Permit t n CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit #: PLM2010 00052
Date Issued: 02/18/2010
[ G A A D 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Parcel: 2S103AB01100
Jurisdiction: Tigard
Site address: 11100 SW WALNUT ST
Subdivision: Lot: 0
Project: Kahn
Project Description: Replace existing water heater with tankless unit.
Owner: FEES
KAHN, STEPHEN Quantity Description Date Amount
11100 SW WALNUT ST
TIGARD, OR 97223 1 ea Water Heater 02/18/2010 $37.52
PHONE: 503-598-0658 1 12% State Surcharge - 02/18/2010 $8.70
Plumbing
35 ea Minimum Fee Adjustment - 02/18/2010 $34.98
Contractor: Plumbing
SELLWOOD PLUMBING
PO BOX 82188
PORTLAND, OR 97282
PHONE: 503 - 239 -0009
FAX: 503 - 236 -1545
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
issuance, or' orkis suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility ification Center. .Those les are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain a copy of the rules
or rest questions to OUNC calk • •:3 246.6699 or 1.800.332.2344.
I sued By: / Permittee Signature: /I
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.
Plumbing Permit Application
Building Fixtures 3 a', , r r fi mit airmp+ "i� , "?g , �,,irS P' ' 3uar�l� ,
,- .4 r : � � r. � > , r � i . � ' `� ` •
City of Tigard Received J ,
g -04 g' • A O / Permit No.: L d -am G,
r: ::,; , "„';
V 1 3125 SW Hall Blvd., Tigard, OR 97223 Date/By:
. ,, B Plan Review Other Permit No.: Hee ot�
Phone: 503.639.4171 Fax: 503.598.1960 Other p1C�! �- 6
Inspection Line: 503.639.4175 Da Read /B ru ns: ®S Pa e 2 for
•ri'GnK). Ready /By: 1;
;iG "'iai Internet: www.tigard - or.gov Notified/Method: Supplemental Information
TYPE OF WORK • FEE* SCHEDULE
❑ New construction ❑ Demolition For special information use check list
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
Id I- and 2- family dwelling 1:1 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: i ( i C� J 5 t� W A-Q.� Catch basin or area drain 18.76
Drywell, leach line, or trench drain 18.76
City /State /ZIP: '1 LA/2-0 1 Cir2 '172Z3
Footing drain (no. linear ft.: ) Page 2
Suite/bldg. /apt. no.: 1 Project name: Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
Rain drain connector 18.76
Sanitary sewer (no. linear ft.: _) Page 2
Storm sewer (no. linear ft.: ) 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
(�D:AC WA i r4S 1 - 20"1 '6 ( 577 1 Dishwasher 25.02
(,U Al ( Ma- TO 11vT-LA 1344- SS Drinking fountain 25.02
LA-14-4- Ejectors /sump 25.02
„ki OWNER I ❑ TENANT Expansion tank 12.51
Name: S -- Ali Ai (L,Lo Fixture /sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address: (( ( 00 S 1/40 Wr FLN Garbage disposal 25.02
City /State /ZIP: r( 6,, ,- , (Tv_ q 72Z 3 Hose bib 25.02
Phone: ( ) Fax: ( ) Ice maker 12.51
APPLICANT ❑ CONTACT PERSON Interceptor /grease trap 25.02
Business name: S�t I ut i N (1-i Medical gas (value: $ ) Page 2
v..50.0. T' Primer 12.51
Contact name: 7 pti( p (,v lag Szct -•-,342.....
Roof drain (commercial) 12.51
Address: (7.. 'Box ell ('' if Sink/basin/lavatory 25.02
City /State /ZIP: ptsa_ �.ae0 ts q ?2d 2 Solar units (potable water) 62.54
Phone: ( 50.3) 23`7 • or:::t Fax: : ( jD7) 23 , / 5 y/5 Tub /shower /shower pan 12.51
E -mail: Urinal 25.02
Water closet 25.02
. CONTRACTOR • .
• Water heater 1 37.52 3
Business name: 5 -) I1» (5 P( (t,et /'- Water piping/DWV 56.29
Address: p. 0 , (� o- - 82 1 g Other: 25.02
City /State /ZIP: p orn.. T - 402 _ e . o� g728 Z Subtotal
Phone: (5 2) 23 �( D c., ;,et Fax: (6 ;) 23 42 L y 5 Minimum permit fee: $72.50 --7A •�
CCB Lic.: 53 03 3 Plumbing Lic. no.: 26, 7 5 ? Pl3 Plan review (25% of permit fee) -
State surcharge (12% of permit fee) et 7
Authorized si ture: TOTAL PERMIT FEE $(.
Print name: Date: 2 -
' g-/ 0 This permit application expires if a permit is not obtained within 180 days
after it has been accepted as complete.
"Fee methodology set by Tri- County Building Industry Service Board.
1: \ 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 Utilities • . Qty. 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 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
Valuation: Permit Fee
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
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
-Tub/Shower as defined in OAR918- 780 -0040.
