Permit (203) CITY OF TIGARD PLUMBING PERMIT
2: COMMUNITY DEVELOPMENT Permit#: PLM2018-00437
T[CARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 09/24/2018
Parcel: 2S114BB08900
Jurisdiction: Tigard
Site address: 16264 SW 104TH AVE
Project: Lange Subdivision: SWANSON'S GLEN Lot: 30
Project Description: 60 ft.of footing drain,70 ft.of storm sewer,(1)dishwasher,(1)garbage disposal,(1)hose bib,and(1)ice maker
for remodel and addition.
Contractor: OWNER Owner: LANGE, NIXON
NIXON LANGE 16264 SW 104TH AVE
16264 SW 104TH AVE TIGARD, OR 97224
TIGARD, OR 97224
PHONE: 971-333-1170 PHONE: 971-333-1170
FAX:
FEES
Quantity Description Date Amount
60 If Footing Drain 09/19/2018 $50.03
Specifics: 70 If Storm Sewer 09/19/2018 $62.54
1 ea Dishwasher 09/19/2018 $25.02
Type of Use: SF 1 ea Garbage Disposal 09/19/2018 $25.02
Class of Work: ALT 1 ea Hose Bib 09/19/2018 $25.02
Type of Const: 1 ea Ice Maker 09/19/2018 $12.51
Occupancy Grp: 1 12%State Surcharge- 09/19/2018 $24.02
Stories: Plumbing
Total $224.16
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: � 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 A I"'�A- trl E.I..
Building Fixtures n QQ FOR OFFICE USE ONE\'
City of Tigard ,E P 1 ` /_01 i) Received
<--� i Permit No.: a
• 13125 SW Hall Blvd.,Tigard,OR 97223 d � ;_ j� __y9 Date/By: tl f (� r (�n, �l��- jC ,
C �.T V o i- 1 1' e-`f.'i. an Review
Phone: 503.718.2439 Fax: 503.598.19 1 /By. Other Permit No.: , _e)C pl cT I G A R D Inspection Line: 503.639.4175 att Ready/By: Juris: lil See Page 2 for
Internet: www.tigard-or.gov Notified/Method: Supplemental Information
TYPE *WORK 4.WORK '..:4-'y FEE* SCHEDULE..It;
❑New construction ❑Demolition For special information use checklist.
Description Qty. 1 Ea. Total
M Addition/alteration/replacement ❑Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
ttrt.
CATEGORY 0 ;0NSTR ION SFR(1)bath 312.70
M.1-and 2-family dwelling ❑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 LO TION .,• Site utilities:
Job site address: 1�2tot f s� tot/44- A, Catch basin or area drain 18.76
City/State/ZIP: (� 11 OK l l 2,LcL Drywell,leach line,or trench drain 18.76
1 U „ L 11 Footing drain(no.linear ft.: s.,-) i Page 2 S o.,o 3
Suite/bldg./apt.no.: I Project name:
Uti\dut..., �(�„7/� Manufactured home utilities 50.03
Cross street/directions to job site: 4I\, 4 1" s, Q4. Manholes 18.76
/!, �/`^' ,"� Rain drain connector 18.76
Sanitary sewer(no.linear ft.:_) Page 2
Storm sewer(no.linear ft.:-ft, l Page 2 (p 2•Cf
.7
Water service(no.linear ft.:_) Page 2
Subdivision: S vjG. t.SO-t s G I4..n 1 Lot no.: 3o Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
tt �}ESCRH'TIONrOF WORK x ' °�
Backwater valve 12.51
t i ',, I''' ' Clothes washer 25.02
MCV\ I.cn,�eA-4.` 3 f' DTC' 'J` `.s t_.!' 1 Dishwasher I 25.02 S5 0-'2„
II (�
fri C;( Dr �
r �2 l r AAA-- f� 2f1.
-x-1- $['D 4 „ Drinking fountain 25.02
Y oa Ejectors/sump 25.02
t P• t'' '.;OWNER.. , ..: }"❑ i' Expansion tank 12.51
Name: 1 _ „ _ , Fixture/sewer cap 25.02
�,K "'"�`" Floor drain/floor sink/hub 25.02
Address: 5a. . i
Garbage disposal 1 25.02 2,4j,01.-
City/State/ZIP: Hose bib 1 25.02 1 .oz.
Phone:( ) Fax:( ) Ice maker I 12.51 i?„.+j 1
:rti : cANT ❑ CONTA WILSON Interceptor/grease trap
25.02
Business name: Medical gas(value:$ ) Page 2
Primer
Roof
12.51
Contact name: N%x O^ RRoof drain(commercial) 12.51
Address: S4P.A-1... Sink/basin/lavatory 25.02
City/State/ZIP: Solar units(potable water) 62.54
Phone:( ) Fax::( ) Tub/shower/shower pan 12.51
E-mail: AA, tan ', 1 Cam Urinal 25.02
,t `0 i NT lir, ,, R , • ilk. Water closet 25.02
3 T •. x=r k * .=.. Water heater 37.52
Business name: N /A - O W"-tf 'ittS ta'- tan Water piping/DWV 56.29
Address: Other: 25.02
City/State/ZIP: Subtotal '/t3• l'"1
Phone:( ) Fax:( ) Minimum permit fee: $72.50
CCB Lic.: P Bing Lic.no.:
Plan review (25%of permit fee)
State surcharge(12%of permit fee) )L(,4..),./
Authorized signature: TOTAL PERMIT FEE d
n180 l(;
Print name: A Date: This permit application expires if a permit is not obtained within 180 days
�+ k Q A 2$`'1$ 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 Etilitiek Qty. Fee(Ca) Totai Square Footage: ,e trait Fee
Footing drain-1s`100' i 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
Valuation:'
Storm&Rain Drain-1st 100' 62.54 7 Permit Fee:
• $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
Or Fee
ca 1 each additional$100.00 or fraction thereof,to
Other I>nspection�s or Fees iand 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*. Plan Re iew..for
Quantity by Fixture Type`= Plan review is required for any of the following.
Fixture Type for; i Replace/ Please check all that apply.
Work Perforni&l: Capped Added Relocate
El 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 CI 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.
Dishwasher: Commercial
0 Any multipurpose fire sprinkler system.
Domestic EI 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" t ,Isometric n.. x er
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
Water Closet-Toilet plumbing permit can be issued.
Urinal
Other Fixtures:
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