Permit (154) CITY OF TIGARD PLUMBING PERMIT
■ ' COMMUNITY DEVELOPMENT Permit#: PLM2016-00588
Tigard Hall Bl
SW H
13125 ay ., and OR 97223 503.718.2439 Date Issued: 11/30/2016
t_f c Alt Dg Parcel: 2S104DC05800
Jurisdiction: Tigard
Site address: 13950 SW ALPINE CREST WAY
Project: Bull Mountain Park Subdivision: None Lot: None
Project Description: Site utilities for new park. 90'of storm line.200'of water service&(1)back flow preventer.
Contractor: 1ST CALL PLUMBING&DRAIN CLEANING LLC Owner: CITY OF TIGARD
6615 SE 42ND AVE 13125 SW HALL BLVD
PORTLAND, OR 97206 TIGARD, OR 97223
PHONE: 503-639-4171
PHONE: 971-409-7463
FAX: 503-961-7108
FEES
Quantity Description Date Amount
90 If Storm Sewer 11/30/2016 $62.54
Specifics: 200 If Water Service 11/30/2016 $100.06
1 ea Backflow Preventer 11/30/2016 $31.27
Type of Use: COM 1 12%State Surcharge- 11/30/2016 $23.26
Class of Work: ALT Plumbing
Type of Const:
Occupancy Grp:
Stories:
Total $217.13
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 ques •. : ` C by calling 503.232.1987 or 1.800.332.2344.
Issued :y: ' Permittee Signature: ���t(/
r /
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.
robing Permit A plication
Site Utilities FOR orrlcI 1 SF Oyl.l'
Received
13125 W Hall Btvd.,Tigard,(5)0R3.
R 97223 Date/By: I, /9j[? /(p , Permit No.: 11L11 jy�- '
II-. Phone: 503.718.2439 Fax: 503.598.1960 Plan Review ( Other Permit No.:
DaDate/By: per la-et:01:.,
Z.1 G,,,p n Inspection Line.503.639.4175 Date Ready/By: Juris: See Page 2 for
Internet: www.tigard-or.gov Notified/Method' Supplemental Information
tes
s = ...k 6£ Vett ti �::11.4::;;..:(--tI 1.
®New construction 0 Demolition For special information use checklist.
Description I Qty. I Ea. I Total
0 Addition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
1 'l °
SFR(1)bath
. ax a 4 n 'it 6 y 312.70
0 1-and 2-family dwelling g Commercial/industrial SFR(2)bath 437.78
0 Accessory building ❑Multi-family SFR(3)bath - 500.32
Each additional bath/kitchen 25.02
0 Master builder 0 Other: Fire sprinkler( sq.ft.) Page 2
,j, .%<a' P s e F t r A., ;.A`, Site utilities:
Job site address:13950 SW Alpine Crest Way Catch basin or area drain 18.76
Drywell,leach line,or trench drain 18.76
City/State/ZIP:Tigard,OR 97223
Footing drain(no.linear ft.:_) Page 2
Suite/bldg./apt.no.:N/A I Project name:Bull Mountain Park Manufactured home utilities 50.03
Cross street/directions to job site:West on SW Walnut St from Hwy 99W Manholes 18,76
Turn south onto SW 132"i Ave from Walnut. 132"d Ave turns into SW Greenfield Drive. Rain drain connector 18.76
(Rt)or SW onto SW Morning Star Drive. West onto SW Woodshire Drive to terminus Sanitary sewer(no.linear ft.:_) Page 2
Storm sewer(no.linear ft.:90) 1 Page 2 62.54
of roadway.
