Permit "-s PLUMBING PERMIT
CITY OF TIGARD
COMMUNITY DEVELOPMENT Permit #: PLM2010 -00180
T {GAR1J 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Date Issued: 06/08/2010
Parcel: 1 S 133AD02200
Jurisdiction: Tigard
Site address: 10730 SW 130TH AVE
Subdivision: Lot: 0
Project: Westgate Baptist
Project Description: Kitchen Remodel.
Owner: FEES
WESTGATE BAPTIST CHURCH Quantity Description Date Amount
12930 SW SCHOLLS FERRY RD
TIGARD, OR 97223 1 ea Dishwasher 06/08/2010 $25.02
1 ea Floor Drain /Floor Sink/Hub 06/08/2010 $25.02
PHONE: 1 ea Ice Maker 06/08/2010 $12.51
4 ea Sink 06/08/2010 $100.08
Contractor: 1 ea Water Heater 06/08/2010 $37.52
MODERN PLUMBING 1 12% State Surcharge - 06/08/2010 $24.02
11120 SW INDUSTRIAL WAY Plumbing
TUALATIN, OR 97062
PHONE: 503 - 691 -6166
FAX: 503 - 691 -6771
Type of Use: COM
Class of Work: ALT Type of Const:
Occupancy Grp:
Stories:
Total $224.17
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 -0100. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By: Permittee Signature:
Call 503.639.4175 by 7:00 a.m. for an inspection that business 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.
Jun. 3, 2010 3.59PM Modern Plumbing No, 1433 P. 1
Plumbing Permit Applica (7 3
4 ���� +7 i.. l iG i8 N1
Building Fixtures ` l � §- ,r r I Itliv(l I I (I R,' Sl l )iv1 � 1 , , ,,„;‘;.:.J, , 4 n a �i �4 9y
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( "`l r ,� Ott City of Tigard 'II 5E ,ew "' ° ' 13125 SW hall Blvd T; ard OR 9 0 4 2 010 g
t ■ Phone: 503.639,4171 Fax: 503.598.1960 Date/By: Olher Permit No.; t kip/ 1 -uo(3
4 Inspection Line: 503.639.4175 CITY OF T / R
l l l t „ \'K 1>i ` Ins 6
P �� ` ► 11� I ��.., , D Date Ready/By; rods: ®See Page Z rot
,:±,:w,„... ,s,r Internet: www.tigard- or,gov . i l ii Qhy; ,, Notified/Method: • 1 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 (1) bath 312.70
omtnercial /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) Pagc 2
J'OB SITE INFORMATION AND LOCATION Site utilities:
Job site address; 1 0 ] 30 �1 i 'Z I^ ctu Catch basin or area drain 18.76
Drywell, leach line, or trench drain 18.76
City /State/ZIP: -Ft 1 G c 0g- 6 1 - 1 -- )-
Footing drain (no. linear ft. ) page 2
Suite/bldg. /apt. no.: Project name: L \ 6 C , g i hi S- - Ma nufactured home utilities 50.03
Cross street/directions to job site: (I �,... Manholes 18,76
[� IA O ((, t r y X - ,ire C�1. Ram drain connector 1 8.76
� � I Sanitary sewer (no. linear ft.; ) Page 2
-
! 1 t 0vt �j 5,,,a,.. Ce CC r)- Stonn sewer (no. linear ft.; _J Page 2
Water service (no. linear ft.: Pagc 2
Subdivision: Lot no.: Fixture or item:
Tax map /parcel no.: Backflow preventer 31.27
D SCRIPTION OF WORK $atdcwater valve 12.51
Clothes washer 25,02
- ._,L r- ' ' VVI • .. II % Dishwasher / 25.02 0 )
.6 t r! ' C ri - yo . L+ t. (l) (� D O i LS 1 [ 10 :t-- __ARM D fountain 25.02
� 1] ' , 1 Ejectors /sump 25.02
.... „ - ... . . . _ • .: E z ansion tank 12.51
. ❑PROPERTY OWNER : ; .„ . Q TENA P
Fixture/sewer cap 25.02
Name:
Floor drain/floor sink/hub / 25.02 rp Sa
Address: - Garbage disposal 25.02
City /Statc /ZIP: Hose bib 25.02
X
Phone: ( ) Fax: ( ) Ice maker 12.51 '/a t 5/
. Interco tor/ ase trap . „ . ; ❑ •. APPLTOANT � - . []. ,CONTACT. PERSON P gn P 25.02
Business name: Medical as (value: $ ) Page 2
Primer 12.51
Contact name:
Roof drain (commercial) 12.51
Address; Sink/basin/lavatory Art 6, ,r 25.02 (p p ;
City /State/2IP: Solar units (potable water) 62.54 -
Phone: ( ) Fax; ; ( ) Tublshowerlshowcrpon ■ 12.51
E -mail: Urinal 25.02
Water closet 25.02
CONTRACTOR
Water heater / 37. S2 Si - )
Business name: Q cE. A , g2 Cip Waterpiping/DWV 56,29
Address: 1' \ _ 0 A L c • e L7.-CL .. Other; 25.02
City /State /ZIP: , tr • . Subtotal 00
Phone: (Cg,?, ( 1 t 1 b Fax (SO3 WI 1 1'1 + Minimum permit fee: 572.50
CCB Lie.: r 1 0 t ii Plumbing Lic. no.:3 t D Plan review (25% of permit fee)
State surcharge (12% of permit fee) 03--
Authorized signatu . - ' / pi L 7/t / If - TOTAL PERMIT FEE �i
J�
Print name: l l�tr /J f �( r �/ P,A as }4t �7 Dare: / ,/b This permit application expires if a permit is not obtained within 180 days
after it has been accepted as complete.
