Permit CITY OF TIGARD PLUMBING PERMIT
II ' COMMUNITY DEVELOPMENT Permit#: PLM2015-00301
Date Issued: 09/14/2015
T IGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 2S102AB04500
Jurisdiction: Tigard
Site address: 12436 SW MAIN ST
Project: Tigard Wine Crafters Subdivision: KINGSTON Lot: 2
Project Description: Install 3/4 double check and a yard hydrant.
Contractor: MIKE PATTERSON PLUMBING Owner: CAPISTRANO, NICOLAS N REV LIV TR
15028 S MITCHELL LN CACH, CHRISTOPHER J
OREGON CITY, OR 97045 6003 4TH AVE NE
SEATTLE,WA 98115
PHONE: 503-632-7374 PHONE:
FAX: 503-632-5647
FEES
Quantity Description Date Amount
1 ea Backflow Preventer 09/14/2015 $31.27
Specifics: 1 ea Hose Bib 09/14/2015 $25.02
1 12%State Surcharge- 09/14/2015 $8.70
Type of Use: COM Plumbing
Class of Work: ALT 16 ea Minimum Fee Adjustment- 09/14/2015 $16.21
Type of Const: Plumbing
Occupancy Grp:
Stories:
Total $81.20
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notif - . Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
or dire• •uestions to OUN • in. 503.232.1987 or 1.800.332.2344.
Is ed By: < /4/
Y r /� �� Permittee Signature: vwvv/
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Plumbing Permit Application
Building Fixtures Fi t L n.v=D FOR OFFICE USE ONIX
City f Tigard c Received Permit No.:
't 13125 SW Hall Blvd.,Tigard,OR 97 1 P 1 4 2015 Date/BY: /7-,�//`, `,� L/7' O/S-e:;630/
Plan Review Other Permit No.:
Phone: 503.718.2439 Fax: 503,$ 1 Y
,�:-- -� Date/
By:
Line: 503.639.4175 ' ' - 1 +� Date Read B mas ® See Page 2 for
TIGARD Ready/By: g
Internet: www.tigard-or.gov ��r+;_,'. , , t Notified/Method: Supplemental Information
lik TYPE OF WORK FEE* SCHEDULE
❑New construction ❑Demolition For special information use checklist
,�,/ - Description I Qty. Ea. I Total
Ly Addition/alteration/replacement ❑Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONS�niUCTION SFR(1)bath 312.70
❑ 1-and 2-family dwelling Ey t,ommercial/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 sprinkler( sq.ft.) Page 2
SITE INFORMATION AND LOCATION Site utilities:
1y 3r_YJ SL,..) MA C7 Catch basin or area drain 18.76
Job site address: 1 J
City/State/ZIP: '�aCl,lr1( 0' C"1Z .3 Footing drain line,ne trench drain age 2
J Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: [ Project name:�,�,en la/t.)Q C r' ,LS 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.: ) Page 2
Subdivision: I Lot no.: Fixture or item:
Tax map/parcel no Backflow preventer 1 31.27
DESCRIPTION OF WORK Backwater valve 12.51
% J Clothes washer
25.02
3 4/ tll8�&� (J�LL a v�r� Dishwasher 25.02
j'���1'Ytiv� Drinking fountain 25.02
/ Ejectors/sump 25.02
❑ PROPERTY OWNER I 0 TENANT Expansion tank 12.51
Name: Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address:
Garbage disposal 25.02
City/State/ZIP: Hose bib 1 25.02
Phone:( ) Fax:( ) Ice maker 12.51
❑ APPLICANT ❑ CONTACT PERSON Interceptor/grease trap 25.02
Business name: Medical gas(value:$ ) 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
- .� Water closet 25.02
CONTRACTOR Water heater 37.52
Business name: M kR Pa I?V oR ?LA(^t1 I�p_J Water piping/DWV 56.29
Address: 19b 22 5, m, L kt I( 1A. . Other: 25.02
City/State/ZIP: 6 V e O n ('.tv Q R t1 l 0-1 S Subtotal
Phone:(G1)3) (03� s-zoc ] ( Fax:( ) Minimum permit fee: $72.50 7 . S U
CCB Lic.: v t 7`T� �+' Plumbing Lic.no.: .-' 3,-;9/0b
Plan review (25%of permit fee) _ r
�j, State surcharge(12%of permit fee) 3/.70
Authorized signature: /ivC TOTAL PERMIT FEE $
Print name: �/k� Date: II Jlc 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-PenniiApp.doc 10/01/09 440-46I6T(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
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
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
t telr n's e 0 5 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*. 011 14,14M,P15WINIFEM111141S
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
I ❑ Any new commercial building with water service 2"and
l3aptistr}/Font
greater,except systems designed and stamped by licensed
Bath: -Tub/Shower
-Jacuzzi/Whirlpool engineer.
El Car Wash: Each Stall New exterior plumbing site utilities for any complex structure
Drive Stall 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 Filer 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 plumbing Closet-Toilet P g P ermit can be issued.
Urinal
Other Fixtures:
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