Water service(no.linear ft.:200) 1 Page 2 1 105.06
Subdivision:N/A I Lot no.:N/A Fixture or item:
Tax map/parcel no.:2S104DC05800 Backflow preventer 1 31.27 31.27
`•� 1:: ' DE RIPT O]V 9 : 'OR l. Backwater valve 12.51
Clothes washer 25.02
installation of 4"storm pipe to drain away from Nature Play playground area 25.02
Dishwasher
Installation of 1"water pipe and backflow device to new drinking fountain and Drinking fountain 25.02
Hose bib Ejectors/sump 25.02
:'� .® PR PERT\' WAVER ' ' ❑'T` NT Expansion tank 12.51
Name:City of Tigard Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address: 13125 SW Hall Blvd
Garbage disposal 25.02
City/State/ZIP:Tigard,OR 97223 Hose bib 25.02
Phone:(503)718-2466 Fax:( ) Ice maker 12.51
` PP tl 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
g .a ,; r Water closet 25.02
Iiritli .. « . e ' y is a,.' a, Water heater 37.52
Business name: I -4' Leal t1_J-_ 3t.A. Water piping/DWV 56.29
Address: tetI S _E., 1.4 p_'S-- Pt0e_ Other: 25.02
City/State/ZIP: ,fir Ll�1,,Y-1CDR.. q 7 P-o Ito Subtotal 193.87
Phone:9-7/ ) l 1_'7q6?). Fax:( ) Minimum permit fee: $72.50
CCB Lie.: l q S 4�O Plumbing Lic.no.: ri j j Plan review (25%of permit fee)
State surcharge(12%of permit fee)
Authorized signature:)9V4((Wie
q TOTAL PERMIT FEE c39/ t(f
Print name:V 11.2_6 t^j k R__I Date,l i gc{ This permit application expires if a permit is not obtained within 180 days
F7 . e� IIILLL��A after it has been accepted as complete.
"Fee methodology set by Tri-County Building Industry Service Board.
I:\Building\Permits\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 S stems:
Footing drain-l a`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' 1 62.54 62.54 Medical Gas Systems:
Water Service-each additional 100' 1 37.52 37.52 - _
Storm&Rain Drain-1st 100' 1 62.54 62.54 � 'E ,r wa
$1.00 to$5,000100 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 a each additional$100.00 or fraction thereof,to
t t 1-4.11b 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 char_e-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 char:e-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 char:e-1/2 hour) each additional$100.00 or fraction thereof.
Subtotal: ___
Other Fixtures:
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*.
�; Quantity by Fixture Type
Fixture Type for e, '14 s Replace/
Work Performed.# r Capped Added Relocate
PlaICA evfor Plambing Installation =
BaptistryFont Plan review is required for any of the following.
Bath -Tub/Shower Please check all that apply.
-Jacuzzi/Whirlpool ❑ Any new commercial building with water service 2"and
Car Wash -Each Stall greater,except systems designed and stamped by licensed
-Drive Thru engineer.
Cuspidor/Water Aspirator ❑ New exterior plumbing site utilities for any complex structure
Dishwasher -Commercial as defined in OAR918-780-0040.
-Domestic ❑ Medical gas and vacuum systems for health care facilities.
Drinking Fountain ❑ Any multipurpose fire sprinkler system.
Eye Wash ❑ Any complex structure as defined in OAR918-780-0040.
Floor Drain/sink -2"
3„ _ Submit 2 sets of plans with any of the above.
-4,
Car Wash Drain f i, .4,t
Garbage -Domestic-non-food -` 4- 0 .,., .rl,O.. 1 m 'lJla d
Disposal -Domestic-food related ❑ Isometric or riser diagram is required for new buildings
-Commercial-food related that meet the qualifications above.
-Industrial-food related
Ice Mach./Refrig.Drains
Oil Separator(Gas Station)
Rec.Vehicle Dump Station Comments regarding fixture work:
Shower -Gang
-Stall
Sink/Lay -Non-food related
-Bradley
-Commercial-food related
-Service
Swimming Pool Filter
Washer-Clothes
Water Extractor *Note: If the fixture work under this permit results in an
Water Closet-Toilet increase of sewer EDUs,a sewer permit will be issued and
Urinal fees assessed for the sewer increase must be paid before the
I:\ENG\1 -Active Projects\92052 Bull Mountain Park ADA path\Design\I rmitting\City Applications\Unrestricted Access to
Permits\PLMU_PermitApp_Bull Mtn Park.doc