Permit q CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit#: PLM2020-00037
TIGARD13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 02/12/2020
Parcel: 2S102BC00111
Jurisdiction: Tigard
Site address: 12528 SW BROOKSIDE AVE
Project: Arms Subdivision: WALNUT ACRES Lot: 10
Project Description: Water, storm and sanitary sewer service,and rain drain connector for manufactured dwelling (ADU).
Contractor: WOLF INDUSTRIES INC Owner: ARMS, STEVEN TIMOTHY& EMILY CLA
1601 SE COMMERCE AVE 12530 SW BROOKSIDE AVE
BATTLE GROUND,WA 98604 TIGARD, OR 97223
PHONE: 360-608-2119 PHONE:
FAX:
FEES
Quantity Description Date Amount
1 If Sanitary Sewer 02/12/2020 $62.54
Specifics: 1 If Storm Sewer 02/12/2020 $62.54
1 If Water Service 02/12/2020 $62.54
Type of Use: ADU 1 ea Rain Drain-Single Family 02/12/2020 $12.51
Class of Work: NEW Dwelling
Type of Const: 1 12%State Surcharge- 02/12/2020 $24.02
Occupancy Grp: Plumbing
Stories:
Total $224.15
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: �' • 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.
,
s •
Plumbing Permit Application � �V i
Site Utilities 1 E FOR MEW E 1 SE ONtA
Received
City of Tigard BAN 2+ �, 2020 DateBy:I/Z� � 6� PermitNo,,OL 2 2 ._ova 7
• 13125 S W Hall Blvd.,Tigard,OR 97223 plan Review
_ Phone: 503.718.2439 Fax: 503.598. pv K gt Other Permit No.:
Inspection 503.639.4175 1,•s! , ",.Jr ti'_ 'DateBy:
I 1��1 I:I� � , t� �°• ;date Ready/By: Juris: ®See Page 2 for
Internet: www.tigard-or.gov ,t 1 1`!t 7t U.t.) U I^.�!' Notified/Method: Supplemental Information
C New construction ❑Demolition For special information use checklist
Description I Qty. I Ea. I Total
❑Addition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
SFR(1)bath 312.70
® 1-and 2-family dwelling 0 Commerciallindustrial SFR(2)bath 437.78
❑Accessory buildingSFR(3)bath 500.32
0Multi-family
Each additional bath/kitchen 25.02
❑Master builder 0 Other: Fire sprinkler( sq.ft.) Page 2
,r , :s 'r Site utilities:
Job site address:12530 SW Brookside Ave., Catch basin or area drain 18.76
Drywell,leach line,or trench drain 18.76
City/State/ZIP:Tigard, OR 97223
Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: I Project name:Arms Accessory Dwelling Unit Manufactured home utilities 50.03
Cross street/directions to job site: SW Woodward Lane Manholes 18.76
Rain drain connector / 18.76
Sanitary sewer(no.linear ft.:]00) 1 Page 2 6.4
Storm sewer(no.linear ft.: j Page 2 4.Z.,S
Water service(no.linear ft.:Mil) I Page 2 246
Subdivision: I Lot no.: Fixture or item:
Tax map/parcel no.: 2S 102BC00111 Backflow preventer 31.27
Backwater valve 12.51
Clothes washer 25.02
Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
Expansion tank 12.51
Fixture/sewer cap 25.02
Name:Steven Arms
Floor drain/floor sink/hub 25.02
Address:12530 SW Brookside Ave., Garbage disposal 25.02
City/State/ZIP:Tigard, OR 97223 Hose bib 25.02
Phone:(971 )940-6415 Fax:( ) Ice maker 12.51
Interceptor/grease trap 25.02
Business name:Wolf Industries Medical gas(value:$ ) Page 2
Primer 12.51
Contact name:Travis Huegel Roof drain(commercial) 12.51
Address:1601 SE Commerce Ave, Sink/basin/lavatory 25.02
City/State/ZIP:Battle Ground WA, 98604 Solar units(potable water) 62.54
Phone:(360 )723 539g d 01-211 Q Fax::( ) Tub/shower/shower pan 12.51
Urinal 25.02
E-mail:th@wolfind.com
Water closet 25.02
Water heater 37.52
Business name:Wolf Industries Water piping/DWV 56.29
Address:1601 SE Commerce Ave, Other: 25.02
City/State/ZIP:Battle Ground WA,
t� 98604 Subtotal ,,O'K
Phone:( '�$B�W ' 2 Hn Fax:( ) Minimum permit fee: $72.50
t/� Plan review (25%of permit fee) '3t "�
-r,
CCB Lic.: 1/>LI 0�LI Plumbing Lic.no.:FB) State surcharge(12%of permit fee) 15,,0Authorized signature:4�!/l 7 117 '"it' TOTAL PERMIT FEE I'7-I,3
� This permit application expires if a permit is not obtained within 180 days
Print name: Ir�� Date: jf- ,F jq after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
I:\Building\Pennits\PLMU-PermitApp.doc 10/01/09 440-46I6T(10/02/COM/WEB)
7e7„91- c2 'I, 45
Plumbing Permit Application - City of Tigard
Page 2-Supplemental Information
Fee Schedule: Residential Fire Su a I ression S stems:
Footing drain-1 a 100' 50.03 O 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' ■111 62.54 Mari 7,201 and treater $327.54
Sewer-each additional 100' 37.52
Water Service-1st 100' q 62.54 m Medical Gas S stems:
Water Service-each additional 100' 37.52
Stonn&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
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 char:e-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 char_e-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 char e-1/2 hour each additional$100.00 or fraction thereof.
Subtotal: -_rThr
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 isrequired for anyof the following.
f ._.� _xr
Baptistry/Font Please check all that apply.
Bath -Tub/Shower ❑ Any new commercial building with water service 2"and
-Jacuzzi/Whiripool 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 ❑ Medical gas and vacuum systems for health care facilities.
-Domestic ❑ Any multipurpose fire sprinkler system.
Drinking Fountain ❑ 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„
Car Wash Drain
Garbage Domestic-non-food ❑ 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./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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