Permit CITY OF TIGARD PLUMBING PERMIT
1. COMMUNITY DEVELOPMENTIII
Permit#: PLM2019-00390
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 10/02/2019
Parcel: 2S111BB01100
Jurisdiction: Tigard
Site address: 14259 SW 100TH AVE
Project: Kastel Subdivision: TIGARDVILLE HEIGHTS Lot: 16
Project Description: Install 50 feet of sanitary sewer line for sewer connection for existing residence. Septic system to be pumped and
filled or removed. Pump/fill receipt required at final inspection.
Contractor: KERR CONTRACTORS OREGON INC Owner: KASTEL, CHARLES&MARY TRUST
PO BOX 1060 14259 SW 100TH AVE
WOODBURN, OR 97071 TIGARD, OR 97224
PHONE: 971-216-0050 PHONE.
FAX:
FEES
Quantity Description Date Amount
50 If Sanitary Sewer 10/02/2019 $62.54
Specifics: 1 12%State Surcharge- 10/02/2019 $8.70
Plumbing
10 ea Minimum Fee Adjustment- 10/02/2019 $9.96
Type of Use: SF Plumbing
Class of Work: OTR
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 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: ,iv/r....
(/ /�� 15---_,deff...77'
Permittee Signature: �ivC
Call 503.639.4175 by 7:00 a.m.for the next available inspe on 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.
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Plumbing Permit Application
Site Utilities ( U
FOR OFFICE USE ONLY
City of Tigard2019OCT 1 Received Permit No�k/r� 9--(�®�,®
. '" 13125 SW Hall Blvd.,Tigard,OR 97223 Date/By: ��//
Plan Review �9 �p
Phone: 503.718.2439 Fax: 503.598.196(1 -�•yr 1 ` f Date/By:III Other Permit ij-ed4 )n/9 420, 40 3
TICARD Inspection Line: 503.639.4175 'v t DateRead B Juris: H SeeP+agee'2ffor
Internet: www.ti and-or. ov 71 I i 411zsa(� w yziC. ` Y Y: g
g g Notified Ntethod: Supplemental Information
TYPE OI?.:WORK FEE* SCHEDULE
El New construction ❑Demolition For special information use checklist
Description Qty. Ea. Total
(g Addition/alteration/replacement ❑Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF C (1iSTt2IICTION SFR(1)bath 312.70
X] 1-and 2-family dwelling 1:1Commercial/industrial SFR(2)bath 437.78
buildingSFR(3)bath 500.32
❑Accessory 0 Multi-family
Each additional bath/kitchen 25.02
❑Master builder ❑Other:
Fire sprinkler( sq.ft.) Page 2
IOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: /L,/ 7 Sw /Do Th` .4ve Catch basin or area drain 18.76
City/State/ZIP: Tj6•/i/Z17 Q(Z 7 Z�� Drywell,leach line,or trench drain 18.76
/ Footing drain(no.linear ft.:_) Page 2
Suite/bldg./apt.no.: Project name: E ,RR(_Vt C. Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
w15-S 1 or t OO' /4�/a a-u ,v1.51../ Rain drain connector 18.76
Sanitary sewer(no.linear ft.:_) ....4"-O Page 2 64,S '
S u;J.b IO-uU f)TtL.v c.T L O n1 .
Storm sewer(no.linear ft.:_) Page 2
Water service(no.linear ft.:_) Page 2
Subdivision: j1L.f(C A cr. Lot no.: Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 25.02
77.n/S j/-Le.. ,50.-:w 1E L,+it-(rL fZ.el-C_ Dishwasher 25.02
41- fae"e,--a v." t SS.` j- j �)_'/,7-(e, T/34VK _ Drinking fountain 25.02
Ejectors/sump 25.02
DTENANT Expansion tank 12.51
ki PROPERTY OWNER
Name: /4/q2V Fixture/sewer cap 25.02
drain/floor sink/hub 25.02
Address: 'LI Z IA./ /0 0 Tlt G Garbage disposal 25.02
City/State/ZIP: 77b-/i . / d1Z q 7 Z Z.`/
Hose bib 25.02
Phone:( ) Fax:( ) Ice maker 12.51
APPLICANT 0 CONTACT PERSON Interceptor/grease trap 25.02
Medical gas(value:$ ) Page 2
Business name: K a12-A Oa,'i-;Zref-0-0/z_5 azeaa v 4.
Contact name: KA..,. nn _ Primer 12.51
}/ l�/q IZ 1 L IZ- Roof drain(commercial) 12.51
Address: ?o �//x /04,c Sink/basin/lavatory 25.02
City/State/ZIP: O1/ fad )((2 t..J ( o\Z et 7671 Solar units(potable water) 62.54
Phone:(17/) 2 5s"--_57)7-LI Fax::17/) �'` -0b7 I Tub/shower/shower pan 12.51
E-mail: j�Gr4/ZTit=�iZ /Z/-1.1,2):-.- Co.�/77Z/¢CTbIZS , 6o i•-• Urinal 25.02
CONTRACTOR Water closet 25.02
Water heater 37.52
Business name: g/5/24Z. 6,Fj,,tiT/Ll4"C.-I dZ) p)Z.(r-0 IJ .�-NC. Water piping/DWV 56.29
Address: 7o OIL /06,f, Other: 25.02
City/State/ZIP: tAi `09_ n 7 I Subtotal 4 L.}""i(
Phone:(971) Z IFax: Minimum permit fee: $72.50 -7L,>�
�0 -O�S-Z1 (`l7/ ) zit„ bV75 Plan review (25%of permit fee) /9,/3
CCB Lie.: f,S-4_5-8 Plumbing Lie.no.:,;y_y.17 pa
State surcharge(12%of permit fee) g.7 0
Authorized signature: TOTAL PERMIT FEE 9R 3-3
Print name: K L,v Cy41LT(�'/Z Date: ��l I This permit application expires if a permit is not obtained within 180 days
J 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) �/i L-41
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Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site Utilities : ttir. Fie(ea) Total Square Footage: Permit Fee:
Footing drain-151 100' 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 $233.20
�b G 2.$ / 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 or Fees Qty. Fee(ea) Total each additional$100.00 or fraction thereof,to
h 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: 42.5Y
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/
Work Performed: Capped Added Relocate Plan review is required for any of the following.
Baptistry/Font Please check all that apply.
Bath Tub/Shower El 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 ❑ New exterior plumbing site utilities for any complex structure
Cuspidor/Water Aspirator as defined in OAR918-780-0040.
Dishwasher -Commercial ❑ Medical gas and vacuum systems for health care facilities.
-Domestic ❑ 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 riser❑ Itridiagramis required for new buildings
Garbage -Domestic-non-food somec or q
Disposal -Domestic-food related that meet the qualifications above.
-Commercial-food related
-Industrial-food related
Ice Mach./Refrig.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 *Note: If the fixture work under this permit results in an
Washer-Clothes
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:
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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. ❑ map & tax lot# ❑ project name ❑ site address ❑ suite number
❑ zoning ❑ applicant name ❑ 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.
I:\Building\Permits\PLMF-PermitApp.doc 12/30/05