Permit (208) CITY OF TIGARD PLUMBING PERMIT
11 ro COMMUNITY DEVELOPMENT Permit#: PLM2018-00033
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 01/22/2018
Tf C D9 Parcel: 2S103BA00800
Jurisdiction: Tigard
Site address: 11865 SW WALNUT ST
Project: McCoy Subdivision: None Lot: None
Project Description: (100)FT of sanitary sewer to connect to existing residence.
Contractor: CLOG BUSTERS LLC Owner: MCCOY, MARY P
2900 SW CORNELIUS PASS RD, STE 549 11865 SW WALNUT ST
HILLSBORO, OR 97123 TIGARD, OR 97223
PHONE: 503-515-5547
503-680-8947
FAX:
FEES
Quantity Description Date Amount
100 If Sanitary Sewer 01/22/2018 $62.54
Specifics: 1 12%State Surcharge- 01/22/2018 $8.70
Plumbing
Type of Use: SF 10 ea Minimum Fee Adjustment- 01/22/2018 $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.
Issued By: j� Permittee Signature:
Call 503.639.4175 by 7:00 a.m.for the next available inspection da
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.
y .. Tat .Virl
Plumbing Permit Application a t� i
Site Utilities q c izT___City of Tigard AN 2 2 ,0 8Date/By: l/22.f` Permit No.: � �0`���j3U 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
INI Phone: 503.718.2439 Fax: 503.598.196( ' -^' (-!1, a r(.,,I spate/By: Other Permit No.: 4 U`fir'
Inspection Line: 503.639.4175 f I 1 a Ready/By: Juris: ® See Pae 2 for
Page T I G A R D '� ll,,N a Supplemental Information
Internet: www.tigard-or.gov ,r,��a� ill .^ ��._:0. b fied/Method: PP
TYPE OF WORK FEE* SCHEDULE a
0 Demolition For special information use checklist.
❑New constructionDescription I Qty. I Ea. Total
❑Addition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(1)bath 312.70
SFR(2)bath 437.78
3=and 2-family dwelling 0 Commercial/industrial 500.32
SFR(3)bath
❑Accessory building 0 Multi-family Each additional bath/kitchen 25.02
❑Master builder 0 Other: Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Catch basin or area drain 18.76
Job site address: j raj(o s 4y'J w> L`T- 61-' Drywell,leach line,or trench drain 18.76
City/State/ZIP: �1 \LTA 1r'--1 i2- c11-2,2-3 Footing drain(no.linear ft.:_) Page 2
Suite/bldg./apt.no.: I Project name: M'-Co y' Manufactured home utilities 50.03
Cross street/directions to job site: \2.\ 6 F, Manholes 18.76
Rain drain connector 18.76
Sanitary sewer(no.linear ft.:/2) Page 2
Storm sewer(no.linear ft.:_) Page 2
Water service(no.linear ft.:_) Page 2
Subdivision: I Lot no.: Fixture or item:
Backflow preventer 31.27
Tax map/parcel no.:
Backwater valve 12.51
, 5 DESCRUPTION OF WORK e ''
Clothes washer 25.02
rJt'\IQ C----(2-- kkop v.v p Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
Expansion tank 12.51
ROPERTY OWNER -- a TENANT Fixture/sewer cap 25.02
Name: (M/ \.( Floor drain/floor sink/hub 25.02
Address: \(0(!) ,,ej '0 #ct-lN.)U T .-1-, Garbage disposal 25.02
City/State/ZIP: 'T-1 6.pc--e___
li ei 1 z:2_3 Hose bib 25.02
Ice maker 12.51
Phone:(�j) �i� ���-+ Fax ( )
PIGANT"" $. CONTAG7" rf1 ON Interceptor/grease trap 25.02
Page 2
Medical gas(value:$ ) Pa g
Business name: -Ma-- Ag0‘) 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 Urinal 25.02
E-mail: Water closet 25.02
CDNTRACTR Water heater 37.52
Business name: ,A i �� Water n m DWV
-1 0. J v�T�. �-5 TDM Y V C - p.p. g/ 56.29
Address: Other: 25.02
Subtotal
City/State/ZIP:
Minimum permit fee: $72.50
Phone:(5f,)3) - -?J Ci -�C �> Fax:( ) 7/I Plan review (25%of permit fee)
CCB Lic.:,20(J Z // / Plumbing Lic.no.: fin if y_"? - State surcharge(12%of permit fee)
Authorized signature: ./.." TOTAL PERMIT FEE
This permit application expires if a permit is not obtained within 180 days
Print name:1vt"-K.,•( ? AAL. 0.( Date: I 2 2 1 (g after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
I:\Bui1ding\Permits\PLMU-PemtitAPP.doc 10/01/09 440-4616T(10/02/COM/WEB)
/L.0 i is
Plumbing Permit Application - City of Tigardp
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site Utilities . Qtr• Fee(ea) , Total x Square Fo tage: Permit Pee•
Footing drain-I'100' 50.03 0 to 2,000 $121.90
Footing drain-each additional 100' 37.52 2,001 to 3,600 $169.69
Sewer-1st 100' 62.54 3,601 to 7,200 $233.20
7,201 and greater $327.54
Sewer-each additional 100' 37.52
Water Service-1st 100' 62.54
Water Service-each additional 100' 37.52 Medical Gas Systems:
Storm&Rain Drain-1st 100' 62.54 Valuation: Permit Fee.,
$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
Other Inspections or Fees ree(ea) Total each additional$100.00 or fraction thereof,to
Inspection of existing plumbing or for and including$10,000.00.
