Permit q CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT14
Permit#: PLM2019 00427
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 10/22/2019
Parcel: 2S 102AB00913
Jurisdiction: Tigard
Site address: 12115 SW 92ND AVE
Project: BUHLE Subdivision: KIMBERLY ADDITION Lot: 13
Project Description: Replacing 90 ft sanitary sewer pipe.
Contractor: BLACK ROCK UNDERGROUND LLC Owner: BUHLE, SHAWN W
267 NE 34TH PLACE 12115 SW 92ND AVE
HILLSBORO, OR 97124 TIGARD, OR 97223
PHONE: 503-747-9312 PHONE:
FAX: 503-214-5886
FEES
Quantity Description Date Amount
90 If Sanitary Sewer 10/22/2019 $62.54
Specifics: 1 12%State Surcharge- 10/22/2019 $8.70
Plumbing
10 ea Minimum Fee Adjustment- 10/22/2019 $9.96
Type of Use: SF 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 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 ado.te., by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may ob - ••py of the rules
or direct questions to OUNC by calling 503.232.1987 or . _
Issued By: .......
Permittee Signa r• 4 /
,.... _
..
Call 503.639.4175 by 7:00 a.m.for the next availabl' ins getion date.
This permit card shall be kept in a conspicuous place on the job site until completion of the pr87bct.
Approved plans are required on the job site at the time of each inspection.
Plumbing Permit Application
Site Utilities RECEIVED FOR OFFICE USE ON 1.1
CT 2 2 2019 Ee1'
/j,�� 17 P �` -Y�jy,Z7
Iii 13125 SW Hall B ,Tigard,OR 9722. w
I Phone: 503.718.2439 Fax: 503 503.598e60,OF TIGAR® Date/By: Other PermitNo.:
T t G A R D Inspection Line: 503.639.4175 t,1!---1. 1
�,-t l ADate Read}/By: loris: ® See Page 2 for
Internet: www.ligard-or.gov BUILDING , yotii,cd/Mcthud: Supplemental Information
TYPE OF WORK FEE* SCHEDULE
❑New construction 0 Demolition For special information use checklist.
Description I Qty. 1 Ea. I Total
Additionialteration'replacement 0 Other: New 1-2-family dwellings(includes 100 0.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(1)bath 312.70
-and 2-family dwelling 0 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:
Job site address: 1 1 15 6v,) Clgs.1AA Air _Catch basin or area drain 18.76
Drywell,leach line,or trench drain 18.76
Ciry/StateiZlP: -1..‘oc,r,k d Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: I Project name: Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
Rain drain connector �t 18.76
Sanitary sewer(no.linear 1I.:-10 ) Page 2
Storm sewer(no.linear ft.:_) Page 2
Water service(no.linear ft.: l Page 2
Subdivision: I Lot no.: Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
Backwater valve 12.51
DESCRIPTION OF WORK
Clothes washer 25.02
V\iei r3-1t MSitt\c -I�Q1- aN- ter\ Dishwasher 25.02
z e eri 0� ,, kOVQ, l O Y lAA (VG\Q, Drinking fountain 25.02
Ejectors/sump 25.02
0 PROPERTY OWNER I 0 TENANT Expansion tank 12.51
Name: 7 tJ `A\e.. Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address:
Garbage disposal 25.02
City/StatelIP: Bose bib 25.02
Phone:( ) Fax:( ) Ice maker 12.51
0 APPLICANT 0 CONTACT PERSON interceptor/grease trap 25.02
Business name: Medical gas(value:S ) Page 2
Primer 12.51
Contact name:
Roof drain(commercial) 12.51
Address: Sink/basin/lavatory 25.02
City/StatelZIP: Solar units(potable water) 62.54
Phone:( )
Fax::( ) Tub/showershower pan 12.51
E-mail: Urinal 25.02
Water closet 25.02
CONTRACTOR \An
M"� V Water heater 56.29
Business name: (\ C.i rpV� Water piping/DW V 56.29
Address: Other: 25.02
dd a,61 NE 3�1, �
City/State`ZIP: F A i l�.S‘i o r-t, 04 Subtotal
Phone:(e3) /12-$ , '�qQ Fax:( ) Minimum permit fee: S72.50
CCB Lie.: 1 l I9 Plum.ing Lie.no.: re 1455 Plan review (25%of permit fee)
f / State surcharge(12%of permit tee)
Authorized signature: r/ � � TOTAL PERMIT FEE
Print name: U PW M(,, Gki Date: I O 2,1 1411
'This permit application expires if a permit is not obtained within ISO days
Iafter it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
I:'BuildingRcrmits:.PLMU-Permi(App.doc 10101'09 440-4616T(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-1"100' 50.03 0 to 2,000 5121.90
Footing drain-each additional 100' 37.522,001 to 3.(100 169.69
3,601 to 7,200 5233.20
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 S72.50
Storm&Rain Drain-each additional 100' 37.52 $5,001.00 to S10,000.00 S72.50 for the first 55,000.00 and SI.52 for
Other Inspections or Fees Qty. Fee(ea) Total each additional 5100.00 or fraction thereof,to
and including$10,000.00.
