Permit (2) �, CITY OF TIGARD PLUMBING PERMIT
F ' "
• COMMUNITY DEVELOPMENT Permit#: PLM2020-00017
Date Issued: 01/09/2020
-ricoAR Df 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 I
Parcel: 1S136AD04102
Irt/y , Jurisdiction: Tigard
Site address: 10735 SW 69TH AVE 14
Project: Gettysburg Apartments Subdivision: VILLA RIDGE Lot: 2
Project Description: 15 ft.of water service and repiping units 13-17.
Contractor: PUDDLETOWN EASTSIDE PLUMBERS LLC Owner: KRICHMAR FAMILY 2012 TRUST
480 OHMART AVE SE BY KRICHMAR, CAMILLE A TR
SALEM, OR 97302 790 HERMOSA WAY
LAGUNA BEACH, CA 92651
PHONE: 503-388-2514 PHONE:
FAX:
FEES
Quantity Description Date Amount
15 If Water Service 01/09/2020 $62.54
Specifics: 1 ea Water Piping/DWV 01/09/2020 $56.29
1 12%State Surcharge- 01/09/2020 $14.26
Type of Use: COM Plumbing
Class of Work: ALT
Type of Const:
Occupancy Grp:
Stories:
Total $133.09
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: ..tee
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.
CITY OF TIGARD PLUMBING PERMIT
. r COMMUNITY DEVELOPMENT Permit#: PLM2020-00017
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 01/09/2020
Parcel: 1 S 136AD04102
Jurisdiction: Tigard
Site address: 10735 SW 69TH AVE 14
Project: Gettysburg Apartments Subdivision: VILLA RIDGE Lot: 2
Project Description: 15 ft.of water service and repiping units 14 and 15.
Contractor: PUDDLETOWN EASTSIDE PLUMBERS LLC Owner: KRICHMAR FAMILY 2012 TRUST
480 OHMART AVE SE BY KRICHMAR, CAMILLE A TR
SALEM, OR 97302 790 HERMOSA WAY
LAGUNA BEACH, CA 92651
PHONE: 503-388-2514 PHONE:
FAX:
FEES
Quantity Description Date Amount
15 If Water Service 01/09/2020 $62.54
Specifics: 1 ea Water Piping/DWV 01/09/2020 $56.29
1 12%State Surcharge- 01/09/2020 $14.26
Type of Use: COM Plumbing
Class of Work: ALT
Type of Const:
Occupancy Grp:
Stories:
Total $133.09
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.
Plumbing Permit Application
Building Fixtures RECEIVED FOR OFFICE USE ONLY
City of Tigard Received / n,
Date/By: I/." f �' ` Permit No.: �yt A)g..t,ale i 7
13125 SW Hall Blvd.,Tigard,OR 97223 9 2020 Plan Review l{{ i rN r 0 u v� G
Phone: 503.718.2439 Fax: 503.598.1960Jr I Date/By: Other Permit No.:
T I G A R D Inspection Line: 503.639.4175
Internet: www.ti and-or, ov CITY OF T IGARD n Date Ready/By: Juris: 63 See Paget for
g g \• Notified/Method: Supplemental Information
;ji1.pING DlJiS1Go.; e�=r Pp
TYPE OF WORD FEE* SCHEDULE
❑New construction El Demolition For special information use checklist
Description Qty. I Ea. I Total
ff a-AAddition/alteration/replacement ElOther: New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(1)bath 312.70
❑ I-and 2-family dwellingmmercial/industrial
SFR(2)bath 437.78
ElAccessory building ❑Multi-family SFR(3)bath 500.32
❑Master builder Each additional bath/kitchen 25.02
❑Other: Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: to I-3 5 5 ,1./ q ,4.., Catch basin or area drain 18.76
.,, Y� Drywell,leach line,or trench drain 18.76
City/State/ZIP: Tt�a,..atO t Q 7-��3
Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.:/3 ) 7 I Project name: f 02€.gttes1(j L4I,�� Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
V in/ ?„(_�Cc-c rJr Rain drain connector 18.76
Sanitary sewer(no.linear ft.: ) Page 2
Storm sewer(no.linear ft.: ) Page 2
Water service(no.linear ft.:,/, _.), ' ( Page 2 6)3-11
Subdivision: I Lot no.: Fixture or item:
Tax map/parcel no.: Backilow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
�Qlk/ v J t "ert `e Clothes washer 25.02
o� L Dishwasher 25.02
(tie i(t 2- bI N 1`I 5 {7J r l L( JL l 5 Thinking fountain 25.02
Ejectors/sump 25.02
"PROPERTY OWNER I 0 TENANT Expansion tank 12.51
Name: i y t le J Fixture/sewer cap 25.02
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 AAP, LIcANT 0 CONTACT PERSON Interceptor/grease trap 25.02
Business name: IA (� cKJ aF.. S� f`I ,y 7 yi L Medical gas(value:$_) Page 2
Contact name: , 11 T' k V.I Primer 12.51
1Address: tier, � 4 A-44_ 5T Roof drain(co r 5.01
�.�} Sink/basin/lavatory 25.02
City/State/ZIP: -2,,,,L2......... ", Solar units(potable water) 62.54
Phone:( h 0, G[ ^y 7-�p Fax::( ) Tub/shower/shower pan 12.51
E-mail: COO et c� g age w, ( (1,140115-- C ygv Urinal 25.02
CONTRACTOR Water closet 25.02
Water heater 37.52
Business name: Water Pm rP g/D WV I 56.29 3
Address: Other: 25.02
City/State/ZIP: Subtotal
Phone:( ) Fax:( ) Minimum permit fee: $72.50 G /Sr,1.
r'� Plan review (25%of permit fee)
CCB Lic.: �it Plumbing Lic.no.:
State surcharge(12%of permit fee) 1 L(.
Authorized signature: �tr/) TOTAL PERMIT FEE /r (1,e('Print name: ` rr't-I i Date: This permit application expires if a permit is not obtained within 180 days
11 i t after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
1:\Building\Permits\PLMU-PetmitApp.doc 10/01/09 440-4616T(10/02/COMWWEB)
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 $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 7,201 and greater $327.54
Sewer-each additional 100' 37.52
Water Service-1st 100' j 62.54 (ov l, Medical Gas Systems:
Water Service-each additional 100' 37.52 Valuation: Permit Fee:
Storm&Rain Drain-I st 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
Qty. Fee(ea) Total each additional$100.00 or fraction thereof,to
Other Inspections or Fees 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 S50,001.00 and up $742.00 for the first$50,000.00 and$1.20 for
(minimum charge-1/2 hour) each additional$100.00 or faction 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 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 Relocate ❑ Any new commercial building with water service 2"and
Baptistry/Font greater,except systems designed and stamped by licensed
Bath: -Tub/Shower engineer.
-Jacuzzi/Whirlpool ❑ New exterior plumbing site utilities for any complex structure
Car Wash: -Each Stall as defined in OAR918-780-0040.
-DriVe Thru ❑ Medical gas and vacuum systems for health care facilities.
Cuspidor/Water Aspirator
0 Any multipurpose fire sprinkler system.
Dishwasher: -Commercialome El Any complex structure as defined in OAR918-780-0040.
-D
Drinking Fountain Submit 2 sets of plans with any of the above.
Eye Wash
Floor Drain/sink: -2"
3„ Isometric or Riser Diagram
4" 0 Isometric or riser diagram is required for new buildings
-Car Wash Drain that meet the qualifications above.
Garbage -Domestic non-food
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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