Permit y p CITY OF TIGARD i 44.1 PLUMBING PERMIT
COMMUNITY DEVELOPMENT / Permit#: PLM2013-00266
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 10/09/2013
Parcel: 2S104AD04501
Jurisdiction:
Site address: 12420 SW 127TH AVE
Project: Jack Park Subdivision: BELLWOOD Lot: 50
Project Description: (1)catch basin,58'of storm drain, 104'of water service and backflow preventer for irrigation system. 11/18/13,
reprinted to add site address.
Contractor: BORINO Owner: CITY OF TIGARD
17675 SW FARMINGTON RD PMB 432 13125 SW HALL BLVD
ALOHA,OR 97007 TIGARD,OR 9722313165
PHONE: 503-639-4171
HONE: 503-367-3903
FAX: 503-214-8489
FEES
Quantity Description Date Amount
1 ea Catch Basin or Area Drain 10/09/2013 $18.76
Specifics: 58 If Storm and Rain Drain 10/09/2013 $62.54
104 If Water Service 10/09/2013 $100.06
Type of Use: COM 1 ea Backflow Preventer 10/09/2013 $31.27
Class of Work: ALT 1 12%State Surcharge- 10/09/2013 $25.52
Type of Const: Plumbing
Occupancy Grp:
Stories:
Total $238.15
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, cif • is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility otification Cen - Those rules are set forth in OAR 952-001-0010 through OAR 952-011-0090. You may obtain a copy of the rules
or ect questions to OUNC • .,n• 503.232.1987 or 1.800.332.2344. `` r-
Ise ed By: L. 10 /\0 4// Permittee Sig ature: ' Dep.(0��
Call 503.639.4175 by 7:00 a.m.for the next available in-.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.
CITY OF TIGARD PLUMBING PERMIT
*.' COMMUNITY DEVELOPMENT Permit#: PLM2013-00266
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 10/09/2013
Parcel: 2S104AD04501
Jurisdiction:
Site address: NO ADDRESS
Project: Jack Park Subdivision: BELLWOOD Lot: 50
Project Description: (1)catch basin,58'of storm drain,104'of water service and backflow preventer for irrigation system.
Contractor: BORINO Owner: CITY OF TIGARD
17675 SW FARMINGTON RD PMB 432 13125 SW HALL BLVD
ALOHA,OR 97007 TIGARD,OR 9722313165
PHONE: 503-639-4171
HONE: 503-367-3903
FAX: 503-214-8489
FEES
Quantity Description Date Amount
1 ea Catch Basin or Area Drain 10/09/2013 $18.76
Specifics: 58 If Storm and Rain Drain 10/09/2013 $62.54
104 If Water Service 10/09/2013 $100.06
Type of Use: COM 1 ea Backflow Preventer 10/09/2013 $31.27
Class of Work: ALT 1 12%State Surcharge- 10/09/2013 $25.52
Type of Const: Plumbing
Occupancy Grp:
Stories:
Total $238.15
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: �— • lttee Signature:
sir
Call 503.639.4175 by 7:00 a.m.for the next available inspection te.
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.
■r
t Plumbin Permit A lica '
Site Utilities FOR OFFICE USE ONLY
Received
City of Tigard uu-II 3 Date/By: 7/3r /3 / Permit No.: Pj '�/3-�(��6�
V 13125 SW Hall Blvd.,Tigard,OR 972id3'I.•• _V
Plan Review
C Phone: 503.718.2439 Fax: 5035 'j o+. r °'!��, Date/By: Other Permit No.: ��O l 3 > .
��, Y
Inspection Line: 503.639.4175 `s .,.. fit,
T I G A R D t3 1! �► ,1 Date Ready/By: Juris: ® See Page 2 for
Internet: www.tigard-or.gov gU�l]li „ ` Notified/Method: Supplemental Information
. TYPE OF WORK � . FEE* SCHEDULE
®New construction ❑ Demolition For special information use checklist.
