Permit (90) CITY OF TIGARD PLUMBING PERMIT
' s' COMMUNITY DEVELOPMENT Permit#: PLM2016-00243
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 05/05/2016
T I c 9 Parcel: 1S135CC03300
Jurisdiction: Tigard
Site address: 10050 SW TIGARD ST
Project: CSC CAP HOLDING LLC Subdivision: GREENBURG HEIGHTS ADDITION Lot: 11
Project Description: Sewer connection for newly relocated house,approximately 40'of sewer line. Septic tank to be pumped and filled
or removed.
Contractor: GROW CONSTRUCTION LLC Owner: CSC CAP HOLDING LLC
7900 SW HUNZIKER ST BY GRAY,TIMOTHY
TIGARD, OR 97223 22846 SW LODGEPOLE AVE
TUALATIN, OR 97062
PHONE: 503-597-2425 PHONE:
FAX:
FEES
Quantity Description Date Amount
40 If Sanitary Sewer 05/05/2016 $62.54
Specifics: 1 12%State Surcharge- 05/05/2016 $8.70
Plumbing
Type of Use: SF 10 ea Minimum Fee Adjustment- 05/05/2016 $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 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.
Issue By: / Permittee Signature:
Call 503.639.4175 by 7:00 a.m.for the next available inspection d e.
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 Foz oFFlcl: tsiON!I
City Of Tigard RErrWEDaceiBd SIlDate/By: Jo (��`) Permit No.:
�/�. V3
11111 13125 SW Hall Blvd.,Tigard,OR 97223
. Plan Review
Phone: 503.718.2439 Fax: 503.598.19 Other Permit No. /�04**C6/440
Inspection Line: 503.639.4175 VIM! U 5 2016 Date/By:
l I c ;1 R I) Date Ready/By: Juris: ® See Page 2 for
Internet: www.tigard-or.gov Notified/Method: Supplemental information
w. ¢ amour = +as
4gi �d. ,8� . x :Ir.:Yj,!4-,!,',;.'h gt _; r -':4 x din.'..- ,i,�yr"'pit `t` "'s.. yp;` `. 3l, 's ,'"' . r'+,�`.r,,.,-,-.
+' ra ,.. 4,.,a,* � 4.,,. i:,:. _: `s - '.r r = i If; .0.`� .. ,..,,:v .,. .�..a�� r. .e,,.ov4.:v '� . '' :ern
0 New construction Iii O PPr I -II 111`t For special information use checklist.
Description Qty. Ea. Total
tl Addition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
, $ vn ,, ciff .: 4t, 1 .-r;. t ta rt z .'r3Ptt
SFR(1)bath 312.70
1-and 2-family dwelling ElCommercial/industrial SFR(2)bath 437.78
0 Accessory building 0 Multi-family SFR(3)bath 500.32
Each additional bath/kitchen 25.02
❑Master builder 0 Other:
Fire sprinkler( sq.ft.) Page 2
' ` r .. @ 5 z Site Utilities:',.K,:,. ,. t �E A . r 'tt 4'-,:r ''; „
Catch basin or area drain 18.76
Job site address:
Q OlcQ S 1 Civi,C p i STDrywell,leach line,or trench drain 18.76
City/State/ZIP: -"(70-p§414) 6'1- `I"1 x/1.3 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
f ,•M S„- ..t.-....Xit: �t� Rain drain connector 18.76
J '" Sanitary sewer(no.linear ft.:40 ) Page 2
Storm sewer(no.linear ft.:_) Page 2
Water service(no.linear ft.:_) Page 2
Subdivision: 1 Lot no.: Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
77:71tx .. t. `i sP o? Backwater valve 12.51
-3tn .4 : w4',A..,x, ,.rrc .r .. ..&::-. .x 2,-,,;:, Z.,.= <..,. ,. Ytki L,41, 4, ao :< '
Clothes washer 25.02
14E.t, µA-IN LtA eyl0'tk i`A''ll-t`�t 7o Dishwasher 25.02
t Q5T Sl ( It- d f(cU Drinking fountain 25.02
Ejectors/sump 25.02
f;Ts w �f »)
