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Permit
a- � 3/ll r� f �►, t �v /i►rc ,t44 s1-I 7 S I CITY OF TIGARD r PLUMBING PERMIT E COMMUNITY DEVELOPMENT Permit #: PLM2010 00253 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 08/03/2010 Parcel: 25111 DB12400 Jurisdiction: Tigard Site address: 15275 SW 94TH AVE Project: VanKleek Subdivision: SUMMERFIELD NO.12 Lot: 651 Project Description: Move clothes washer and sink. 2/3/11, reprinted permit to include (1) tub and (1) shower. BT. Contractor: M D PLUMBING Owner: VANKLEEK FAMILY TRUST 939 SW WILLOWCREEK DR BY JAMES A & LENORE J VANKLEEK TRS BEAVERTON, OR 97006 15275 SW 94TH AVE TIGARD, OR 97224 PHONE: 503 - 267 -3914 PHONE: FAX: 503 - 533 -2075 FEES Quantity Description Date Amount 1 ea Clothes Washer 08/03/2010 $25.02 Specifics: 1 ea Sink 08/03/2010 $25.02 22 ea Minimum Fee Adjustment - 08/03/2010 $22.46 Type of Use: SF Plumbing Class of Work: ALT 1 12% State Surcharge - 08/03/2010 $8.70 Plumbing Type of Const: 3 12% State Surcharge - 02/03/2011 $3.00 Occupancy Grp: Plumbing Stories: 2 ea Tub /Shower /Shower Pan 02/03/2011 $25.02 Total $109.22 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 by calling 503.232.1987 or 1.800.332.2344. Issued By: "ermittee 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. 7 '' q C OF TIGARD PLUMBING PERMIT ` > COMMUNITY DEVELOPMENT Permit #: PLM2010 00253 sT !G 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 08/03/2010 .. , ,emu Parcel: 2S111 DB12400 Jurisdiction: Tigard Site address: 15275 SW 94TH AVE Subdivision: SUMMERFIELD NO.12 Lot: 651 Project: VanKleek Project Description: Move clothes washer and sink. Owner: FEES VANKLEEK FAMILY TRUST Quantity Description Date Amount BY JAMES A & LENORE J VANKLEEK TRS, 15275 SW 94TH AVE 1 ea Clothes Washer 08/03/2010 $25.02 PHONE: 1 ea Sink 08/03/2010 $25.02 22 ea Minimum Fee Adjustment - 08/03/2010 $22.46 Plumbing Contractor: 1 12% State Surcharge - 08/03/2010 $8.70 M D PLUMBING Plumbing 939 SW WILLOWCREEK DR BEAVERTON, OR 97006 PHONE: 503 - 267 -3914 FAX: 503- 533 -2075 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 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 • = • •UNC by calli • 503.246.6699 or 1.800.332.2344. Issued = - / / Permittee Signature: �or AP 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 FOR OFFICE USE ONLY City of Tigard cE ) Received DateBy: of/ h 877 Permit No.: `� ?_(.) do -0 114 • 13125 SW Hall Blvd., Tigard, OR 972 Plan Review 1 v " • ' Phone: 503.639.4171 Fax: 503.598.196Q Date/Sy: Other Permit No.: I i \ �\ l Inspection Line: 503 F B " Date Ready/By: Juris: B See Page 2 for Internet: www.tigard - or.gov Notified/Method: --1:76 Supplemental Information TYPE OF WORK � U* r,G rF } DIV[ ,I FEE* SCHEDULE ❑ New construction o Awn For s ecial in ormation use checklist Description Qty. Ea. 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 ❑ 1- and 2- family dwelling ❑ Commercial/industrial SFR (2) bath 437.78 building SFR (3) bath 500.32 ❑ Accessory g ❑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: Catch basin or area drain 18.76 City/State /ZIP: Drywell, leach line, or trench drain 18.76 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. 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 / `v �) Clothes washer 25.02 C.,:. 