Permit 4 CITY OF TIGARD PLUMBING PERMIT
1111 2' COMMUNITY DEVELOPMENT Permit#: PLM2013-00357
Date Issued: 10/15/2013
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 2S102CD02706
Jurisdiction: Tigard
Site address: 9695 SW OMARA ST
Project: Worley Subdivision: FREWING'S ORCHARD TRACTS Lot: 27
Project Description: Replace approximately 150'of water service,from meter to house.
Contractor: OWNER Owner: WORLEY, MARTHA W
MARTHA WORLEY 9695 SW O'MARA
9695 SW OMARA ST TIGARD,OR 97223
TIGARD,OR 97223
P
PHONE: 503-639-6563
PHONE: 503-639-6563
FAX:
FEES
Quantity Description Date Amount
150 If Water Service 10/15/2013 $100.06
Specifics: 1 12%State Surcharge- 10/15/2013 $12.01
Plumbing
Type of Use: SF
Class of Work: ALT
Type of Const:
Occupancy Grp:
Stories:
Total $112.07
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 'cation .-nter. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
or •ect questions to• NC by calling 503.232.1987 or 1.800.332.2344.
I ued By: / /. Po Permittee Signature: x /�
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.
`ire
Plumbing Permit Application-, l,,
IvvlolAtu QNIO1Iif
Site Utilities (JHN91! 10 A110 FOR OFFICE USE ONLY
lig City of Tigard 1 Received /G / L/7�oi3 D0 75.7
q 13125 SW Hall Blvd.,Tigard,OR 9'h23 Z 5 1 130
Date/By: Permit No.: J
Phone: 503.718.2439 Fax: 503,598.1960 Plan Review
® Other Permit No.:
y q.,_Ta.p Date/By:
Inspection Line: 503.639.4175 � ) s' ```'''���
1 l q It L7 ,+1�I I ll l I Date ed/Met Ready/By: Juris: Supplemental See Page 2 for
Internet: www.tigard-or.gov Notified/Method: Information
TYPE OF WORK FEE* SCHEDULE •
0 New construction 0 Demolition For special information use checklist
Description I 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
•
❑ 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
ji]Master builder ❑Other: Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION . Site utilities:
Job site address: q‘ (S- S.w i]'F�eV a Catch basin or area drain 18.76
City/State/ZIP:-T--y �/ (92_ Drywell,leach line,or trench drain 18.76
Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: I Project name: Manufactured home utilities 50.03
Cross street/directions to job site: Manholes_ 18.76
Rain drain connector 18.76
Sanitary sewer(no.linear ft.: ) Page 2
Storm sewer(no.linear ft.: ) Page 2
Water service(no.linear ft.:/SJ) ( Page 2 /OQ.6P
Subdivision: I Lot no.: Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
j y Clothes washer 25.02
'rep/�C e wc�-4 e,r jt, cry M�l<4 Tv of e- Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
y.
Er PROPERTY OWNER I 0,TENANT Expansion tank 12.51
Fixture/sewer cap 25.02
Name: 1t/ a,o 4 l,,Ot ( ,,v,t,0...1 .
Floor drain/floor sink/hub 25.02
Address: S ,e Garbage disposal 25.02
City/State/ZIP: Hose bib 25.02
Phone:(S.9 ) 6).e _6513 Fax:( ) Ice maker 12.51
[7f APPLICANT' OCONTACT PERSON Interceptor/grease trap 25.02
Business name: Medical gas(value:$ ) Page 2
Contact name: ,o� �DQ/61 Roof (commercial)) 12.51
Roof drain commercial 12.51
Address: p r
S�6' .� dy f� S� Sink/basin/lavatory 25.02
City/State/ZIP: 2t1 r'.A D K. 4'1 1(3 Solar units(potable water) 62.54
Phone:(So) ) '7,L0 ('613 Fax::( ) Tub/shower/shower pan 12.51
E-mail: Urinal 25.02
Water closet 25.02
CONTRACTOR . '
fl)tr,//��- Water heater 37.52
Business name: ip
Water i in WV 56.29
Address: Other: 25.02
City/State/ZIP: Subtotal 760.op
Phone:( ) Fax:( ) Minimum permit fee: $72.50
CCB Lic.: Plumbing Lic.no.: Plan review (25%of permit fee)
State surcharge(12%of permit fee) /A .of
Authorized signature: �(/{ TOTAL PERMIT FEE a
Print name: ✓ ��„1 (� (� Date:�Svci t 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.
•
1:\Building\Permits\PLMU-PermitApp.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
Sewer- 1st 100' 3,601 to 7,200 $233.20
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
Storm&Rain Drain-1st 100' 62.54 Valuation: Permit Fee:
$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/
•
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.
4 Isometric or Riser Diagram
Car Wash Drain
Garbage Domestic-non-food ❑ Isometric or riser diagram is required for new buildings
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
Washer-Clothes *Note: tithe 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 plumbing permit can be issued.
Other Fixtures:
I:\Building\PermitsWLMU-PermitApp.doc 2
I" Site Utilities — Plumbing Permit Application
0
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.
1:Building\Permits\PLMF-PermitApp.doc 12/30/05