Permit .1 CITY OF TIGARD PLUMBING PERMIT
` COMMUNITY DEVELOPMENT Permit #: PLM2010 -00387
.TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 12/10/2010
Parcel: 2S104CD10000
Jurisdiction: Tigard
Site address: 13652 SW TRACY PL
Project: Jacques Subdivision: HILLSHIRE ESTATES NO. 2 Lot: 99
Project Description: Remove and replace shower drain, shower pan & shower valve.
Contractor: KELSO CONSTRUCTION Owner: LAFORTUNE, MARIO & JACQUES, SYLVIE
5750 HWY 35 13652 SW TRACY PL
MOUNT HOOD PARKDALE, OR 97041 TIGARD, OR 97223
PHONE: 541 - 399 -4723 PHONE: 503-524-6518
FAX:
FEES
Quantity Description Date Amount
1 ea Tub /Shower /Shower Pan 12/10/2010 $12.51
Specifics: 1 12% State Surcharge - 12/10/2010 $8.70
Plumbing
Type of Use: SF 60 ea Minimum Fee Adjustment - 12/10/2010 $59.99
Plumbing
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 .II other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 1 • days of
issuance, or if suspended for more the 180 days. ATTENTION: Oregon law requires you to folio e rules adopted the Oregon
Utility N. `cation Center. o les are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. o may obtain a .2 of the rules
or dlr questions to OUNC b - ling 0. '.1987 or 1.800.332.2344.
Is - ued By: Permittee Signature: //if
Call 503.639.4175 by 7:00 a.m. for the next available inspe < ion 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 FOR OFFICE USE ONLY
City of Tigard Received P ermit No.:
v
11 1 I 13125 SW Hall Blvd., Tigard, OR 97223
Date/By: ► c� /o l�03g7
Pl
: • Phone: 503.639.4171 Fax: 503.598.1960 an Review
Date /By: Other Permit No.:
D
T I G A R D Inspection Line: 503.639 Date Ready/By: Juris: H 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 1 Qty. 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
11- 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: 13 6 6Z S k..1,.) 1/ AC I CL Catch basin or area drain 18.76
City /State /ZIP: 6 4 g d V i 2 9 22 3 Drywell, leach line, or trench drain 18.76
i !! Footing drain (no. linear ft: ) Page 2
Suite/bldg. /apt. no.: 1 Project name: '
y 1 iiI e 3 c 1 e S Manufactured home utilities 50.03
Cross street/directions to job site: I I 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: 1 Lot no.: Fixture or item:
Tax map /parcel no.: Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
(J Clothes washer 25.02
I? 2w- 9Z,._,Q 1 -1- P c r lc- e._ e : Dishwasher 25.02
a -. `�__1 p V,.J C, / (� r-- t Drinking fountain 25.02
svl D \At , - y - l( Ctlttt_ Ejectors /sump 25.02
❑ PROPERTY OWNER ❑ TENANT Expansion tank 12.51
Fixture /sewer cap 25.02
Name: 1 iJ tL G C J LS Floor drain /floor sink/hub 25.02
Address: 1 2 6 5 2, S v.1 1 7 4 - L , / PI Ot c Garbage disposal 25.02
City /State /ZIP: --- G j, Q 2 • C '"1'Z- 23 Hose bib 25.02
Phone: (G03) S2 / - 6 .5 / , • " Fax: ( l Ice maker 12.51
❑ APPLICANT ❑ CONTACT PERSON Interceptor /grease trap 25.02
Business name: K t S c, CorYS 4 rJcc -1_ ! 'er
M edical gas (value: $ ) Page 2
O
Q ( _ Primer 12.51
Contact name:
e t. 'or ` _e_ < U-�- ( -'e IS 0 Roof drain (commercial) 12.51
Address: ! j r±, (� 3 Gf ` Sink/basin/lavatory 25.02
City /State /Z1P: i riJ+ _l • r �7t7 `7 � Solar units (potable water) �, 62.54
-
Phone: (�i�/ b 3 L/ 7 Z 3 Fax: : ( ) Tub /showe(wi4rJv�Jv j 12.51
E -mail:
Urinal 616 /1 25.02
Water closet �ltu/t/ 25.02
CONTRACTOR
Water heater 37.52
Business name: Q \ a Co M. S4'Y _ Water i m WV 56.29
Pp P� �(
Address: .(7 1 lj�11m:.m) ffirti�r�.�s Other: Sal pw�/ V.a (- C 1 25.02
City /State /ZIP: /44 010" 7) op PAe L/ ,(, ,0L' dig -,U Subtotal
Phone: (S(*) 2 q- 72 Fax: ( ) Minimum permit fee: $72.50 7A -50
CCB Lic.: / a d "is (o / /�• Plumbing Lic. no.: ( 6 L/ Plan review (25% of permit fee) ---
State surcharge (12% of permit fee) e 70
Authorized signature:� 7/t / TOTAL PERMIT FEE a(�
Print name: E . tti L Date: / a This permit application expires if a permit is not obtained within 18 days
/ J `� / 0 / 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 Utilities Qty. Fee (ea) Total Square Footage: Permit Fee:
Footing drain - l " 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 ec
Ins tions or Fees Qty. Fee (ea) Total each additional $100.00 or fraction thereof, to
p 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 El New exterior plumbing site utilities for any complex structure
Jacuzzi /Whirlpool as defined in OAR918- 780 -0040.
-Each W irlp ❑ Medical gas and vacuum systems for health care facilities.
Car Wash z
Drive Stall ❑ 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
3 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 aid before the
Washer - Clothes p
Water Extractor plumbing permit can be issued.
Water Closet - Toilet
Urinal • • --
Other Fixtures:
I:\Building \Permits \PLMF - PermitApp.doc 2