Car Wash Each Stall ❑ Medical gas and vacuum systems for health care facilities.
Drive tall ❑ 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.
-4"
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
CITY OF TIGARD PLUMBING PERMIT
o COMMUNITY DEVELOPMENT Permit#: PLM2010-00052
13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 02/18/2010
Parcel: 2S103AB01100
Jurisdiction: Tigard
Site address: 11100 SW WALNUT ST
Subdivision: Lot: 0
Project: Kahn
Project Description: Replace existing water heater with tankless unit.
Owner: FEES
KAHN, STEPHEN Quantity Description Date Amount
11100 SW WALNUT ST
TIGARD, OR 97223 1 ea Water Heater 02/18/2010 $37.52
PHONE: 503-598-0658 1 12% State Surcharge - 02/18/2010 $8.70
Plumbing
35 ea Minimum Fee Adjustment - 02/18/2010 $34.98
Contractor: Plumbing
SELLWOOD PLUMBING
PO BOX 82188
PORTLAND, OR 97282
PHONE: 503-239-0009
FAX: 503-236-1545
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
issuance, or kis suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility ification Center- .Those les are set forth in OAR 952-001-0010 through OAR 952-001-0100. You may obtain a copy of the rules
or rect questions to OUNC, calla 3.246.6699 or 1.800.332.2344.
I sued 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.
Plumbing Permit Application
Building Fixtures
City of Tigard Received ~ Permit No.:
/ .9'1 CJ~~-~O
n 13125 S50 Hall Blvd., Tigard, OR 97223 Date/By: q Plan Review 1 ,~C O!
Other Permit No.:
Phone: 503.639.4171 Fax: 503.598.1960 Date/By:
Inspection Line: 503.639.4175 Date Ready/By: Juris: ® See Page 2 for
Internet: www.tigard-or.gov Notified/Method: Supplemental Information
TYPE OF WORK FEE* SCHEDULE
❑ New construction ❑ Demolition For special information use checklist
Description Qty. Ea. Total
1Fgj Addition/alteration/replacement ❑ Other: New I- 2-family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (1) bath 312.70
I- and 2-family dwelling ❑ Commercial/industrial SFR (2) bath 437.78
El Accessory building ❑Mu1ti-family SFR (3) bath 500.32
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: to wyQp--t~t Catch basin or area drain 18.76
Drywell, leach line, or trench drain 18.76
City/State/ZIP: l D or
'z?ZZ3
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 18.76
Sanitary sewer (no. linear ft.: Page 2
Storm sewer (no. linear ft.: Page 2
Water service (no. Iinear ft.: Page 2
Subdivision: Lot no.: Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
DESCRIPTION OF, WORK Backwater valve 12.51
Clothes washer 25.02
~ DJIC l -V) T6" i 4S 26-r- ~ ?C15 -1-7 C--J ~ Dishwasher 25.02
TA*N ZSS Drinking fountain 25.02
(.L Ejectors/sump 25.02
OPROPERTY OWNER ❑ TENANT Expansion tank 12.51
Name: Stc-JC - ~J VLA40 Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address: (I
Garbage disposal 25.02
City/State/ZIP: T j q 72Z 3 Hose bib 25.02
Phone: ( ) Fax: ( ) Ice maker 12.51
APPLICANT ❑ CONTACT PERSON Interceptor/grease trap 25.02
Business name: s~ Medical gas (value: $ ) Page 2
Primer 12.51
Contact name: pA,.N p W (,(iZGW 4~
Roof drain (commercial) 12.51
Address: P'6- 90A 21 ✓ 0 Sink/basin/lavatory 25.02
City/State/ZIP: ts'L-k A-4V3D b✓L a 720 Z- Solar units (potable water) 62.54
Phone: ( 5r>) 23~t - Fax:: ( ~ ) 23 L 0 5 1/S Tub/shower/shower pan 12.51
E-mail: Urinal 25.02
Water closet 25.02
CONTRACTOR
Water heater ) 37.52 7
Business name: S ~1 f l~t'00 ' I Gum 6, y "i Water piping/DWV 56.29
Address: p. 0, (Z OX B2 ( ?,S Other: 25.02
City/State/ZIP: 74:12E- ®7Z T- t)yL 7 2 B Z Subtotal
Phone: (fC03) 2-3q, O c5 ~`Z Fax: ( 570 3 ) 2'2, I 1__" rj Minimum permit fee: $72.50
CCB Lie.: 5 3 (D'3'-',' Plumbing Lic. no.: ZG 5 P~ Plan review (25% of permit fee)
State surcharge (12% of permit fee) Q . 7
Authorized si ture: TOTAL PERMIT FEE g~ • 2-0
Print name: Date: 2 Q This permit application expires if a permit is not obtained within 180 days
after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
I:\Building\Permits\PLMU-PermitApp.doc I0/01109 440-4616T(10/02/COM/WEB)