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Permit
qCITY OF TIGARD PLUMBING PERMIT *,. COMMUNITY DEVELOPMENT Permit#: PLM2016-00070 T WARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 02/10/2016 Parcel: 2S103BB13600 Jurisdiction: Tigard Site address: 12600 SW 124TH AVE Project: Herman Subdivision: 2015-031 PARTITION PLAT Lot: 2 Project Description: Install 100'of storm sewer service. Contractor: PIPE REPAIR SERVICES Owner: HERMAN, JENNY L&LAWRENCE S PO BOX 5603 12600 SW 124TH AVE PORTLAND, OR 97228-5603 TIGARD, OR 97223 PHONE: 503-701-9625 PHONE: FAX: 503-772-9220 FEES Quantity Description Date Amount 100 If Storm Sewer 02/10/2016 $62.54 Specifics: 1 12%State Surcharge- 02/10/2016 $8.70 Plumbing Type of Use: SF 10 ea Minimum Fee Adjustment- 02/10/2016 $9.96 Plumbing Class of Work: ALT Type of Const: Occupancy Grp: Stories: Total $81.20 Required Items and Reports(Conditions) This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the r - •... _. by the Oregon Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. .0 may obtain a cop of the rules • or d - questions o :• C by cal 503.232.1987 or 1.800.332.2344. Issued By: Permittee Si.. ure: Call 503.639.4175 by 7:00 a.m.for the next available inspection • This permit card shall be kept in a conspicuous place on the job site unt '•mpletion of the project. Approved plans are required on the job site at the tim• = each inspection. c/" Plumbing Permit Application Building Fixtures RECEIVED City of Tigard Receivedy /a b Pennit No.:pi r-/�1/_�vM)ZQ .11114 81 13125 SW Hall Blvd.,Tigard,OR 97221- : 722 Date/By: �r/ (v Com" Phone: 503.718.2439 Fax: 503.598.14-6B1 Plan Review 8 0 2016 Date/By: Other Permit No.: Inspection Line: 503.639.4175 1 1 I e Page 2 for Internet: www.tigard-or.gov CITY OF 7IGAR N tified/MeDathod: Juris: Supplemental FZI Information f TYPE OP; DING = ' ' FEE*SCHEDULE ❑ wOthconstruction 0 Demolition For special information use checklist Description Qty. I Ea. I Total p ❑ er: New 1-2-family dwellings(includes 100 ft.for each utility connection) Addition/alteration/re lacement £AT*GORV 1)'C I$i'RU�©N SFR(1)bath 312.70 1-and 2-family dwelling ❑Commercial/industrial SFR(2)bath 437.78 El Accessory buildingSFR(3)bath 500.32 0 Multi-family Each additional bath/kitchen 25.02 0 Master builder 0 Other: Fire sprinkler( sq.ft.) Page 2 JOB SITE INFORMATION AND LOCATION Site utilities: Job site address: ,b 2 /O 0 C /2 // Catch basin or area drain 18.76 ✓ 7 Drywell,leach line,or trench drain 18.76 City/State/ZIP: 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 4 `L- (i Y 0 7 Rain drain connector 18.76 / Sanitary sewer(no.linear ft.:_) Page 2 Storm sewer(no.linear ft.: /(70) / Page 2 Water service(no.linear ft.: ) Page 2 Subdivision: Lot no.: Fixture or item: Tax map/parcel no.: Backflow preventer 31.27 DESCRIPTION OF WORK Backwater valve 12.51 Clothes washer 25.02 Dishwasher 25.02 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 25.02 Phone:( ) Fax:( ) Ice maker 12.51 0'APPLICANT 0 CONTACT PERSON Interceptor/grease trap 25.02 • Business name: pi7(_ /? [-/j it 5(7/ Ct__ Medical gas(value:$ ) Page 2 Primer 12.51 Contact name: o 61-- Roof drain(commercial) 12.51 Address: Sink/basin/lavatory 25.02 City/State/ZIP: Solar units(potable water) 62.54 Phone:(5 (,,3) 76,/ / 2 C Fax::('j ) 72Z 2 22 C Tub/shower/shower pan 12.51 E-mail: (// . r f 4 /AC Urinal 25.02 ' ., Water closet 25.02 OONTRAcr° Water heater 37.52 Business name: Water piping/DWV 56.29 Address: Other: 25.02 City/State/ZIP: Subtotal Minimum permit fee: $72.50 � Phone:( ) Fax:( ) 7.Z„ CCB Lic.: / ,(fr 2 , / ) Plumbing Lic.no.: %og/c)3 e Plan review (25%of permit fee) State surcharge(12%of permit fee) g.70 Authorized signature:z- TOTAL PERMIT FEE it j Print name: L /- �-� Date: /U /=�/j This permit application expires if a permit is not obtained within 180 days 1 i // /, after it has been accepted as complete. *Fee methodology set by Tri-County Building Industry Service Board. I:Building Permits PLMU-PermitApp.doc 1001'09 440-4616T)10 02 COM WEB) Plumbing Permit Application - City of Tigard Page 2 - Supplemental Information • Fee Schedule: Residential Fire Suppression Systems: Site Vit 1�s ,. , Qty. Fee(ell) Tota! : 1)o1 a ;, k; a 'P >t 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 $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 lnspectL,ons or"Fees Fee(ca) Tot>!7 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*. Plan Reiew 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 0 Any new commercial building with water service 2"and greater,except systems designed and stamped by licensed Bath: -Tub/Shower engineer. -Jacuzzi/Whirlpool Car Wash: Each Stall ❑ New exterior plumbing site utilities for any complex structure Drive as defined in OAR918-780-0040. 111Cuspidor/Water Aspirator Medical gas and vacuum systems for health care facilities. Dishwasher: Commercial 111 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*'Riser Diagram 4" 0 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/Sery/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 Water Closet-Toilet plumbing permit can be issued. Urinal Other Fixtures: I:\Building\Permits\PLMF_PennitApp.doc 08/04/2011 2