Permit (104) CITY OF TIGARD PLUMBING PERMIT
IN .
S COMMUNITY DEVELOPMENT Permit#: PLM2017-00358
T[clik RD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 08/31/2017
Parcel: 2S 103CD07400
Jurisdiction: Tigard
Site address: 13800 SW 118TH CT
Project: City of Tigard Subdivision: CREEKSIDE PARK
Lot: 4
Project Description: Extending rain drains 80 ft.to adjacent City of Tigard property for landslide repair.
Contractor: ELTING NORTHWEST INC Owner: KLETTKE FAMILY TRUST
P.O. BOX 1400 BY RICK L/N RENEE KLETTKE TRS
CLACKAMAS, OR 97015 13800 SW 118TH CT
TIGARD, OR 97223
PHONE: 503-656-0954 PHONE:
FAX:
FEES
Quantity Description Date Amount
80 If Storm Sewer 08/31/2017 $62.54
Specifics: 1 12%State Surcharge- 08/31/2017 $8.70
Plumbing
Type of Use: SF 10 ea Minimum Fee Adjustment- 08/31/2017 $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. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By:A Permittee Signature: 445 ,
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
Site Utilities F012 OFFICE USI. OyLv
City of Tigard ... { "` E Received
41 13125 SW Hall Blvd.,Tigard,OR 972 13 ERJ � Date/By: Other Permit No.:
liq
Date/By: 8/3Ili'7 //J-/.�AtJ Permit No.: 'L,f 7„ )3,,,g
= Phone: 503.718.2439 Fax: 503.598.1960 t Plan Review V
T t G A R D Inspection Line: 503.639.4175 AU VI 3
Internet: www.tigard-or.gov roc Date Ready/By: Juris: H See Page 2 for
d'10poi, Notified/Method: o Supplemental Information
TYPE OF WORK ell t}" rN0VIS1 . 0 FEE* SCHEDULE
❑New construction ❑l iblifionwle " For special information use checklist
�F a r� (includes Description
❑Addition/alteration/replacement Other: //�� Qty. I Ea. Total
171 t/1 New I-2-family dwellings 100 ft.for each utility connection)_
CATEGORY OFSCONSTRUCTION. 0>, SFR(1)bath 312.70
0 1-and 2-family dwelling 0 Commercial/industrial SFR(2)bath 437.78
❑Accessory building 0 Multi-family SFR(3)bath 500.32
❑ •�))-�
Each additional bath/kitchen 25.02
Master builder Other:La
4`4l R ( Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address1n raj ;„Le. Le tnri 13*Dµ/r' C / Catch basin or area drain 18.76
City/State/ZIP: b �. Q a 1 �-T µ,ell,leach line,or trench drain 18.76
? ! Op��''' Footingdrain(no.linear ft.:
Suite/bldg./apt.no.:�� Project na>��'� �j�-o1e•T.��101s qr►4 ) Page 2
r Manufactured home utilities 50.03
Cross street/directions to job site: Gr �' 4 4'�� � Manholes
//f1 t y
�V`� On
18.76
acka_e G tlI S C ) TUf n 01n ')044, Rain drain connector 18.76j,
- IT • a b (ocJk �/_ _ the._ S / : 1 Sanitary sewer(no.linear ft.:_) Page r4Z .54
5, W 11 lex,
O� 1�] C r yin h� �To c A ! Storm sewer(no.linear ft.: i Page 2 15.6
i- °�•e, Water service(no.linear ft.: ) Page 2
Subdivision: o r ono.:
G l� e I Lt N Fixture or item:
Tax map/parcel no.: 0 25 io 3 GC072O p Backflow preventer 31.27
Backwater valve
"�1SCRi1�'TIOI�itOF 4 12.51
„ nn�n -T� kit)/ ,/ Clothes washer 25.02
evW pF /Z PAI 1P Q V I it S gx 1 ' //ik Dishwasher
2 i2 O p PRA/Ai Od T yo 744 lC' 25.02
-TiltQ/ �/4�+� �� Drinking fountain 25.02
fZ4fe ggp l A. Ejectors/sump 25.02
s, tit
-
PROPERTY R , '" t �* 0 TENANT ' Expansion tank
p 12.51
Name: Gr T Y of -7--,, ,,,,,,,,R_.,(:), Fixture/sewer cap 25.02
Address: /'.1 29 SW I A /i !�/./y� Floor gedrdisposal/floor sink/hub 25.02
� IL,
l V/� Garbage 25.02
City/State/ZIP: / and t ,OR„ Gl 7 Z 2,3
Hose bib
Phone:(5,4„a .7/ ' Ze$9,7Fax:( ) 25.02
'4
h Ice maker 12.51
