Permit CITY OF TIGARD PLUMBING PERMIT
M �� R3
" COMMUNITY DEVELOPMENT Permit#: PLM2017-00264
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 07/05/2017
Parcel: 2S 109DA15600
Jurisdiction: Tigard
Site address: 15346 SW GREENRIDGE PL
Project: Kent Subdivision: ARLINGTON HEIGHTS NO.3 Lot: 75
Project Description: Replace 30'of sanitary sewer line.
Contractor: BLACK ROCK UNDERGROUND LLC Owner: KENT FAMILY HOMES INC
267 NE 34TH PLACE 3 MONROE PKWY STE P 435
HILLSBORO, OR 97124 LAKE OSWEGO, OR 97035
PHONE: 503-747-9312 PHONE:
FAX: 503-214-5886
FEES
Quantity Description Date Amount
30 If Sanitary Sewer 07/05/2017 $62.54
Specifics: 1 12%State Surcharge- 07/05/2017 $8.70
Plumbing
Type of Use: SF 10 ea Minimum Fee Adjustment- 07/05/2017 $9.96
Class of Work: ALT Plumbing
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. Y. ay obtain a copy of the r es
or direc :.es ion •UNC by calling 503.232.1987 or 1.800.332.2344.
Issu•d By: Permittee Signature:
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 Applic4RECEIVEP
Building Fixtures n FOR OFFICE ISE ONLY
- City of Tigard J U L 5 20Received 5-/7 /,
NI III 13125 SW Hall Blvd.,Tigard,OR 97223
Date/By: Permit No.: �L� J�7
Phone: 503.718.2439 Fax: 5(e ` F'ft ICARD Plan Date/By:
vie
Date/BOther Permit No.:
T I G A R D Inspection Line: 503.639.4175
Internet: www.tigard-or.gov BUILDING DIVISION Date Ready/By: funs: (a See Page for
Notified Method: Supplemental Information
TYPE OF WORK FEE* SCHEDULE
❑New construction 0 Demolition For special information use checklist
Description I Qty. Ea. I Total
\gji6.icldition/alteration/replacement ❑Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(1)bath 312.70
V 1-and 2-family dwelling ❑Commercial/industrial SFR(2)bath 437.78
❑Accessory building 0 Multi-family SFR(3)bath 500.32
0 Master builder Each additional bath/kitchen 25.02
❑Other: Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMATION AND.LOCATION Site utilities:
Job site addressCatch basin or area drain 18.76
1 5'SCS(�ee.V\t`,�qe Drywell,leach line,or trench drain 1836
City/State/ZIP:--c; ( O�
Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: Project name: K f-) I--
Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
Rain drain connector 18.76
Sanitary sewer(no.linear ft.:2i ) 1 Page 2
Storm sewer(no.linear ft.:_) 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; !OI.K Backwater valve 12.51
• ,m, Clothes washer 25.02
P,v`QR' •I - \ �Q'��at . c\A 9,KV•NA-CPm )R,V.Itc- Dishwasher 25.02
ST(GV\ )v\ C.'« O V\r, o \-\&t, Vokr‘t,ko \- Drinking fountain 25.02
(1\\N• Ejectors/sump 25.02
rg 'rv'❑?PRO E OWNERi' TENANT " Expansion tank 12.51
Name: '��C�T r"jL'/l,11 P .)1 f�L}lidfC5 ilJ Fixture/sewer cap 25.02
Address: Floor drain/floor sink/hub 25.02
Garbage disposal 25.02
City/State/ZIP:
Hose bib 25.02
Phone:( ) Fax:( ) Ice maker 12.51
uk, "*:0 APP IC 1g- NAC PERSON , Interceptor/grease trap 25.02
ONc�\L Medical gas(value:$ ) Page 2
Business name: ��� �V'�t-f j o i L LC_ Primer 12.51
Contact name: •
d`e.W c., R
Roof drain(commercial) 12.51
Address: fk(a A N E ���� �D\
\ Sink/basin/lavatmy 25.02
City/State/ZIP: \\'.\S\_(1,c,o 1 IzI12.. i C` `FL\ Solar units(potable water) 62.54
Phone:(C0s3) 11 a 0 O \/N Fax:_:( ) Tub/shower/shower pan 12.51
Email: 1 ACCO Eb\Ac-k('o �►NIV a.i` rON .cat-. Urinal 25.02
3
e. ra CTOR.: ' ur ., Water closet 25.02
'^ `', " _ ,. .,,_ . Water heater 37.52
Business name: R U �
J _ Water piping/DWV 56.29
Address:
Other: 25.02
City/State/ZIP: Subtotal
Phone:( ) Fax:( ) Minimum permit fee: $72.50 79,S
CCB Lie.: \�o``0 Plum ng Lic.no.: Q16 ` LAr-) Plan review (25%of permit fee)
_\ v State surcharge(12%ofpermit fee) (+7t
Authorized signature:
7.;:;20(
TOTAL PERMIT FEE V,
Print name: „`_ . , Date:1\5 4.)...41,� This permit application expires if a permit is not obtained within 180 days
�+W L�Q"" after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
I:\Building\Permits\PLMU-PermitApp.doc 10/01/09 440-4616T(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) TotalSquare Footage: Permit Fee:
Footing drain-ls`100' 50.03 0 to 2,000 $121.90
2,001 to 3,600 $169.69
Footing drain-each additional 100' 37.52 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
accurately report fixtures could result in increased sewer fees*. Plan eview 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 ❑ 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 0 Medical gas and vacuum systems for health care facilities.
Cuspidor/Water Aspirator 0 Any multipurpose fire sprinkler system.
Dishwasher: -Commercial 0 Any 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" � , omel c ,T.: ser iagrai
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 Comments regarding fixture work:
Ice Mach./Refrig.Drains
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 plumbing permit can be issued.
Water Closet-Toilet
Urinal
Other Fixtures:
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