which no fee is specifically indicated 90.00/hr $10,001.00 to$25,000.00 $148.50 for the first$10,000.00 and$1.54 for
(minimum charge-1/2 hour) each additional$100.00 or fraction thereof,to
Inspections outside of normal business 90.00/hr and including$25,000.00.
hours(minimum charge-2 hours) $25,001.00 to$50,000.00 $379.50 for the first$25,000.00 and$1.45 for
Reinspection Fees 90.00/hr each additional$100.00 or fraction thereof,to
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*.
Fixture Tjipe for ,;' Quantity b. Fixture Type ii ''}
Flan Rene v for i'lutml m Installa 0
Work Performed: Capped Added, Roc , Plan review is required for any of the following.
Baptistry/FontPlease check all that apply.
Bath Tub/Shower
0 Any new commercial building with water service 2"and
-Jacuzzi/Whirlpool greater,except systems designed and stamped by licensed
Car Wash -Each Stall engineer.
-Drive Thru 0 New exterior plumbing site utilities for any complex structure
Cuspidor/Water Aspirator as defined in OAR918-780-0040.
Dishwasher -Commercial 0 Medical gas and vacuum systems for health care facilities.
-Domestic ❑ Any multipurpose fire sprinkler system.
Drinking Fountain ❑ Any complex structure as defined in OAR918-780-0040.
Eye Wash
Floor Drain/sink -2" Submit 2 sets of plans with any of the above.
Car Wash Drain Isometrse 4T Riser Diiagra> n
, .
Garbage Domestic-non-food ❑ Isometric or riser diagram is required for new buildings
Disposal -Domestic-food related that meet the qualifications above.
-Commercial-food related
-Industrial-food related
Ice Mach./Refrig.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
Washer-Clothes *Note: If the fixture work under this permit results in an
Water Extractor increase of sewer EDUs,a sewer permit will be issued and
Water Closet-Toilet fees assessed for the sewer increase must be paid before the
Urinal plumbing permit can be issued.
Other Fixtures:
I:\Building\Permits\PLMU PermitApp.doc 2
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Site Utilities — Plumbing Permit Application
Plan Submittal Requirements
TIGARD
A plumbing permit for site utility plumbing work is required for sanitary sewer, storm sewer
and potable water systems on private property.
1. SITE PLAN and vicinity map showing the geographic location (fully dimensional, drawn
to scale) labeled with:
A. El map&tax lot# ❑ project name ❑ site address ❑ suite number
❑ zoning ❑ applicant name ❑ phone number
B. North arrow.
C. Scale (architectural or engineering only).
D. Street names.
E. Building pads with project location.
2. PLUMBING PLANS-Two (2) complete sets, civil only.
All details listed below shall be incorporated into the plumbing plans:
A. Storm drainage plan showing:
1) Finish elevations throughout the developed site.
2) Grade breaks determining area serving each catch basin.
3) Location of catch basins.
4) Pipe size.
5) Type of material.
6) Slope of piping.
7) Manholes and field drains.
8) Cleanouts provided for each 100 feet or fraction thereof.
9) Roof drain laterals specifying cleanouts at each upper terminal.
10) Location of existing or proposed connection to a public sewer line.
B. Utilities plan showing:
1) Sanitary sewer line location,pipe size, type of material, slope of piping,manholes
and cleanouts provided as required for storm.
2) Size and location of domestic water piping and drainage.
3) Proposed location of connection to a public water or sanitary sewer line.
I:\Building\Pernrits\PLMF-PermitApp.doe 12/30/05
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
11865 SW WALNUT ST, TIGARD, OR, 97223
Record Type: Record ID:
Residential - Plumbing PLM2018-00033
Inspection Type: Inspector:
399 Plumbing final Don Sylvester
Result:
PASS - NoCofO
Comments:
Violation Summary:
Inspector Contractor