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Permit
Y PLUMBING PERMIT a CITY OF TIGARD COMMUNITY DEVELOPMENT Permit #: PLM2009 -00312 Date Issued: 10/29/2009 FGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 W n Parcel: 2S110AD90029 Jurisdiction: Tigard Site address: 14888 SW 109TH AVE Subdivision: CANTERBURY WOODS CONDOMINIUM Lot: 29 Project: Conrath Project Description: Converting existin closet to bathroom, adding shower and toilet. Owner: FEES CONRATH, KELLY J Quantity Description Date Amount 14888 SW 109TH AVE TIGARD, OR 97224 1 ea Tub /Shower /Shower Pan 10/29/2009 $12.51 1 ea Water Closet 10/29/2009 $25.02 PHONE: 503 - 684 -8147 1 12% State Surcharge - 10/29/2009 $8.70 Plumbing Contractor: 35 ea Minimum Fee Adjustment - 10/29/2009 $34.97 OWNER Plumbing PHONE: FAX: Type of Use: SF 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 issuan e 1 wor 1 ...ended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Uti' Notification Center. T' se r - are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain a copy of the rules direct questons to OUNC b ailing 503 6.6699 or 1.800.332.2344. allow ssued By: i Permittee Signature: / 451- Call 503.639.4175 by 7:00 a.m. for an inspection that busines- day. 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. CITY OF TIGARD PLUMBING PERMIT 111 COMMUNITY DEVELOPME "o, 1; Permit #: PLM2009 -00312 �� Date Issued: 10/29/2009 TIGARD 13125 SW Hall Blvd , Tigard OR 97223 503 718 2439 Parcel: 2S110AD90029 Jurisdiction: Tigard Site address: 14888 SW 109TH AVE Project: Conrath Subdivision:ANTERBURY WOODS CONDOMINIUr\ Lot: 29 Project Description: Converting existing closet to bathroom, adding shower and toilet. 10/21/11, adding (2) lays, (1) toilet & (1) tub /shower to scope of work Contractor: OWNER Owner: CONRATH, KELLY J 14888 SW 109TH AVE TIGARD, OR 97224 PHONE: PHONE 503 - 684 -8147 FAX • FEES Quantity Description Date Amount 2 ea Lavatories 10/29/2009 $50.04 Specifics: 2 ea Tub /Shower /Shower Pan 10/21/2011 $25.02 2 ea Water Closet 10/21/2011 $50.04 Type of Use: SF 1 12% State Surcharge - 10/21/2011 $15 01 Class of Work: ALT Plumbing Type of Const: Occupancy Grp: Stories: Total $140.11 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 Notifica. • I enter. 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 z ' estions to O b . C by ' . g 503 232.1987 or 1.800.332 2344 lssuv. By: A / / 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. • Plunmbing Permit Application FOR OFFICE USE ONLY City of Tigard Date/ By. /0 4 29 4,9 ( Permit No.: 8 /14 0 12252..605/ 1.11111 - a 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review Phone: 503.639.4171 Fax: 503.598.1960 Date /By: Other Permit No.: TIGARD' Inspection Line: 503.639.4175 Date ReadyBy: ® See Page 2 for Internet: www.tigard or.gov Notified /Method: /f(f Supplemental Information TYPE OF WORK ' • - FEE* SCHEDULE'; ❑ New construction ❑ Demolition For special information use checklist Description 1 Qty. 1 Ea. 1 Total [Addition /alteration /replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection) - CATEGORY OF CONSTRUCTION SFR (I) bath 312.70 ❑ 1- and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 437.78 SFR (3) bath 500.32 ❑ Accessory building 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: / Lf g g S> 5 Ltd / O q ',i ✓l �q7 Catch basin or area drain 18.76 Drvwell, leach line, or trench drain 18.76 Cit /State /ZIP: ` j ' ` , ` r y / A a 6'� , f -� (` c c) Footing drain (no. linear ft.: ) Page 2 Suite/bldg. /apt. no.: 4,) Project name: 0.610 aft -net-- Manufactured home utilities 50.03 Cross street/directions to job site: ' , - 0 :')., J r j Manholes 18.76 '':'1 • ;c ' ri a ,.J o ` '-' I Rain drain connector 18.76 d Sanitary sewer (no. linear ft.: ) Page 2 ' : i ' ` 6 )t (1 6 1 ' Storm sewer (no. linear ft.: ) Page 