Permit CITY OF TIGARD PLUMBING PERMIT
111111
COMMUNITY DEVELOPMENT Permit#: PLM2019-00500
T I G A R.CI 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 12l19/2019
Parcel: 2S111 CB01741
Jurisdiction: Tigard
Site address: 10455 SW HOODVIEW DR
Project: Nelson Subdivision: HOOD VIEW NO.2 Lot: 40
Project Description: Replacing 80 ft of storm sewer and (3)rain drain connectors.
Contractor: TCJ CONSTRUCTION Owner: NELSON, JAMES R& LINDA S
19750 SW PAGE CT 10455 SW HOODVIEW DR
BEAVERTON, OR 97007 TIGARD, OR 97224
PHONE: 503-320-7831 PHONE:
FAX: 503-259-2432
FEES
Quantity Description Date Amount
3 ea Rain Drain Connector 12/19/2019 $56.28
Specifics: 80 If Storm Sewer 12/19/2019 $62.54
1 12%State Surcharge- 12/19/2019 $14.26
Type of Use: SF Plumbing
Class of Work: ALT
Type of Const:
Occupancy Grp:
Stories:
Total $133.08
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
or direct questions to OUNC y calling 503.2 .1987 or 1.8 .332.2344. n
Issued By: T-- emtlttee Signature: X\ l j.OV._
Call 503.639.4175 by 7:00 a.m.for the next available inspectio dab. l
This permit card shall be kept in a conspicuous place on the job site until completibr(of the project.
Approved plans are required on the job site at the time of each inspection.
Plumbing Permit Applic
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Site Utilities t,.
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City of TigardDECPermit N
11111 • 13125 SW Hall Blvd.,Tigard,OR 97223 Day' �Z/�9 ly �CL 9-Q�Isc�
- Plan Review
Phone: 503.718.2439 Fax: 51f:598.1960 ,.� Date/By: Other Permit No.:
r i G A r i Inspection Line: 503.639.417$ Date Ready/By: r°ris:
Internet: www.ti -or. ov - --'+yi Supplemental
See Page 2 for
!' g Notified/Method: Supplemental Information
TYPE OF WORK FEE* SCHEDULE
ID New construction ['Demolition For special information use checklist
Description I Qty. I Ea I Total
Addition/alteration/replacement ❑Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(1)bath 312.70
I2I I-and 2-family dwelling 0 Commercial/industrial SFR(2)bath 437.78
❑Accessory buildingSFR(3)bath 500.32
0 Multi-family
Each additional bath/kitchen 25.02
❑Master builder ❑Other: Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: i CLi 5-5- SL.' t_kioOV i �- k OQ . Catch basin or area drain 18.76
Drywell,leach line,or trench drain 18.76
City/State/ZIP:
Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: Project name: Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
Rain drain connector 3 18.76
Sanitary sewer(no.linear ft.:_) Page 2
Storm sewer(no.linear ft.: 2/0) Page 2
Water service(no.linear ft.: ) Page 2
Subdivision: I Lot no.: Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 25.02
'(Z EL A -( (1 A l t...t 012 41 5 O F'--t P✓ o P C/Z P) Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
❑ PROPERTY OWNER I ❑ TENANT Expansion tank 12.51
Fixture/sewer cap 25.02
Name:
/(/ S� o41� Teat, r s L Pt ore� s Floor drain/floor sink/hub 25.02
Address:
Garbage disposal 25.02
City/State/ZIP: Hose bib 25.02
Phone:( ) Fax:( ) Ice maker 12.51
f`n APPLICANT ,n CONTACT PERSON Interceptor/grease trap 25.02
Business name: TG3 Coy�-1 gretiL-(l O,KA (moo i� Medical gas(value:$ ) Page 2
Contact name: t� Primer 12.51
Q flZO5D ,�f J'EiJ.k L L Roof drain(commercial) 12.51
Address: 111 � (A t E 67 /��y Sink/basin/lavatory 25.02
City/State/ZIP: /5 AvEr/Zroyn.t / c 71)OTA7 Solar units(potable water) 62.54
Phone:(p73 )- ?-(j- 17 f Fax::( ) Tub/shower/shower pan 12.51
E-mail: �GJ GrJv�.snwt.Tvti. P Atgn cow
Urinal 25.02
/ Water closet 25.02
CONTRACTOR
Water heater 37.52
Business name: SAv✓t t1 S. n �.7
Water piping/DWV 56.29
Address: Other: 25.02
City/State/ZIP: Subtotal
Phone:( ) Fax:( ) Minimum permit fee: $72.50
CCB Lic.: O 74 1 7 Plumbing Lic.no.:03 ' LI co b Plan review (25%of permit fee)
State surcharge(12%of permit fee)
Authorized signature: � ( `� I� TOTAL PERMIT FEE
Point dame: a!l"1 ,. ,f•L"` Date: �a--j el This permit application expires if a permit Is not obtained within 180 days
11"""��✓✓ after it has been accepted as complete.
'Pee methodology set by Tri-County Building Industry Service Board.
d:lBaildioeennits\PLMU-PermtApp.doc 10/01/09 940.4616T(10/02/COMJWEB)
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-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' 62.54 Medical Gas Systems:
Water Service-each additional 100' 37.52
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
each additional$100.00 or 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 51.45 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*.
Quaint,by Fixture Type Plan Review for Plumbing Installations.
Fixture Type for Replace/
Work Performed: Capped Added Relocate Plan review is required for any of the following.
Baptistry/Font Please check all that apply.
Bath -Tub/Shower ❑ 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 ❑ New exterior plumbing site utilities for any complex structure
Cuspidor/WaterAspirator as defined in OAR918-780-0040.
Dishwasher -Commercial ❑ Medical gas and vacuum systems for health care facilities.
-Domestic ❑ Any multipurpose fire sprinkler system.
Drinking Fountain ❑ Any complex structure as defined in UAR918-780-0040.
Eye Wash
Floor Drain/sink -2" Submit 2 sets of plans with any of the above.
-3"
Isometric or Riser Diagram
Car Wash Drain
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 *Note: If the fixture work under this permit results in an
Washer-Clothes
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