Permit CITY OF TIGARD PLUMBING PERMIT
1111 _ .,, Permit tt: PLM2014-00020
COMMUNITY DEVELOPMENT
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 01/22/2014
Parcel: 2S109AB00600
Jurisdiction: TIGARD
Site address: 14031 SW ALPINE CREST WAY
Project: Otis Subdivision: ELK HORN RIDGE ESTATES Lot: G
Project Description: Connect existing house to sewer service. Septic tank to be decommissioned.
Contractor: STRAUSS EXCAVATING Owner: OTIS, BRIAN D& LORRAINE M
3671 SW 229TH AVE 14031 SW ALPINE CREST WAY
BEAVERTON. OR 97007 TIGARD, OR 97224
PHONE: 503-649-8117 PHONE 503-504-2185
FAX:
FEES
Quantity Description Date Amount
40 If Sewer Service 01/22/2014 $62.54
Specifics: 1 12%State Surcharge- 01/22/2014 $8.70
Plumbing
Type of Use SF 10 ea Minimum Fee Adjustment- 01/22/2014 $9.96
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
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 t3 ` (26,{� '•, ,/ C , Permittee Signature:
Alf ��r 4Z F/L/ /Y� �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 Appli l IQ 9NIQ'III1B
Building Fixtures GUN/911M)A1I3 FOR OFFICE USE ON 15
113x 1 11 City of Tigard Rtr� �, N'df Dattee/By- f cr/- ) ` Permit No.: iLhlo'�D/' /ICJ
13125 SW Hall Blvd.,Tigard 0
Plan Review `,,,A��
Phone: 503.7182439 Fax: 503.598.1960 Other Permit No.: 7
DatelBy:
Inspection Line: 503.639.417 ^ Date Read B Juris: ® Set Page 2 for
I i c n K n Internet: www.ti and-or. o /�IAJ3� Ready/By: cnt
8 8 [ 11 Notified/Method: Suppkneatal Information
TYPE OF WORK FEE* SCHEDULE
❑New construction ❑Demolition For special information use checklist
Description L Qty. I Ea. [ Total
❑Addition/alteration/replacement ❑Other. New I-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(1)bath 312.70
❑ 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: Fire nkler
spri L _.sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
lob site address: /yD3/ SW ,4GP/N La CQiST 4jf, / Catch basin or area drain 18.76
City/State/ZIP: Tlq �/ -Drywell,leach line,or trench drain 18.76
��ip��j OR �IT Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: Project name: pro's Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
Rain drain connector 18.76
Sanitary sewer(no.linear fL:Yb) Page 2
Storm sewer(no.linear ft.: ) Page 2
Water service(no.linear ft.: Page 2
Subdivision: l Lot no.: Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 25.02
2Na/gL'T Tb tEX/sr/A/4i S4-/U/TAtAy/ Dishwasher 25.02
6"4E WLE L,,¢-Tas R4 L. Drinking fountain 25.02
Ejectors/sump 25.02
I[7 PROPERTY OWNED I ❑ TENANT Expansion tank 12.51
Name: 3,e/4N if Lazy /�E 0771 Floo
Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address: /p.03/ ,s w A-ipmi e &DES r ,c/ Garbage disposal 25.02
City/State/ZIP: 74,9/2Z Q,C 7,01 Hose bib 25.02
Phone:(503) 5 1_eVe,t- Fax:( - Ice maker 12.51
❑ APPLICANT ❑ CONTACT PERSON Interceptor/grease trap 25.02
Business name: Medical gas(value:S ) 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: 5-trt. SS iSoctt_y1 44-1,,t 'a( Water piping/DWV 56.29
Address: 3 6-7 , sk,,,, 7 25 t'~ I\.nC.-J Other: 25.02
City/State/ZIP 3 Qr c'l(��7 Subtotal
V Minimum permit fee: $72.50 7a
Phone:( ) (a�(4-�'/!? Fax:(513 ) G t(4-Er/(7 Plan review (25%of permit fee) r'
CCB Lic.: 3 Z v 7 Plumbing Lic-no.3'I-Y Li r PR
State surcharge(12%of permit fee) $�70
Authorized signature: TOTAL PERMIT FEE g( ,ot?
Print name:�/ �(� �' I Date: 1� This permit application expires if a permit is not obtained within ISO days
W f1 2A-/ I after it has been accepted as complete.
*Feee1�/lethodology set by Tri aunty uildCinng Inn�dustry Service Board.
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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-la 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:
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
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/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*. - 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
El Any new commercial building with water service 2"and
greater,except systems designed and stamped by licensed
Bath: -Tub/Shower
-Jacuzzi/Whirlpool engineer.
Car Each Stall ❑ New exterior plumbing site utilities for any complex structure
Drive tall as defined in OAR918-780-0040.
Cuspidor/Water Aspirator ❑ Medical gas and vacuum systems for health care facilities.
Dishwasher. Commercial ❑ Any multipurpose fire sprinkler system.
Domestic ❑ 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
Garbage -Domestic non-food that meet the qualifications above.
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
WaterCloset-Toilet plumbing permit can be issued.
Urinal
Other Fixtures:
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