$ f.t6 s Y v
s f a ' ' Expansion tank 12.51
--I/44A
Fixture/sewer cap 25.02
Name: /' ✓4'l Gey
Address: /Oil?U r4,. '7"„ 5- Floor drain/floor sink hub 25.02
p l Garbage disposal 25.02
City/State/ZIP: 7-;-, , 0 f, 17 2'2.3 Hose bib 25.02
Phone:( ) Fax:( ) Ice maker 12.51
.:i - s tp � i. 61PJ' � rN ' Interceptor/grease trap 25.02
,t aII."4 i : Brn3 .i,. S' ✓ >.r�X
Business name: Medical gas(value:$ ) Page 2
Contact name: Primer 12.51
��M � �� Roof drain(commercial) 12.51
Address: /0/290 ri / 74 S'/ Sink/basin/lavatory 25.02
City/State/ZIP: / 'f Ok f 7 27-3 Solar units(potable water) 62.54
Phone:(51?) f 3-5"s-�3 ? Fax::( ) Tub/shower/shower pan 12.51
E-mail: Urinal 25.02
,°,7-r� " � 4 s *s a `;" pl ..ar• �< rn ah
Water closet 25.02
� : t . ' 0t: . ze.r� _Yd ." rSu ,a.i'-- ;,l il ae.
water hearer 37.52
Business name: V�� dlA 0...,;e_, vL
'Tle'N c--- Water piping/DWV 56.29
Address: bZ454o 5,. g-‘v f In Other: 25.02
rt
City/State/ZIP: ,,�S/,„ c, e� '7 t j,3 Subtotal
Phone:(Z3.35 ) `�� _712 4c., Fax:( ) Minimum permit fee: $72.50 72..5
Plan review (25%of permit fee) ---
CCB Lic.: 0 i 4 9 L Plumbing Lic.no.: -
/A/ - State surcharge(1T %L fee)
EE Ff 70
Authorized signature: ,(La.,y/ TOTAL PERMIT FEE g'/,9-6
Print name: A , ✓,r`0[,5 ✓A - Date:5-1 1 I 1 4, This permit application expires if a permit is not obtained within 180 days
I( after it has been accepted as complete.
*Fee methodology set/�by�Tri-County Building Indust Service Board.
I:Building.Permits`.PLMU-PermitApp.doc 1001'09 440-4616T(1002COM-WEB) � E4 *JA)gd r?O �!'�� •f3f7
* 6- 47.2-15
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems
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 vh, A , **
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
i n, 1101# each additional$100.00 or fraction thereof,to
,« . 4- , 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*. 7.} s ) i1/+" ` : mugs ° " . :#dOii
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 ❑ Any new commercial building with water service 2"and
Baptistry/Font greater,except systems designed and stamped by licensed
Bath: -Tub/Shower
engineer.
-Jacuzzi/Whirlpool
Car Wash: -Each Stall 1=1 New exterior plumbing site utilities for any complex structure
Drive as defined in OAR918-780-0040.
Cuspidor/Water Aspirator 0 Medical gas and vacuum systems for health care facilities.
Dishwasher: Commercial
0 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"
4„ ❑ 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
-Copn/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
Water Closet-Toilet plumbing permit can be issued.
Urinal
Other Fixtures:
1:ABuilding\Pernits\PLM F_PermitApp.doc 08/04/2011 2
Location:
Record Type:
Inspection Type:
Result:
Comments:
Inspection Date:
Record ID:
Inspector:
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
10050 SW TIGARD ST, TIGARD, OR, 97223
Residential - Plumbing
399 Plumbing final
PASS - No C of O
PLM2016-00243
David Young
Septic tank cover approved, see previous inspection.
Violation Summary:
Inspector Contractor