Permit CITY OF TIGARD PLUMBING PERMIT
III a COMMUNITY DEVELOPMENT Permit #: PLM2013 -00161
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 06/05/2013
Parcel: 1 S135DB05504
Jurisdiction: Tigard
Site address: 11350 SW 95TH AVE
Project: Kreisberg Subdivision: THOMAS TERRACE Lot: 5 -6
Project Description: Connect existing house to sewer service, 100' or less. Septic tank is to be properly abandoned. No existing lateral
on property, PFI2013 -00018 issued 06/04/13.
Contractor: CRN EXCAVATION INC Owner: KREISBERG, LOUIS & ELIZABETH J
PO BOX 301517 11350 SW 95TH AVE
PORTLAND, OR 97294 TIGARD, OR 97223
PHONE: 503 - 254 -2540 PHONE:
FAX:
FEES
Quantity Description Date Amount
100 If Sewer Service 06/05/2013 $62.54
Specifics: 1 12% State Surcharge - 06/05/2013 $8.70
Plumbing
Type of Use: SF 10 ea Minimum Fee Adjustment - 06/05/2013 $9.96
Class of Work: ALT
Plumbing
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 i i •ended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility No ation Center. lose rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. You may obtain a copy of the rules
or dire questions to OUNC by • ng - 03.- 1987 or 1.800.332.2344.
lss ed By: /� �/ Permittee '.nature: , � , � ��I� , ;
Call 503.639.4175 by 7:00 a.m. for the next available i. : .ection 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.
05/23/2013 08:33 5032542474 LDN PAGE 02
Plumbing Permit Application .RE CEIVE t
Site Utilities 1, rIlc 01:1-1(' I: 'lm': f: ,It,y
r City of Tigard M AY 2 9 2013 R°CC J (---0-, G1 f
a 13125 SW Hall Blvd., Ti OR 97223 �a�y S /2Q�/ 3 Permit N o.: P1 �����
• 4 Phone: 503.718.2439 Fax: 503.548,196 Plan ►�a .eiRc20 /3 dO //7
Ti C; A Fi p inspection Line. 503.639.4175
C ITY OF TIGAR 1 Date/By: otnet Permit
Internet: www.tigard- or.gov BUILDING DNISI • Date Read /B hrin S See Page 2 for
7- L . 1` ottficd/Meh'd: Su " I°mentetInformation
fi '�i i': :,. _��,. liii� r.! :11 "��;, .•.L �y,��y, � - uea "•I''` _ -,, I L I ,., .. . ;l`,_. , ,'' "" u rt , .,,,,. ' a',r 'CII ' y�
' 1FI' L;i: e.•r;:, :ln:u". i;�' , .taL ;11 ': ll , 1 I p' neat;:.
� ,• � =�ij�`�lB! .A q , 11. 1_ •�', , , . q,)i i r;: `:;1.• ,,r ; )I' L 1 1.. , °� u •
0 New construction '1 t: -r..
' 1111'• i 'i• 11 � i pI, i „ , 1;) L. , ,f �A,:)ih ��tfii I •' 6{lk1G IIE��� 1 III �... 1i�7liti ° %'!i" l .1 I _,,
.. ' r..' .1 119 1 s � � �1, Ti �,�., ;, � ' 1 pr „�
�. ; °„ .. 1.1'.`1 ; • l
. ..,:,•.`,�I: �• lu du )1� �,�,, ,d {•. ,.
_� 'I'• „ • "'•'�" 5;,�;ifi,�ll,;,i Uv; , I• II,I'il,l'+'��i'',�•i
❑ Demolition For Veda/ informal/on Sae CheCidiSf.
