Permit (5) „ CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit#: PLM2019-00411
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 10/10/2019
Parcel: 2S 111 AD20300
Jurisdiction: Tigard
Site address: 14944 SW 89TH CT
Project: EYKELBOSCH Subdivision: LADY APPLE Lot: 27
Project Description: Excavating and replacing 12 ft. of sanitary sewer.
Contractor: MT HOOD EXCAVATION Owner: EYKELBOSCH, EVAN & CHRISTINE
744 SE ROBIN WAY 14944 SW 89TH CT
GRESHAM, OR 97080 TIGARD, OR 97224
PHONE: 503-459-1076 PHONE: 541-908-0798
FAX:
FEES
Quantity Description Date Amount
12 If Sanitary Sewer 10/10/2019 $62.54
Specifics: 1 12%State Surcharge- 10/10/2019 $8.70
Plumbing
Type of Use: SF 10 ea Minimum Fee Adjustment- 10/10/2019 $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 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_ ou to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 962-001-0090. 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: Permittee Signature: +,f
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
Building Fixtures FOR OFFICE LSF, ONLY
Clt of Tigard t a ''Rdceived
yDate/By: Permit No.: Q
4 13125 SW Hall Blvd.,Tigard,OR 97223 1 �)� 1'/ ` /L�O�(�l � �%��
_ Phone: 503.718.2439 Fax: 503.598.1960 OCT0 2 019 Plan Review
Date/By: Other Permit No.: 4-___, ` j Y 1. 7
Inspection Line: 503.639.4175
TIGARD Juris: 0 See Page 2 for
Internet: www.tigard-or.gov CITY OF i-" Notifed/Method: �6 Supplemental Information ormation
TYPE OF WORKdUILO!NG DIVISION
FEE* SCHEDULE
0 New construction 0 Demolition For special information use checklist.
Af
_Description Qty. Ea. Total
Addition/alteration/replacement ❑Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(1)bath 312.70
'Err-and 2-family dwelling 0 Commercial/industrial SFR(2)bath 437.78
SFR(3)bath 500.32
0 Accessory building 0 Multi-family
Each additional bath/kitchen 25.02
❑Master builder ❑Other:
Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: Pi 5 9 q Stu $7 h- t i7 Catch basin or area drain 18.76
Drywell,leach line,or trench drain 18.76
City/State/ZIP: 1--; ��� b�
Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: Project name: Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
Rain drain connector 18.76
Sanitary sewer(no.linear ft.:L) 1 Z ' Page 2 tea) S�
Storm sewer(no.linear ft.:_) Page 2
Water service(no.linear ft.:_) Page 2
Subdivision: 1 Lot no.: Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
�' Clothes washer 25.02
_' A. l; t�(yI " Sewer 5eJJ i Ct. )i he- ' Ssrft ' ( Dishwasher 25.02
e LC.o...da O-r4 Ife-f lA►.R- `2.1 eQI -t o I.. Drinking fountain 25.02
)a,(-'-'o-k AN-t- 4-d GL, `\ Se..1 -I o i/ " \oG Ejectors/sump 25.02
0 PROPERTY OWNER 0 TENANT Expansion tank 12.51
Name: ja, a v K,Qt b 0 y C Fixture/sewer cap 25.02
l Floor drain/floor sink/hub 25.02
Address:
Garbage disposal 25.02
City/State/ZIP: Hose bib 25.02
Phone:( ) Fax:( ) Ice maker 12.51
0 APPLICANT 0 CONTACT PERSON Interceptor/grease trap 25.02
Business name: !',4- I400 d Medical gas(value:$ ) Page 2
Contact name: J tusk &to its" PRoof
12.51
ofd
Roof drain(commercial) 12.51
Address: 7c4 4 SE Ko to/h �'`�
W Sink/basin/lavatory 25.02
City/State/ZIP: 6,1/Ls kQ.,fr.n. C / 170 8 0 Solar units(potable water) 62.54
Phone:(Cj 6 3) q S 1 - / O-7 (, Fax::( ) Tub/shower/shower pan 12.51
E-mail: n00(f QI.-C A,,,ex..'}-j 01/, @ ow-\obl< cowl Urinal 25.02
-' - Water closet 25.02
CONTRACTOR
Water heater 37.52
Bust na e: Waterpiping/DWV 56.29
Address: Other: 25.02
City/Sta /ZIP: Subtotal 69,Szi
Minimum permit fee: $72.50 7) 5 Z)
Phone:( ) Fax:( )
Plan review (25%of permit fee) '
CCB Lie.: (0 Plumbing Lic.no.: State surcharge(12%of permit fee) r.-h,
Authorized signature: ec 4- TOTAL PERMIT FEE '-Ji,t)
Print name: J 0 51,, c r o A-5 Date: fp -/O , 17 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\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-I'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 � c17 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$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 or Fees Qty. 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: �� Z
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 for Plumbing 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: Capped Added j Relocate pp y
Baptistry/Font
0 Any new commercial building with water service 2"and
greater,except systems designed and stamped by licensed
Bath: -Tub/Shower
engineer.
-Jacuzzi/Whirlpool
Car Wash: -Each Stall ❑ New exterior plumbing site utilities for any complex structure
Drive as defined in OAR918-780-0040.
Cuspidor/Water Aspirator 0 Medical gas and vacuum systems for health care facilities.
Dishwasher: Commercial
0 Any multipurpose fire sprinkler system.
Domestic 111 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" Isometric or Riser Diagram
4" ❑ Isometric or riser diagram is required for new buildings
-Car Wash Drain
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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