APP ICANT - CONTACT,PERSON Interceptor/grease trap,, �� c� � / � �. " �==";" I
&' 25.02
Business name: Medical gas(value:$ ) Page 2
Contact name:CT (ite,vece 6110 Ide\atAG Primer 12.51
Roof drain(commercial) 12.51
Address: 1- /2 %I A C-L_ j1�l J
Sittk/basin/lavatory 25.02
City/State/ZIP:--;ei„,,,,f 1 ez Solar units
�0 3 7( 9 3 (potable water) 62.54
Phone:(g03) _ Z 79 Q Fax::( Tub/shower/shower pan 12.51
E-mail: Coc✓t,, e Q ed Or D✓ Urinal 25.02
C N'1'RACTOIt Water closet 25.02
Water heater
Business name: E 14-; NO filet 37.522
Address: P.0, X u r. Q Otherater piping/DWV 56.29
Other: 25.0k
City/State/ZIP: !ate/Ga a 5 ) 0A G) 7o 1S Subtotals'62 5(
Phone:(503? CCi""I p'75 Fax:`( ) / / Minimum permit fee: $72.50 "�� ��
CCB Lic.: ' 7 ?>r://7/ lumbing Lic.no.: A Plan review (25%of permit fee) •�
Authorized sign tore: ....._......,
State surcharge(12%of permit fee) g?
p Q' c.,LA_--- i3i
TOTAL PERMIT FEEPrint name:Cp' --b J1s Date: / 4p This permit application expires ifapermitisnotobtained within 8 days
1' 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)
r-�
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site Utilities
Qty. Fee(ea) Total Square Footage: Permit:Fee
Footing drain-l't 100' 50.03 0 to 2,000 $121.90
37.52 2,001 to 3,600 $169.69
Footing drain-each additional 100' 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 l .5 $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 each additional$100 00 or00 and$1.52 for
fraction thereof,to
Other Inspections or Fees Qty. Fee(ea) Total 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.
$50,001.00 and up $742.00 for the first$50,000.00 and$1.20 for
90.00/hr
Additional plan review for revisions 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*.
Quantity by Fixture Type .J Plan'RevieW for Plumbing l t latlo s
Replacel '
Fixture Type for - Plan review is required for any of the following.
Work Performed: Capped Aaaed. Relocate":. Please check all that apply.
Baptistry/Font 0 Any new commercial building with water service 2"and
Bath -Tub/Shower greater,except systems designed and stamped by licensed
-Jacuzzi/Whirlpool engineer.
Car Wash -Each Stall ❑ New exterior plumbing site utilities for any complex'structure
-Drivepror as defined in OAR918-780-0040.
Di
Cuspidor/Water Coirator
Dishwasher -Commercial ❑ Medical gas and vacuum systems for health care facilities.
-Domestic ❑ Any multipurpose fire sprinkler system.
Drinking Fountain 0 Any complex structure as defined in OAR918-780-0040.
Eye Wash Submit 2 sets of plans with any of the above.
Floor Drain/sink -2"
Isometric or,Riser Diagram.
Car Wash Drain 0 Isometric or riser diagram is required for new buildings
Garbage -Domestic-non-food that meet the qualifications above.
Disposal -Domestic-food related
-Commercial-food related
-Industrial-food related
Ice MachiRefrig.Drains
Oil Separator(Gas Station) Comments regarding fixture work:
Rec.Vehicle Dump Station
Shower -Gang
-Stall
Sink/Lav -Non-food related
-Bradley
-Commercial-food related
-Service
Swimming Pool Filter *Note: If the fixture work under this permit results in an
Washer-Clothes increase of sewer EDUs,a sewer permit will be issued and
Water Extractor fees assessed for the sewer increase must be paid before the
Water Closet-Toilet
Urinal plumbing permit can be issued.
Other Fixtures:
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