Permit (24) 1111 J CITY OF TIGARD PLUMBING PERMIT
;' COMMUNITY DEVELOPMENT Permit#: PLM2016 00382
TWARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 07/14/2016
Parcel: 1S 135AD02900
Jurisdiction: Tigard
Site address: 8570 SW SPRUCE ST
Project: Faez Subdivision: None Lot: None
Project Description: Replace 40'of water service. Single service line for both units.
Contractor: GREENWATERS PLUMBING Owner: SOUD,AMY KYUNGMI
3519 NE 15TH AVE#343 SOUD, FAEZ
PORTLAND, OR 97212 8875 PIPPEN LN
PORTLAND, OR 97223
PHONE: 503-345-2979 PHONE:
FAX:
FEES
Quantity Description Date Amount
40 If Water Service 07/14/2016 $62.54
Specifics: 1 12%State Surcharge- 07/14/2016 $8.70
Plumbing
Type of Use: SF 10 ea Minimum Fee Adjustment- 07/14/2016 $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 Notifi tine Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090 ' may obtain a copy of the rules
or dire uestions to •. C •- . ing 503.232.1987 or 1.800.332.2344.
Iss
Ira. k , `/ • �� , 4 / / Permittee Signature: 1 t1 ,` '�
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 '
City of Tigard Received1111111)ISIMII,IMIIIIDate/By: 7//1.4 16 (ik.."-')Lt.s. h Permit No.: 6/6.116
. 13125 SW Hall Blvd.,Tigard,OR 97223; 1 6 C 'IL,
III
I Phone: 503.718.2439
Fax: 503.598.1960 Plan Review
Date/By: Other Permit No.:
Inspection Line: 503.639.4175 - .-.!: Date Ready/By: Juris: FZI See Page 2 for
1-
IC.ARD ,
Internet: www.tigard-or.gov Notified/Method: Supplemental Information
TYPE OF ' ': i)IiN43 IJI VISION FEE* SCHEDULE
0 New construction 0 Demolition For special information use checklist.
Description Qty. I Ea. I Total
ILISCrldition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
. ,
CATEGORY OF CONSTRUCTION SFR(1)bath 312.70
-and 2-family dwelling
0 Commercial/industrial SFR(2)bath
437.78
SFR(3)bath 500.32
El Accessory building 0 Multi-family
Each additional bath/kitchen 25.02
El Master builder 0 Other:
Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
.„,
Job site address: g 576 ( ¼J, Catch basin or area drain 18.76
6 ,
,,, ,, "spi..„,.--c---
Drywell,leach line,or trench drain 18.76
City/State/ZIP: i •sok ve a C.2.Ae.. , 17-2,.._2_3
Footing drain(no.linear ft.:_) Page 2
Suite/bldg./apt.no.: I Project name: +0,e-e___.
Manufactured home utilities 50.03
Cross street/directions to job site: 5.E., k __. 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.:q))P Page 2 60,A..5Y
Subdivision: Lot no.: Fixture or item:
Backflow preventer 31.27
Tax map/parcel no.:
•,,,,i, -4.-, _1,-1 Backwater valve 12.51
3,*„„,, 'OFSCITvribt4 OV WORK Clothes washer
.A , „ ,
25.02
i -- QYCY.C...Q Wv..1/4%_4. '52v qk e....9.-
Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
PROPERI'V OWNER': '' r6. '. Expansion tank
12.51
Fixture/sewer cap 25.02
Name:
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
O. APPLICANT . . El CONTACT PERSON Interceptor/grease trap 25.02
Business name:Gsveeti (in.. Medical gas(value:$ ) Page 2
Contact name:t\k (, Primer 12.51
kk.)(QkS CeVO )CA2:2-
Roof drain(commercial) 12.51
Address: '3 k,,c‘ 1.4 t _ S ..4cike-, 114. Q(..._ .11._34.3
Sink/basin/lavatory 25.02
City/State/ZIP: )(IAA k.(.1,A".6 0 a_ n 1/2-.1 ."?.....--- Solar units(potable water) 62.54
Phone:(SCS 1 S.""P.--.7-7 ei Fax::( ) Tub/shower/shower pan 12.51
E-mail: tik‘k/-0-...A%s 2 e.....C5.06Ack. \ ...ez,..,tv-N Urinal 25.02
Water closet 25.02
CONTRACTOR ,
‘,.% _ __.,... Water heater 37.52
Business name*.\„"VE -1" kf.....y...„, ,a_V;`OPC31 Water piping/DWV 56.29
Address: 'b kc.\ VIE. - ‘'c5 .1(71.-' Other: 25.02
City/State/Z1P:'d••• 112-'111ir V\, 0' . ../.1 2-f-2--- Subtotal
Phone:(54;.) 7)14 --,X.Ci'll Fax:( ) Minimum permit fee: $72.50 7e .5t)
CCB Lic.:Ae-1(4) i 4_Aiiiy4/7 Plumbing Lic.no.:Y.01Plan review (25%of permit fee) .---
State surcharge(12%of permit fee) g.70
1W11111114kla I 1 4
Authorized signature: s tigiaai TOTAL PERMIT FEE ?i.2.9
Print name: \)
,
.
_, Pate: "71(f
This permit application expires if a permit is not obtained within 180 days
k \.4a,.. Cia,
after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Boar .
PauldingTermits\PLMU-PermitApp.doc 10/01/09 440-4616T(l0/02/COMB)
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site Utilities . . Fee(ea) Total Square Footage: Permit Fee:
Footing drain-Pt 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
Qty
Fee ea) Total each additional$100.00 or fraction thereof,to
Other Inspections" Or"Fees ' 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
each additional$100.00 or fraction thereof.
(minimum charge-1/2 hour)
Subtotal:
Commercial Fixture Work:
Are you capping,adding or replacing fixtures? If"yes",
please indicate work performed by fixture. Failure to
,r
accurately report fixtures could result in increased sewer fees*. flan Review for Plumbing Installations tl
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 0 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 0 New exterior plumbing site utilities for any complex structure
Car Wash: -Each Stall as defined in OAR918-780-0040.
-Drive Thru
❑ Medical gas and vacuum systems for health care facilities.
Cuspidor/Water Aspirator
0 Any multipurpose fire sprinkler system.
Dishwasher: -Commercial I=1Any complex structure as defined in OAR918-780-0040.
-Domestic
Drinking Fountain Submit 2 sets of plans with any of the above.
Eye Wash
Floor Drain/sink: -2"
3" -.;Isometric or Riser Diagram x.
4"
0 Isometric or riser diagram is required for new buildings
-Car Wash Drain that meet the qualifications above.
Garbage -Domestic non-food
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
Water Closet-Toilet plumbing permit can be issued.
Urinal
Other Fixtures:
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