Inspection of existing plumbing or for $10,001.00 to S25,000.00 S148.50 for the first$10.000.00 and$1.54 for
which no tee is specifically indicated 90.00/hr each additional 5100.00 or fraction thereof,to
(minimum charge-I'2 hour) and including$25,000.00.
Inspections outside of normal business 90.00/hr $25,001.00 to$50,000.00 5379.50 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 90.004n $50,001.00 and up $742.00 for the First$50.000.00 and$1.20 for
(minimum charge-1!2 hour) each additional 5100.00 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*.
Quantity by Fixture Type Plan Review for Plumbing Installations
Fixture Type for Replace/ Plan review is required for anyof the following.
Work Performed: Capped Added Relocate g
Baptistry/Font Please check all that apply.
Bath -Tub,'Shower ❑ Any new commercial building with water service 2"and
-Jacuzzi/Whirlpool greater,except systems designed and stamped by licensed
Car Wash -Each Stall engineer.
-Drive Thru 0 New exterior plumbing site utilities for any complex structure
Cuspidor/Water Aspirator as defined in OAR918-780-0040.
Dishwasher -Commercial 0 Medical gas and vacuum systems for health care facilities.
-Domestic 0 Any multipurpose fire sprinkler system.
Drinking Fountain 0 Any complex structure as defined in OAR918-780-0040.
Eye Wash
Floor Drain/sink -2" Submit 2 sets of plans with any of the above.
3"
4., Isometric or Riser Diagram
Car Wash Drain
Garbage -Domestic-non-food 0 Isometric or riser diagram is required for new buildings
Disposal -Domestic-food related that meet the qualifications above.
-Commercial-food related
-Industrial-food related
Ice Mach.IRelrie.Drains
Oil Separator(Gas Station) Comments regarding fixture work:
Rec.Vehicle Dump Station
Shower -Gang
-Stall
Sink/Lav -Non-food related
-Bradley
-Commercial-food related
-Service
Swimming Pool Filter
Washer-Clothes *Note: If the fixture work under this permit results in an
Water Extractor increase of sewer EDUs,a sewer permit will be issued and
Water Closet-Toilet fees assessed for the sewer increase must be paid before the
Urinal plumbing permit can be issued.
Other Fixtures:
I:ABuildingvPermits\PLMU_PcrmitApp.doc 2
Y
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7 Site Utilities — Plumbing Permit Application
Plan Submittal Requirements
TIGARD
A plumbing permit for site utility plumbing work is required for sanitary sewer, storm sewer
and potable water systems on private property.
1. SITE PLAN and vicinity map showing the geographic location (fully dimensional, drawn
to scale) labeled with:
A. 0 map&tax lot# 0 project name 0 site address ❑ suite number
0 zoning 0 applicant name 0 phone number
B. North arrow.
C. Scale (architectural or engineering only).
D. Street names.
E. Building pads with project location.
2. PLUMBING PLANS-Two (2) complete sets, civil only.
All details listed below shall be incorporated into the plumbing plans:
A. Storm drainage plan showing:
1) Finish elevations throughout the developed site.
2) Grade breaks determining area serving each catch basin.
3) Location of catch basins.
4) Pipe size.
5) Type of material.
6) Slope of piping.
7) Manholes and field drains.
8) Cleanouts provided for each 100 feet or fraction thereof.
9) Roof drain laterals specifying cleanouts at each upper terminal.
10) Location of existing or proposed connection to a public sewer line.
B. Utilities plan showing:
1) Sanitary sewer line location,pipe size, type of material, slope of piping,manholes
and cleanouts provided as required for storm.
2) Size and location of domestic water piping and drainage.
3) Proposed location of connection to a public water or sanitary sewer line.
l:\Building\Permits\PLMF-PermitApp.doc 12/30/05