Permit CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit#: PLM2014-00383
T t G AR La 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 11/24/2014
Parcel: 2S102CD02704
Jurisdiction: Tigard
Site address: 13580 SW ASH AVE
Project: COX Subdivision: FREWING'S ORCHARD TRACTS Lot: 27
Project Description: Replacing 75 ft.of water service.
Contractor: SHERWOOD PLUMBING COMPANY Owner: COX, GLORIA J&CLEON M III
22718 SW MARTIN CT 13580 SW ASH AVE
SHERWOOD, OR 97140 TIGARD,OR 97223
PHONE: 503-349-5429 PHONE:
FAX:
FEES
Quantity Description Date Amount
75 If Water Service 11/24/2014 $62.54
Specifics: 1 12%State Surcharge- 11/24/2014 $8.70
Plumbing
Type of Use: SF 10 ea Minimum Fee Adjustment- 11/24/2014 $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 1.8 2344.
Issued By: rmittee Signature:
Call 4175 by 7:00 a.m.for the next available insp9ction date.
This permit card shall be kept in a conspicuous place on the job site uiftil completion of the project.
Approved plans are required on the job site at the time of each inspection.
Plumbing Permit Application
Building Fixtures �� FOR OFFICE USE ONI.\'
g OS t
City of Tigard Received / ! permit No.: n
N
et 13125 SW Hall Blvd.,Tigard,OR 97223 p 410 D to/By: II I `if &� / �'"�lk-U J3�3
i Phone: 503.718.2439 Fax: 503.598t(� f� Other Permit No.:
\N\ Date/By:
TI G A R D Inspection Line: 503.639.4175 1tV�' v Date ReadyBy: Lurie: 0 See Page 2 for
Internet: www.tigard-or.gov 11� \� ���Q`0 Notified/Method: a Supplemental Information
TYPE OF WO- fit*,- a FEE* SCHEDULE
Ils
❑N construction Ortolition 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
d 2-family dwelling ❑Commercial/industrial SFR(2)bath 437.78
building SFR(3)bath 500.32
❑Accesso ry g ❑Multi-family
Each additional bath/kitchen 25.02
❑Master builder ❑Other: Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
c
Job site address: I e Q clA) ok fe Catch basin or area drain 18.76
City/State/ZIP: �` V Q1 i 223 Doting leach line,or trench drain Page 2
t 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.: 7r) / Page 2 ,517
Subdivision: Lot no.: Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
�p i - -1-8\a,-, Clothes washer 25.02
I kbo LlU�7-e r wta- Y>"R- V Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
'PROPERTY OWNER I 0 TENANT Expansion tank 12.51
Name: C[� C' Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address: [9-,S630 S\1/ --' S Vk trIk•Je t Garbage disposal 25.02
City/State/ZIP: ;7%.-1A U ' Hose bib 25.02
Phone:( ) Fax:( ) Ice maker 12.51
APPLICANT ❑ CONTACT PERSON Interceptor/grease trap 25.02
Business name: S'A,e a a( �6 n� � c a, Medical gas(value:$ ) Page 2
Contact name: _ w a Roof drain 12.51
'l � Roof drain(commercial) 12.51
Address: *2-1 kb ) arb • CI- Sink/basin/lavatory 25.02
City/State/ZIP: Q,v.„rti A Q_ 1‘--4 Solar units(potable water) 62.54
Phone:( c) - G-`f2Cl Fax::( ) Tub/shower/shower pan 12.51
Lit Urinal 25.02
E-mail: L It V(h C.ke .Q 4'W ctic-(p(u 0h1.?045 C o`Vvtpotvly - (171/(.-
Water closet _
CONTRACTOR
Water heater 37.52
Business name: 5. , � P.,129��&) Water piping/DWV 56.29
Address: Other: [ 25.02
City/State/ZIP: Subtotal GA_97
Phone:( ) Fax:( ) Minimum permit fee: $72.50 72..9)
CCB Lic.: ?�J0 g S t CO 5 Plumbing Lic.no.: F�(�8j Plan review (25%of permit fee)
6" a2(apt,„z___,) 71 f p(i State surcharge(12%of permit fee) F_ 7 0
Authorized signature: TOTAL PERMIT FEE I 1rt
Print name: /� r (� (L(n f Date: //72477/1 This permit application expires if a permit is not obtained within 180 days
l/LJ�� 7 after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
I:\Building\Pennits\PLMU-PermitApp.doe 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' 62.54 3,601 to 7,200 $233.20
7,201 and greater $327.54
Sewer-each additional 100' 37.52
Water Service-1st 100' / 62.54 ( 5 i 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 ec
Ins tions or Fees Qty. Fee(ea) Total each additional$100.00 or fraction thereof,to
Inspections 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
Quanti ty 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 Wash: Each Stall ❑ New exterior plumbing site utilities for any complex structure
Drive tall as defined in OAR918-780-0040.
CI Cuspidor/Water Aspirator Medical gas and vacuum systems for health care facilities.
Dishwasher: Commercial 1:1 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:
I:\Building\Permits\PLMF_PermitApp.doc 08/04/2011 2