Dcscri uo
ddition/alteration/ ❑ ] Qty. I Ea. I Total Other:
_� l 'I I � , y .,��t���� -� � New 1- 2- family dwellings (includes 100 R. for each utility connection)
'"IE4m$ul ..: 1 LI._ , l. ;,-,. I ,� 1 i ,. - .,.. , lu�•.;n�h n,• t
"1. '' ( _ :t 1 111,': fn ��l�t� illl'lii. , 11 �'Illl i1 F R (I) bath 3120
:?i�ir-:t r y ; . {.!;;i• {)� ; ,I:i. I` S .7
• ;,•1°, IF u - ,,, a, ., .,'w� • y ., F.n,nI1l1 l.•t ., 1 ^
- and 2- family dwelling ❑ Commercial/industrial SFR (2) bath 437.78
Accessory building SFR (3) bath 500.32 1
❑ ry g ❑ Multi- family -
❑ Master builder Each additional hathncitchen 25.02 •
❑ Other:
, il , ,: .!, I Fire sprinkler ( _ sq. R.) Page 2
a I ':$ i; dLtrF� L” (7 � ��. i P.:: � ; • 'iv:
i,d•f�: � ItJ � ��,li'; .'�� `') , m -lr ,. � � n. '' 1,5 . 'i " glltleA: _
, ..:" . .., ., e , • •: � .n „ai,n r a!I,7�I r ; n �dtilt
,. Site a
i"
Job site address: 1 �.M Catch basin or area drain 18.76 -
D
City / State/ZIP: I ('r et G( U I 7d P-3 F000titing ng leach (no trench drain - 18.76
drain (no linnte er ft.: __, Page 2
Suite/bldg, /apt. no.: Project name: 2,‘E S /13EQCc. Manufactured home utilities 50.03
Cross strect/directions to job site: S.L. 0 .0 .A..._ < ( . 1 ( SI _ Manholes 18,76
— ! Rain drain connector 18.76
Sanitary sewer (no. linear fl.:/i'r) Page 2 easy
Storm sewer (no. linear ft.: ) Page 2
Water service (no. linear ft.: _) Page 2
Subdivision: i Lot no.: Fixture or Item: —
Tax map/parcel no.: Backflow prcvcntcr 31.27
,�'? iii � ` ,l '�'� `;u ` r;� 1 � u r :, ,,, „ � ,1 ;i,,�, 12.51
I. ii1 "�,�! "'� ; t:'. •, ; ' ��r;; �'�( ,{ j�(�t( }1 u 1 t 4. , � Backwater valve
,Its _ -'Zi. i .101. 11__ ,',\r, „, 1- - .'.'!'?. t.{ 1_ Sjn,l71I11( .!; ,r:'- _'.:.r '.1601 • 'Nii,l:lllu�_'
Clothes washer 25.02
_____P 1 A S4 (1 )G I-4 ice-( V) w I 1. 1 Ss - )P/ Dishwasher 25.02
. -Q- 4 In. Ou.s Drinking fountain 25.02
}+ t� y�, �e ( te•Q t� Ejectors /sump 25 02
_,i a °I'. @IC ItL�JFF'. ��1 1,'7; " ' S , : _ ", „': I '' tf ,: •--
,�l'; I - , _ _ _I''. ..." .L-;'-: - "" p
T �: Ii ii Aia 6 , I I
1-,I , - Expansion tank
I,. , -• — =' ,. p .;d- II', 12.51
Name: 1_..1 x �f (� rd�'�O Fixture/sewer cap 25.02
Address: Floor drain/floor sink /hub 25,02
Garbage disposal 2.5.02
City/State/ZIP: Hose bib
. ? .3,/7 25.02
Phone: 1
������ ' (5(�� � �/ y (p 7 ;! Fax: ( ) Ice maker 12.51
a;1Iii: -. U!rderi 111{ % 14'�„I r 9;l .1t�`� ' tre 1.' �y e Interceptor /grcawtra
a,, >> . :, ;4 - 1- 11iM)... 41 , , ;ft!''�`,",0)11 I t
� _;!: „:,; _ trap 25.02
Business name: C 1.. Medical gas (value: S ) Page 2
)� ,n a I se. „
12 51
Contact name:
�` r r ( i' 1 — ( 7 Roof drain (commercial) 12,51
Address: p o . B.6 C " 3 0/ SI 7 Sink/basin/lavatory 25.02
City / State/ZIP: 0 '- ( Ott ' ,.4e (/ Sntar units (potable water) 62.54
Phone: ) ?`;-1/- ') e . y Fax: : S ) ;.I' _ ,2S/ / Tub /shower /shower pan 12.51
E -mail: r D 11 C, � ,G n o& f( f vi ,v, / I Urinal 25,02
r.' 1 ,,,,” 1 Q i ct,,M9ji i. ''' 1 • 'j:. ' 1 ? 1 ' d•�'o : • �• -,I . , _
w I " Water cl q
� $;•� „ • jn c''� :: ,11 F 1.1 :. �1 , �1Jy4� i ,`If g •. h ' Il ll 1'0'111 '.. O, Ct
,cl'1,:I l{ 1 11'1, : ' i •'i dl,_, IL,i 25.02
, ,.�d�i• ' -';di, :a .. ,� .,Lie -,•r ",�:,', :m " »: plllll, t,1h -11 "iG�. Ltd ;'.'i�iil`iilill;ilh ", "') {Ij
Water heater 37 52
Business name, ( /A /j f ytri vt Z' e� Water piping/DWV 56.29
Address: f �'C' 31)/ ,j7 7 Other: 25.02
City /State/ZIP: p p . r/f 4. a 0 £ Cl 7; 554/ Subtotal
Phone 153 ) 3 ..f./- 5L/ 0 Fax:,13) 2e. / /. _Je/7e/ — Minimum permit tee: $72.50 '71.
CCD Lie.: r c 76 56 (el! /1Y Plumbing Lic. no.: Pa '1, y 4 , _ _ Plan review (25 °� of permit fe
1 T .�� ! /� O'
State surcharge (12 %ofpermit fee) % .70
Authorized si mum: ' Q ��i,_ TI'AI, PERMIT PEE
Print name. 7 � LL' e p ' E Date: 6,/ ThB permit application c :pircy Ira permit is not obtained within t 0 aye
j�
6 F after It has been accepted as complete.
m
"Fee mhodotogy set by Tri- County Building Industry Service Board. 8/.
