Aspirator 0 Medical gas and vacuum systems for health care facilities.
CW
C -Commercial
al 0 Any multipurpose fire sprinkler system.
Dishwasher:
-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"
;, :,:ISO� � a#' ;wj .,r. .r .:. zi- :
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:
I:\Building\Permits\PLMF PermitApp.doc 08/04/2011 2