Permit CITY OF TIGARD PLUMBING PERMIT
' COMMUNITY DEVELOPMENT Permit#: PLM2019-00505
Date Issued: 12/31/2019
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439
Parcel: 2S110BB02400
Jurisdiction: Tigard
Site address: 12180 SW CHANDLER DR
Project: MAHAN Subdivision: ARLINGTON RIDGE Lot: 1
Project Description: Adding 20 ft of rain drains.
Contractor: OWNER Owner: MAHAN, ROBERT H
ROB MAHAN NAKATA, KUMIKO
12180 SW CHANDLER 12180 SW CHANDLER DR
TIGARD, OR 97224 TIGARD, OR 97224
PHONE: 503-828-6600 PHONE:
FAX:
FEES
Quantity Description Date Amount
20 If Storm Sewer 12/31/2019 $62.54
Specifics: 1 12%State Surcharge- 12/31/2019 $8.70
Plumbing
Type of Use: SF 10 ea Minimum Fee Adjustment- 12/31/2019 $9.96
Plumbing
Class of Work: ALT
Type of Const:
Occupancy Grp:
Stories:
Total $81.20
Required Items and Reports(Conditions)
77 72
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State 9 OR. Spec' Ity Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire it' work is' n started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow 'he/rules adopted by the Oregon
Utility Notification Center. Those rules a e set forth in OAR 952-001-0010 through OAR 952-001-0Q 0. 4Yo!t,7nay obtain a copy of the rules
or direct questions to OUN by calling 503.2 2. 87 or 1.8 . 32.2344. ( 'j
1 u�
Issued By: Permittee Signature: ,y r(t,/ C
V 7Y
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 I a FOR OFFICE USE ONLY
City of Tigard Received f • i' /'
• 13125 S W Hall Blvd.,Tigard,OR 97223 n 7„ " , Date/By: 3 , ( /:ja r L - C) j- (/, - _
g d. Plan Review �r
e Phone: 503.718.2439 Fax: 503.598.1960 Date By: a e ' )!/`li -!� )
T 16 A R D Inspection Line: 503.639.4175 Date Ready/By: Loris: Hi See Page 2 for
Internet: www.tigard-or.gov Notified/Method: Supplemental Information
,,�r,f''T� TYPE OF WORK FEE* SCHEDULE
y vew construction ❑Demolition For special information use checklist
Description Qty. I Ea. I 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
El1-and 2-family dwelling 0 Commercial/industrial SFR(2)bath 437.78
SFR(3)bath 500.32
❑Accessory building ❑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: !a(/a e 3 w eh a-Plc /eft- At Catch basin or area drain 18.76
aZ Drywell,leach line,or trench drain 18.76
City/State/ZIP: CI
7 f( 'c 04 e Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: I Project name: plei,a-6704dk Manufactured home utilities 50.03
Cross sheet/directions to job site: Manholes 18.76
Rain drain connector 18.76
Sanitary sewer(no.linear ft.:_) Page 2
Storm sewer(no.linear ft.:AC)) ( Page 2
Water service(no.linear ft.:_) Page 2
Subdivision: I Lot no.: Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 25.02
11icvet ct rA i 5 Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
PROPERTY OWNED I ❑ TENANTExpansion tank 12.51
^{, Fixture/sewer cap 25.02
Name: F"F v /.�0 ( Floor drain/floor sink/hub 25.02
Address: ,2/QQ ;io e/,s.�//Az cbe Garbage disposal 25.02
City/State/ZIP: y 1 Giqi 97,2d y Hose bib 25.02
Phone:(50y ) gF (, Fax:( ) Ice maker 12.51
❑ APPLICANT ❑ CONTACT PERSON Interceptor/grease trap 25.02
Business name: / Medical gas(value:$_) Page 2
Contact name: S e j / bfreie Primer 12.51
Roof drain(commercial) 12.51
Address: Sink/basin/lavatory 25.02
City/State/ZIP: Solar units(potable water) 62.54
Phone:( ) Fax::( ) Tub/shower/shower pan 12.51
E-mail: Urinal 25.02
Water closet 25.02
CONTRACTOR
Water heater 37.52
Business name: Water piping/DWV 56.29
Address: Other: 25.02
City/State/ZIP: Subtotal
Phone:( ) Fax:( ) Minimum permit fee: $72.50
CCB Lic.: Plumbing Lic.no.: Plan review (25%of permit fee)
State surcharge(12%of permit fee)
Authorized signature:iliii
/ TOTAL PERMIT FEE
/A
Print name: o Date: /2-}I -i 9 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\Petmits'PLMU-PermitApp.doe 10/01/09 490-4616T(10/02/COM/WEB)
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site Utilities Qty. Fec(ca) 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' 62.54 Medical Gas Systems:
Water Service-each additional 100' 37.52 Valuation: Permit Fee:
Stone&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
p 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/br $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 S50,000.00.
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:
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
Baptistry/Font ❑ Any new commercial building with water service 2"and
greater,except systems designed and stamped by licensed
Bath: -Tub/Shower
-Jacuzzi/Whirlpool engineer.
ElCar 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 ❑ Any multipurpose fire sprinkler system.
Domestic 0 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
❑ 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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