4 , wry► 6) b ��/Q l 1 , "t)'e'✓iY,A Dishwasher 25.02 Drinking fountain 25.02 Ejectors/sump 25.02 ❑ PROPERTY OWNER I ❑ TENANT Expansion tank 12.51 Name: Fixture/sewer cap 25.02 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 ❑ APPLICANT ❑ CONTACT PERSON Interceptor /grease trap 25.02 Business name: Medical gas (value: $ ) Page 2 Primer 12.51 Contact name: Roof drain (commercial) 12.51 Address: Sink/basin/lavatory 25.02 City/State /ZIP: Solar units (potable water) 62.54 Phone: ( ) Fax: : ( ) Tub /shower /shower pan #'2_ 12.51 v, 'v)-, E -mail: Urinal 25.02 v J ' CONTRACTOR Water closet 25.02 Water heater 37.52 Business name: / k) 0 fok ell 7 L-7 Water piping/DWV I 56.29 Address: / Other: 25.02 City/State/ZIP: Subtotal �S Phone: ( ) Fax: ( ) Minimum permit fee: $72.50 CCB Lic.: Plumbing Lic. no.: Plan review (25% of permit fee) State surcharge (12% of permit fee) 3 , 03 Authorized signature: TOTAL PERMIT FEE X 6) L.---''' This permit application expires if a permit is not obtained within 180 days Print name: Date: ../FT 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 Building Fixtures RE VE;1 _ l I Ic i.:_ ( O 1 i . City of Tigard ' % Received c, e� I q 13125 SW Hall Blvd., Tigard, OR 97223 , I ; t DateBy D 5 /0 Permit No.: at; /0-- 7 � " 0 Phone: 503.639.4171 Fax: 503.598.1960 r Q � ! Pla Rev Other Permit No.: Inspection Line: 503.639.4175 Date/By: f I G A IL I) CITY OF TIGARD Date ReadyBy: inns: ® See Page 2 for Internet: www.tigard-or.gov Notifie Supplemental Information TYPE- OF WORK BUILDIINCi DIVISION • FEE* SCHEDULE ❑ New construction ❑ Demolition For special information use checklist Description 1 Qty. 1 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 R1- 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: /52 7 5 5 w '1 A U� Catch basin or area drain 18.76 City/State /ZIP: t ci. DA �I 7ZZ - U Footing 1, leach line, or trench drain 18.76 c Footin drain (no. linear ft.: ) Page 2 Suite/bldg. /apt. no.: I Project name: VCA yX K I Pie, K Manufactured home utilities 50.03 Cross street/directions to job site: $1/t/ c 4 4,... Manholes 18.76 Rain drain connector 18.76 Sanitary sewer (no. linear ft.: ) Page 2 Storm sewer (no. linear ft.: J 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 MCJ , A/w X c!- Od CJ El/i< Dishwasher 25.02 Drinking fountain 25.02 Ejectors /sump 25.02 fELPROPERTY OWNER' I . ❑ TENANT Expansion tank 12.51 / Fixture /sewer cap 25.02 Name: �(� V �0- n KIA0 K Floor drain/floor sink/hub 25.02 Address: / 6 7 5 5 L✓ 947 Garbage disposal 25.02 City /State /ZIP: 7)q ��4 -cl ©� 1 ez Hose bib 25.02 Phone: ( ) � Fax: ( ) Ice maker 12.51 ' ❑ APPLICANT ❑ CONTACT PERSON Interceptor /grease trap 25.02 Business name: Medical gas (value: $ ) Page 2 Primer 12.51 Contact name: Roof drain (commercial) 12.51 Address: Sink/basin/lavatory , 25.02 City /State /ZIP: Solar units (potable water) 62.54 Phone: ( ) Fax: : ( ) Tub /shower /shower pan 12.51 E -mail: Urinal 25.02 Water closet 25.02 CONTRACTOR • Water heater 37.52 Business name: M c `i ` ell ? 1 , ) ,.. 9 Water piping/DW V 56.29 Address: l / Sid ) r /, /n/(iC`eLK'Jr' Other: 25.02 City /State /ZIP: Pe ve © ? 7046 Subtotal Phone: (593) 26 -3., I W Fax: (So 3) 833 2875 Minimum permit fee: $72.50 eig•60 CCB Lic.: I $F5268 p a 75 7 Plumbing Lic. no.: � 76) 7 u--6, Plan review (25% of permit fee) State surcharge (12% of permit fee) f6 /0 Authorized signature: TOTAL PERMIT FEE Print name: r- Date: This permit application expires if a permit is not obtained within 10 s 'i �� 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 - 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 • 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 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 ❑ New exterior plumbing site utilities for any complex structure Tub /S i/Whirlpool 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 3 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 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