Description I Qty. I Ea. Total
❑Addition/alteration/replacement ❑Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
. CATEGORY OF CONSTRUCTION I SFR(1)bath 312.70 d
❑ I-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: Park Impvmts
So
Fire sprinkler( sq.ft.) • Page 2
. JOB SITE.INFORMATION AND LOCATION I Site utilities: I
Job site address: N/A • Catch basin or area drain I 18.76 18.76 0
City/State/ZIP:Tigard,OR 97223 Drywell,leach line,or trench drain 18.76 O
Footing drain(no.linear ft.:_) Page 2
Suite/bldg./apt.no.: I Project name:Jack Park Ph 1 Imprvmts Manufactured home utilities 50.03
Cross street/directions to job site:Access to the project from trailheads: Manholes 18.76
127th Aveneu located at the east side of the intersection of 127th Ave and Bell Rain drain connector 18.76
South side of project from TVFR fire station on Walnut St(12617 SW Walnut St) Sanitary sewer(no.linear ft.:_) Page 2
Storm sewer(no.linear ft.:58) I Page 2 62.54
Water service(no.linear ft.: 104) I Page 2 100.06
Subdivision: n/a I Lot no.: Fixture or item:
Tax map/parcel no.:2S104AD 04501, Backflow preventer 1 31.27 31.27
DESCRIPTION OF WORK I Backwater valve 12.51
- Clothes washer 25.02
Installation of 58 LF 4"drainage pipe, I storm cleanout
Dishwasher 25.02
(1) 1 1/2"double detector check valve assembly, (1)irrigation meter Drinking fountain 25.02
(1) 5/8"water meter for future drink fountain,104 LF 1"pvc water service Ejectors/sump 25.02
® PROPERTY OWNER II ❑ TENANT I Expansion tank 12.51
Name:City of Tigard Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address: 13125 SW Hall Blvd
_ Garbage disposal 25.02
City/State/ZIP:Tigard,OR 97223 Hose bib 25.02
Phone:(503)718-2466 Fax:( ) Ice maker 12.51
® APPLICANT ❑ CONTACT PERSON Interceptor/grease trap 25.02
Business name:City of Tigard Medical gas(value:$ ) Page 2
Primer 12.51
Contact name:Jeff Peck
Roof drain(commercial) 12.51
Address: 13125 SW Hall Blvd Sink/basin/lavatory 25.02
City/State/ZIP:Tigard,OR 97223 Solar units(potable water) 62.54
Phone:(503)718-2466 Fax::( ) Tub/shower/shower pan 12.51
E-mail:jeffp @tigard-or.gov Urinal 25.02
l Water closet 25.02
CONTRACTOR
I Water heater 37.52
Business name: Or/
\ - Water piping/DWV 56.29
Address: t 1,7c Sw •-rgrmtA5TA rd Pveib Ll3")- Other: 25.02
City/State/ZIP: /-L jt-vet / p r- Cr7vol �" Subtotal 212.63
Phone:(, ) 36 7_39V 3 Fax:(9:5 ) Li �y W Minimum permit fee: $72.50
CCB Lie.: Plumbing Lic.no.: ,Q/� - Plan review (25%of permit fee) �-
12��1 i V pi g P �36r
State surcharge(12%of permit fee) 25-.5 2
Authorized signature: -mill TOTAL PERMIT FEE g.15".
Print name: Jo I.-t 6Q r t,o Date: /o/1/,`�O I'3 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\Permits\PLMU-PermitApp.doc 10:01/09 440-4616T(1O'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: - I Permit Fee:
Footing drain- I" 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' I 62.54 62.54 Medical Gas Systems:
Water Service-each additional 100' I 37.52 37.52
Valuation: Permit Fee:
Storm&Rain Drain- Ist 100' I 62.54 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
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 $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/ Plan review is required for any of the following.
Work Performed: Capped Added Relocate
Please check all that apply.
y g
Baptistry/Font
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 OAR9I 8-780-0040.
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 g q g
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:
I:\ENG\l -Active Projects\92022 Jack Park\Permits\COT Bldg DepartmeT\PLMU-PermitApp.doc
lig 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