Permit (170) CITY OF TIGARD PLUMBING PERMIT
P I1 'J< COMMUNITY DEVELOPMENT Permit#: PLM2017-00085
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 03/14/2017
a"'� Parcel: 2S 102AA01100
Jurisdiction: Tigard
Site address: 12047 SW PACIFIC HWY
Project: Suby-Yota Import Auto Repair Subdivision: None Lot: None
Project Description: 40 ft.of sanitary sewer repair.
Contractor: FLYING H CONSTRUCTION CO Owner: WACHENBERG INVESTMENTS LLC
PO BOX 2533 3902 RIVERS EDGE DR
WILSONVILLE, OR 97070 LAKE OSWEGO, OR 97034
PHONE: 503-925-1280 PHONE:
FAX: 503-678-4221
FEES
Quantity Description Date Amount
40 If Sanitary Sewer 03/14/2017 $62.54
Specifics: 1 12%State Surcharge- 03/14/2017 $8.70
Plumbing
Type of Use: COM 10 ea Minimum Fee Adjustment- 03/14/2017 $9.96
Plumbing
Class of Work: ALT
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 •f •- Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire ' wa is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you • fo • the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-f0•'I. '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: Leiree....„
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.
f,
Plumbing Permit Application ,,
Building Fixtures �``l FOR OFFICE. L SE ONLI
) n`� * Received
City of Tigard n By:
Permit No.:
U 13125 SW Hall Blvd.,Tigard,OR 97 �. ,` „ it view
Phone: 503.718.2439 Fax: 503.598.1960 .,�. Other Permit No.:
�_ +�'�
Inspection Line: 503.639.4175 ��� �ti to'ate/By:
T I G A R p , Q ti Date Ready/By: him: ® See Page 2 for
Internet: www.tigard-or.gov e�, ;+ .� > Notified/Method: Supplemental Information
TYPE OF WORK *,1„;:,..1,-1::)1
FEE* SCHEDULE
0JNew construction 0 Demol • For special information use checklist
DescriptionQ��Ea. Total
o 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
p�� axi kaRlfr wefling X Commercial/industrial SFR(2)bath 437.78
SFR(3)bath 500.32
❑Accessory building 0 Multi-family
Each additional bath/kitchen 25.02
❑Master builder 0 Other: Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
�--CJ Y? S c.,_.., Catch basin or area drain 18.76
Job site address: (
At'A ¢ts'L- kt.7-
Drywell,leach line,or trench drain 18.76
City/State/ZIP: 11?GI-,,tc?-- 4-722-3
Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: 1 Project name: 5L,7.1 -yo-fa, £A6tC v"Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
S-w , & .n j _ tt �S • /- Rain drain connector 18.76
l� Sanitary sewer(no.linear ft.: ( Page 2 6A„c L./
Storm sewer(no.linear ft.:_) Page 2
Water service(no.linear ft.:_) Page 2
Subdivision: I Lot no.: Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
DESEIPTION OF WORK
Backwater valve 12.51
Clothes washer 25.02
12 /ct.e ...S 2r1 o 1 eJ e Dishwasher 25.02
/ Drinking fountain 25.02
Ejectors/sump 25.02
[PROPERTY OWNE.I<. ' 0 TENANT _ Expansion tank 12.51
62_,--
- Fixture/sewer cap 25.02
Name: Ahl f t.t.P_( %rocFte"Wel tr,✓tfrw,.tetT-R. Floor drain/floor sink/hub 25.02
Address:
&on&t I r QC,"'" Garbage disposal 25.02
City/State/ZIP: Hose bib 25.02
Phone:( ) Fax:( ) Ice maker 12.51
PPLICANT 0 COIc.I' ON Interceptor/grease trap 25.02
Business name: �yo� Medical gas(value:$ ) Page 2
G' i-7 c`_.pi51AC CD" Primer 12.51
Contact name:
141,x-S✓'L �lRoof drain(commercial) 12.51
Address: �.c t3f c 25-3 3 Sink/basin/lavatory 25.02
City/State/ZIP: ..,,ill \ - ? f Solar units(potable water) 62.54
t.Phone:(5t.)3) I rl 2x17 Fax::( ) Tub/shower/shower pan 12.51
E-mail: (`[„6� Urinal 25.02
{` -/ C� " „:` ,-; Water closet 25.02
CONTRACTOR v
Water heater 37.52
Business name: 1
t r.1 ii_co-�5 ret-e rshl(5eN Water piping/DWV 56.29
Address: SPA G & .,. Other: 25.02 •
Subtotal$6,,p -4
u r 1
Phone:(D3 ) 7$0 ill 1 Fax:( ) Minimum permit fee: $72.50 ?,, ...1--0
CCB Lic.: 0 6,, r [1, Plumbing Lic.no.: ° t{ / Plan review (25%of permit fee)
�/ State surcharge(12%of permit fee) a,70
Authorized signature: ,/� r //, TOTAL PERMIT FEE$pi Ad
�u R This permit application expires if a permit is not obtained wit it
80 days
Print name: l y S � Date:
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(ea) Total Square Footage: Permit Fee:
Footing drain-l'100' 50.03 0 to 2,000 $121.90
Footing drain-each additional 100' 37.52 2,001 to 3,600 $169.69
Sewer-1st 100' 62.54 3,601 to 7,200 $233.20
L ( .y�' 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
Storm&Rain Drain-1st 100' 62.54 Valuation: 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
Other inspections oir Fees { • Fee(ea) Total each additional$100.00 or fraction thereof,to
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*. Plan Review forPlumbing 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: 7 Capped Added Relocate
Baptistry/Font
0 Any new commercial building with water service 2"and
-,-.- greater,except systems designed and stamped by licensed
Bath: -Tub/Shower
-Jacuzzi/Whirlpool engineer.
Car Wash: Each Stall
0 New exterior plumbing site utilities for any complex structure
Drive tallThras defined in OAR918-780-0040.
Cuspidor/Water Aspirator ❑ Medical gas and vacuum systems for health care facilities.
Dishwasher: Commercial
0 Any multipurpose fire sprinkler system.
Domestic ❑ 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"
i l 1
4„
0 Isometric or riser diagram is required for new buildings
-Car Wash Thain
Garbage Domestic non-food that meet the qualifications above.
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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