2 Water service (no linear ft.: _) Page 2 Subdivision: (" p - V k f/ �� s l bL -Cd 0 I Lot no.: 2- C l Fixture or item: ' C I Q A D _ -1 n!1 z1 Q Backflow preventer 31.27 Tax map/parcel no.: ) CJCJOC 1 :.DESCRIPTION OF WORK , ., ac water valve B k I 1 51 Clothes washer 25.02 t^t j +Gt l∎ E (D f i 'e + f J o Lo e it Dishwasher 25.02 ' Drinking fountain 25.02 Ejectors /sump 25.02 .. la PROPERTY OWNER'':' ' '❑ TENANT . -, Expansion tank 12.51 �r t Fixture /sewer cap 25.02 Name: �� el IlYI j .04a-r1 C-0 In f 6 �i l} Floor drain /floor sink/hub 25.02 �y 45� . Address: � ti �6 � (Jib 1 e�f')f L , ,'k, 1J..( Garbage disposal 25.02 City/State/ZIP: \ 1 e1 (.t'Z C , t J )__ ('q F N, - ), J k-- [ Hose bib 25.02 Phone: (C)2J) ( ) ( 1 1 ' j ( - - ' 1 L. `l Fax: ( ) Ice maker 12,51 ,,K)oLTCANT • .. ;' . i' CONTACT PERSON Interceptor /grease trap 25.02 Business name: Medical gas (value: $ ) Page 2 / Primer 12.51 Contact name: -, i, j , l _ b Yl r cd 1.1 Roof drain (commercial) 12.51 Address: I G (! CI ()C1 - {, 11 _ 1 J. Sink/basin /lavatory 25.02 City /State /ZIP: " It r ()I (` )'; ` 4A Solar units (potable water) 62.54 Phone: (t1 r° ) j � ii J. C : / f 4%i Fax: : ( ) Tub /shower /shower pan / 12.51 E -mail: � l / b . , Urinal 25.02 , , Water closet f 25.02 CONTRACTOR Water heater I 37.52 Business name: ©�> � tie_ Water P 1 p � in DWV 56.29 Address: Other: 25.02 City /State /ZIP: Subtotal Phone: ( ) Fax: ( ) Minimum permit fee: $72.50 7x , Plan review (25% of permit fee) $' CCB Lic.: f Plumbing L . no.: State surcharge (12% of permit fee) g ,7 0 Authorized signature:( / 1"..(1 A) • l 6 L A &/ 2 ) TOTAL PERMIT FEE 4 1 • �/ This permit application expires if a permit is not obtained within 180 days Print name: l Lc, �� Date:,0 -� °�, after it has been accepted as complete. 1 *Fee methodology set by Tri- County Building Industry Service Board 1 \ Building \PermitsWLMU - Permit App doc 10/01/09 440- 4616T(10 /02 /COMM'EB) 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 Other Inspections or Fees Qty- Fee (ea) Total each additional $100.00 or fraction thereof, to 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 ", • Plan,Review for.Plumbing Installations please indicate work performed by fixture. Failure to Plan review is required for any of the following. accurately report fixtures could result in increased sewer fees Please check all that apply. Quantity by (Fixture) Work Performed ❑ Any new commercial building with water service 2" and Fixture Type: Replace greater, except systems designed and stamped by licensed Previous Capped Added Existing engineer. Baptistry/Font Bath - Tub /Shower ❑ New exterior plumbing site utilities for any complex structure Jacuzzi /Whirlpool as defined in OAR918- 780 -0040. Car Wash Each Stall ❑ Medical gas and vacuum systems for health care facilities. Drive Thru ❑ Any multipurpose fire sprinkler system. Cuspidor /Water Aspirator ❑ Any complex structure as defined in OAR918 780 - 0040. Dishwasher - Commercial Domestic Submit 2 sets of plans with any of the above. • Drinking Fountain Eye Wash ,Isometric or Riser Diagram Floor Drain /sink - 2" ❑ Isometric or riser diagram is required for new buildings that meet the qualifications above. Car Wash Drain Garbage - Domestic Disposal - Commercial - Industrial Comments regarding fixture work: Ice Mach. /Refrig. Drains Oil Separator (Gas Station) Rec. Vehicle Dump Station Shower -Gang -Stall Sink - Bar/Lavatory - Bradley - Commercial *Note: If the fixture work under this permit results in an - Service increase of sewer EDUs, a sewer permit will be issued and Swimming Pool Filter fees assessed for the sewer increase must be paid before the Washer - Clothes Water Extractor plumbing permit can be issued. Water Closet - Toilet Urinal Other Fixtures: 1:\ Building \Permits \PLMF - PermitApp.doc 2