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Permit (59) CITY OF TIGARD PLUMBING PERMIT '- COMMUNITY DEVELOPMENT Permit#: PLM2019-00277 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 07/10/2019 TIGARD Parcel: 1S134BD11800 Jurisdiction: Tigard Site address: 12079 SW SUMMERBROOK LN Project: David Werkly Subdivision: SUMMERBROOK SUBDIVISION Lot: 1 Project Description: 100 ft.of water service for sales trailer. Contractor: MALMEDAL ENTERPRISES INC Owner: WILLOW CREEK LAND LLC PO BOX 207 PO BOX 1060 BANKS, OR 97106 WOODBURN, OR 97071 PHONE: 503-324-0759 PHONE: FAX: 503-324-0580 FEES Quantity Description Date Amount 100 If Water Service 07/10/2019 $62.54 e- 07/10/2019 $8.70 12%State Surcharge Specifics: 1 9 Plumbing Type of Use: COM 10 ea Minimum Fee Adjustment- 07/10/2019 $9.96 Plumbing Class of Work: ALT Type of Const: Occupancy Grp: Stories: Total $81.20 Required Items and Reports(Conditions) in in the Tigard Municipal Code, State of OR. Specialty Codes and all other This permit is issued subject to the regulations contained g pp Y 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. •t' Issued By: rmittee Signature: rf 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 RECEIVE eceived /M 9 Date/By: 7�(� �P �--- PermitNo.:�� /^�[�/9_020177 ill 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review ■ Phone: 503.718.2439 Fax: 503.598.1960 J U L 1 0 2019 Other Permit No.: Date/By: Inspection Line: 503.639.4175 TIGARD Date Ready/By: Juris: H See Page 2 for Internet: www.tigard-or.gov CITY OF TIGARD Notified/Method: 7" ..--e..., Supplemental Information t ❑New construction 0 Demolition For special information use checklist Description Qty. Ea. I Total ❑Addition/alteration/replacement [g Other: New 1-2-family dwellings(includes 100 ft.for each utility connection) CATEGORY OF CONSTRUCTION SFR(1)bath 312.70 ❑ 1-and 2-family dwelling 0 Commercial/industrial SFR(2)bath 437.78 1:1Accessory building 0 Multi-family SFR(3)bath 500.32 Each additional bath/kitchen 25.02 ❑Master builder Other: Fire sprinkler( sq.ft.) Page 2 TOB SITE".INFO II*t, ION AND LOCATION: Site utilities: Job site address: I ZO7 Su4i,n 2 g OK CANS Catch basin or area drain 18.76 1i Drywell,leach line,or trench drain 18.76 City/State/ZIP: -r)GYM © G1 Footing drain(no.linear ft.: ) Page 2 Suite/bldg./apt.no.: Project name: 5VMA?e231WUK Manufactured home utilities 50.03 Cross street/directions to job site: Manholes 18.76 0//" ©) SW i a t 5 r A/ Rain drain connector 18.76 Sanitary sewer(no.linear ft.:_) Page 2 Storm sewer(no.linear ft.: ) Page 2 Water service(no.linear ft.: /LU) ` Page 2 ,5-LI Subdivision: ,F-)0,4,10.1/7604,06V Lot no.: 1 Fixture or item: Tax map/parcel no.: Backflow preventer 31.27 0 r N 1 ON OF WOR Y '' Backwater valve 12.51 Clothe 54(- .5 IL--, Dishwashers was25.02 25.02 Drinking fountain 25.02 Ejectors/sump 25.02 r•Rt O'er _ t' ANT 6' Expansion tank 12.51 Name: Fixture/sewer cap 25.02 �Jiflvt,� �� LSC .r n � . Address: �� x 'd U Floor drain/floor sink/hub 25.02 Garbage disposal 25.02 City/State/ZIP: cop 602,J t 43-2077 Hose bib 25.02 Phone:( ) Fax:( ) Ice maker 12.51 " ; ❑ CONTx,PERSON Interceptor/grease trap 25.02 4 ,1J ► . ?. ,�`fel Medical gas(value:$ ) Page 2 Business name: t/t/ 7 I-10 Liff Primer 12.51 Contact named /14/0-1.6(...1 �GxW/ Roof drain(commercial) 12.51 Address: N10 5 ati /beYii f t�fC6 /,2ZrY Sink/basin/lavato 25.02 City/State/ZIP: i 0 27v") 0(2_ 077e)06:2 Solar units(potable water) 62.54 --- J - Phone:O Zi 3,yy/S Fax::( ) Tub/shower/shower pan 12.51 E-mail: M(504 rtbctd D kid.rV i Urinal 25.02 4,1,:::,,, " ,- Water closet 25.02 A ,,,__ ..� .t)R .; , '.'7i '1,7-,7- Water heater 37.52 Business name: MALWI6614t. ?Lt.):11�3/AfC7 Waterpiping/DWV 56.29 Address: Po 30 X Z c.) Other: 25.02 City/State/ZIP: gA f(V`S ®2 cr-i (Q (, Subtotal .._51/ Phone:(503) ' '1 Fax: Minimum permit fee: $72.50 '2 3Z f- d�s�j ( ) �-s CCB Lic.: /0,2 c• �'- Plumbing Lic.no.: Jai/`-91.--24 Plan review (25%of permit fee) 7 S State surcharge(12%of permit fee) 70 Authorized signs : / 00ci� �Cpj0ref- TOTAL PERMIT FEE 3'),j6 Print name: � Date:Q-� This permit application expires if a permit is not obtained within 180 days Y} J �� M 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 UtilitiesTel % Hare Footage: Permit Fee: > Qty. re 0_., Footing drain-1"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 6,t. Medical Gas Systems: Water Service-each additional 100' 37.52 'Valuation: . PermftFee. 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 -5, ections oil'rFees Qty. Fee LI ) Total each additional$100.00 or fraction thereof,to w, 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 (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*. ''. o evie ytiftninbing Installs j Quantity bb k"lx !l e .Plan review is required for any of the following. ll�lxture T,r a for ; ace Please check all that apply. =Work Pertermed: Capped A '& 0 Any new commercial building with water service 2"and Baptistry/Font greater,except systems designed and stamped by licensed Bath: -Tub/Shower -Jacuzzi/Whirlpool engineer. Car Wash: -Each Stall 0 New exterior plumbing site utilities for any complex structure as defined in OAR918-780-0040. -Drive Tani Cuspidor/Water Aspirator 0 Medical gas and vacuum systems for health care facilities. Dishwasher: Commercial 0 Any multipurpose fire sprinkler system. Domestic 0 Any complex structure as defined in OAR918-780-0040. Drinking Fountain Eye Wash Submit 2 sets of plans with any of the above. Floor Drain/sink: -2" 4:024 4 _ -�r"�� )114417;7::.,.. 1 0 Isometric or riser diagram is required for new buildings -Car Wash Drain Garbage Domestic non-food that meet the qualifications above. 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: I:\Building\Permits\PLMF PermitApp.doc 08/04/2011 2