/ I
"Fee meihodology set by Tri- County $ uilding Industry Service Boma,
r.\ Building \Permiu\PLMU- PermisAap.doc 10/01/09 440.4616r(10 /02 /C0MMEta)
Jun. 3. 2010 3:59PM Modern Plumbing „yy No. 1433 P. 2
Plumbing Permit Application - City of Tigard e
DLL.t:- 2 f .2/3
Page 2 - Supplemental Information �I G„ Wt,C,Gt<
•
Fee Schedule: Residential Fire Suppression Systems:
Site Utilities . .. . . .. Qtr, Fee (ea) Total Square Footage: + Permit Fee:
Footing drain - I” 100' 50.03 0 to 2,000 $121.90 .
Footing drain • each additional 100' 37.52 2,001 to 3600 , 5169.69
3,601 to 7.200 -- $233.20
Sewer 1st 100' 62,54 7,201 an d greater 5327.54 _
+ Sewer - each additional 100' 37.52
Water Service - 1st 100' 62.54 Medical Gas Systems:
Water Service - each additional 100' 37.52 -
• V`aluation:, P .
Storm & Rain Drain • 1st 100' 62.54 $1.00 to $5,000.00 Minimum fcc 572.50
Storm & Rain Drain - each additional 100' 37.52 55,001.00 to $10,000.00 572.50 for the first 55,000.00 and 51,52 for
Qt: •: F ee (ea) Total cach additional 5100.00 or fraction thereof, to
Other.inspections •or Fees • y . and including 510,000.00.
Inspection of existing plumbing or for $10,001.00 to $25,000.00 5148.50 for the first 510,000.00 and 51.54 for
which no fcc is specifically indicated 90.00/hr each additional $100;00 or fraction thereof, to
(minimum charge -1/2 hour) and including 525,000.00.
Inspections outside of normal business 90.00/hr 525,001.00 to 550,000.00 5379.50 for the first $25,000,00 and 51.45 for
hours (minimum charge - 2 hours) - cach additional 5100,00 or fraction thereof. to
Reinspection Fees 90,00/hr and including 550,000,00.
Additional plan review for revisions 90.00/hr 550,001.00 and up 5742.00 for the first $50,000.00 and 51.20 for
(minimum charge -1/2 hour) each additional $100.00 or fraction thereof.
Subtotal:
Commercial Fixture Worker _
Are you ca in adding or a lacin 1 ores? If "yes ", -- :Plan for''P1nmbiai ations. • .
please indicate work performe y 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 -
Quanti byFixture) Work Performed ❑ Any new commercial building with water service 2" and
Flttture lfypr
' Replace greater, except systems designed and stamped by licensed
_ Previous Capped - Added Existing , engineer.
Baptistry/Font • — ❑ New exterior plumbing site utilities for any complex structure
Bath • - Tub /Shower - as defined in 0AR918 780 - 0040.
, - Jacuzzi/Whirlpool . ❑ Medical gas and vacuum systems for health care facilities.
Car Wash •Each Stall -- ❑ Any multipurpose fire sprinkler system.
-Drive Thru — ❑ Any complex structure as defined in OAR918 -780 -0040.
Cuspidor/Water Aspirator
Dishwasher -Commercial I Submit 2 sets of plans with any of the above.
- Domestic •
Eye Wa s h Fountain on etl is or Riser •Diagralou:
Eye Was 1< :. :... •
Floor Drain/sink - 2" 1 E1isometric or riser diagram is required for new buildings
3 " . that meet the gualifications above.
-4
Car Wash Drain -
Garbage - Domestic _
Disposal - Commercial . - - Industrial Comments regarding fixture work:
IceMach./R.efrig. Drains. .. 1
—
Oil Separator (Gas Station)
Rec. Vehicle Dm. Station
Shower -Gang
-Stall
Sink Bar/Lavatory _
- Commercial I *Note: If the fixture work under this permit results in an
-service...IA. 4 7— 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 plumbing permit can be issued.
Water Extractor
Water Closet - Toilet
Urinal
Other Fixtures: `47_.
r'\ Building \Permits\PLMP- PcrmitApp,doc 2