Permit CITY OF TIGARD PLUMBING PERMIT
3 COMMUNITY DEVELOPMENT Permit #: PLM2012 -00074
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 03/30!2012
Parcel: 25102CD03005
Jurisdiction: Tigard
Site address: 9965 SW MCDONALD ST
Project: DelaCruz Subdivision: FREWING'S ORCHARD TRACTS Lot: 30
Project Description: Plumbing permit for sewer connection, approximately 65'.
Contractor: COFFMAN EXCAVATION LLC Owner: DELACRUZ, ELDON
PO BOX 687 9965 SW MCDONALD ST
OREGON CITY, OR 97045 TIGARD, OR 97224
PHONE: 503 - 648 -8555 PHONE:
FAX:
FEES
Quantity Description Date Amount
65 If Sewer Service 03/30/2012 $62.54
Specifics: 1 12% State Surcharge - 03/30/2012 $8.70
Plumbing
10 ea Minimum Fee Adjustment - 03/30/2012 $9.96
Type of Use SF 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
issuan. :, or if wor 's suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utili Notification Cente \ Th. les are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. You may obtain a co- - of the rules
or . red questions to OUN • calling 50 2.1987 or 1.800.332.2344.
■
I ued By: r Permittee Signature: el r 1/i
• - •
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
Site Utilities W
Rec
City of Tigard R Dat ived 1.1_ e/B � Permit No.: L "..0f/ .�
0 d y
13125 SW Hall Blvd., Tigard, 0 9 v
�� 3 O 2012 Plan Review
Phone: 503.718.2439 Fax: 503.59 Date/By: Other Permit No.:
Inspection Line: 503.639.4175 gar -or. ov
Date Rea B orri ®See Page 2 for
T I G r\ R D Internet: www.ti d R B
g n` TIGIO0 Not Supplemental Information
TYPE OF W I. _ k ON FEE* SCHEDULE
ial ow
❑ New construction r emolition For s ecaal information use checklist
Description Qty. Ea. Total
® Addition/alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (I) bath 312.70
® 1- and 2- family dwelling ❑ Commercial/industrial SFR (2) bath 437.78
SFR (3) bath 500.32
❑ Accessory building ❑ 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: 9965 SW McDonald St. Catch basin or area drain 18.76
City/State/ZIP: Tigard, OR 97224 Drywell, leach line, or trench drain 18.76
Footing drain (no. linear ft.: ) Page 2
Suite/bldgiapt. no.: I Project name: Connect to public sewer Manufactured home utilities 50.03
Cross street/directions to job site: On McDonald in between O'Mara and 100th Manholes 18.76
Rain drain connector 18.76
Sanitary sewer (no. linear ft.: 65) Page 2 62.54
Storm sewer (no. linear ft.: ) Page 2
Water service (no. linear ft.: ) Page 2
Subdivision: Frewing's Orchard Tracts I Lot no.: 30 Fixture or item:
Tax map /parcel no.: Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 25.02
Installing 4" PVC pip from septic tank to sewer lateral at edge of property Dishwasher 25.02
including existing tank abandonment Drinking fountain 25.02
Ejectors/sump 25.02
® PROPERTY OWNER I ❑ TENANT Expansion tank 12.51
Name: Eldon delaCruz Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address: 9965 SW McDonald St
Garbage disposal 25.02
City/ State/ZIP: Tigard, OR 97224 Hose bib 25.02
Phone: (503)705 -2933 Fax: ( ) Ice maker 12.51
❑ APPLICANT ❑ CONTACT PERSON Interceptor/grease trap 25.02
Business name: Medical gas (value: $ ) Page 2
Primer 12.51
Contact name:
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
CONTRACTOR Water closet 25.02
Water heater 37.52
Business name: Coffman Excavation Water piping/DWV 56.29
Address: 13014 Clackamas River Dr. Other: 25.02
City / State/ZIP: Oregon City, OR 97045 Subtotal
Phone: (503) 656 -7000 Fax: (503) 656-0686 Minimum permit fee: $72.50 72.50
CCB Lic.: 146689 Plumbing Lic. no.: Plan review (25% of permit fee)
• i State surcharge (12% of permit fee) 8.70
`
Authorized signature: 1lT� .'u TOTAL PERMIT FEE 81.20
Print name: Noel delacruz Date: 03 -29 -12 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.
t:\ Building \Permits\PLMU- Pen°itApp.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 -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' I 62.54 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:
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
Q ty. 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 - I/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:
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 ❑ 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 ❑ 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 ❑ Isometric or riser diagram is required for new buildings
Garbage - Domestic- non -food
Disposal - Domestic -food related that meet the qualifications above.
-Commercial -food related
- Industrial - food related
lee 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:
C: \Users\Noel\ Documents \PLMU- PermitApp_delaCruz.doc 2
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