I,Rui din,permltl \VI....., rmitApp Iwo mu 440-4616T(10102/COM(WFR)
05/23/2013 08:33 5032542474 LDN PAGE 03
Plumbin Permlit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule:
A w))e � �u`p ,. ,r 1, _ ,a., ,4l ^r `_: �r < � T 1 yy�y ry�yy Residential Fire Su. u ression S stems:
I•r"•n'k L1W1 :�yf14i,! :,,k11' 1 •Allr•MI1f, 1 fe114 i,if � j'lllli illl�. VW?. ,i - (}'y { y 4,1(:.• II ''� y .III
Y i( •' .... � I� :11 ..1 :. 1 'A:1� + { I: ` MV:•C7 V , G 4 -�' IAiNlli " � �'G� � 1 Vlll. 4' q y 1 ,
Footing drain ° . •, e 111 U, A•. ��u� I • �- �' � li,..,.,,..,,. l•' 1 �n 1' y d il)I v{ � tiu
- l 100' 50,03 d+n. �r .i,2• 'l,'I!ill "ilhl�l(! >,, -',<� 1 , lu poi
O to 2,000 $121.90 � , 'll`: - ,
F
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
�D?+` 7,201 and greater $327.54
Sewer - cach additional 100'
37.52
Water Service - 1st 100' 62,54
Water Scrvice - each additional 100' 87 52
Medical y eas Systems:
Storm & Rain Drain • 1St 100' ill#ukil{ •
N �li: {'�if•( Vyil { S! "!'i {II '!I;
,l n' {I � ' ,' u li:
62.54 l•I '1. 0 , t ... P � !�lt;,hh'•,xiil d •,A,•i11d { 11 „ylj,.�,
Storm 61 Rain Praia -cach additional 100'
51.00 to $5,000.00 Minimum fcc $72.50
37.52 $5,001.00 to $10,000.00 $72.50 for the first $5,000.00 and SI 52 for
':i;t y tli;@ i �' I fi 1 6 f9 ' , 9'1 ' ;2 !I ;,'l[ each additional $100.00 or fraction thereof. to
Inspection ofcx(sting plumbing or for and including $10,000.00,
which no fcc is specifically indicated 90.00/hr 410,001.00 to 525.000,00 $148.50 for the first $10,000.00 and $1.54 for
(minimum charge - 1/2 hour cach additional 5100.00 or fraction thereof to
Inspections outvidc of normal businccs 90,00/hr
including $25,000,00.
_hours (minimum cha�c - 2 hours) $25.00 1.00 to $50,000 00 $379 50 f o r the first $25,000.00 and S I 45 for
Reins (minimum
Fees 90.00/hr each additional $100.00 or fraction thereof, to
Additional plan review for revisions — q and including 550,000.00.
0 00/hr $50.001.00 and up $742.00 for the first $50,000.00 and $1.20 for
Smrnimtrm charge - 1/2 hour) cacti additional 5100.00 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 reeort fixtures could result in increased sewer fees * .
"" I'f,. , - . :• 77: 2 adtlOt ,fi9ttdr TiYpi4t;:'•.. II �ny,,l,l! M�pu� , y[{ l y e , yam �
, ifig:ii1...1 .; .
, Wtot! .. �i 1 ,: • :; :. ' Rid 1 / •' tp' •�„ >.•� Cry, L� ' ;i✓S 11,1 1 i�LLILSI�i�i1� � I 1 •i �� {'.
J'f:Ow �`cr 1rriY ” ',:",",r.,"., :Y,,. , •;: • „1 :;, { .,.. '• " ,. t% it a�N(' � I� �;`,;
ni ed :. . • „l., ; PapprfF ,+ � eei+tt,':: :,: Ei4 ,5:;: Plan review is re F or any of the follo wing,
' .:•.• ,.. �
I: y
Baptistry /Font Please cheek all that apply.
Bath -Tub/Shower ❑ My 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.
Car Wash Drain 1 ' 1 1, litil . ' 1 'li n it l eigi . I;n ' Ii1111il:iiid . :
( ?4i1]
Garbage - Domestic- non -food — • isometric or riser diagram is required for new buildings
Disposal - Domestic -food related that meet the ualifications above.
- Commercial -food related
- Industrial -food related
Inc Mach. /Refrig, Drains
Oil Separator (Gas Station/ Comments regarding fixture work:
Rec. Vehicle Dtj_np Station
Shower gang
-Stall
Sink/Lav - Non -food related
- Bradley
- Commercial- food related
- Smite
Swimminn Pool Filter
washer - Clothes *Note: If the fixture work under this permit results in an
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 permit can be issued.
Other Fixtures. plumbing P
httpl /www. tigard- or.gov /eity_h al l/d epartmentc/ed/docs/PLMU -perm itAp2 d oc