Permit CITY OF TIGARD PLUMBING PERMIT
* COMMUNITY DEVELOPMENT Permit #: PLM2011 -00060
T t GA P O 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 03/01/2011
Parcel: 2S114AB14100
Jurisdiction: Tigard
Site address: 9375 SW JULIA PL
Project: Subdivision: KNEELAND ESTATES NO. 2 Lot: 106
Project Description: Move clothes washer, add new master bath.
Contractor: MINYARD PLUMBING LLC Owner: SCHENDEL, THOMAS A AND CLAUDIA S
7037 NW BURLINGTON 9375 SW JULIA PL
PORTLAND, OR 97203 TIGARD, OR 97224
PHONE: 503 - 962 -9797 PHONE:
FAX:
FEES
Quantity Description Date Amount
ea Clothes Washer 03/01/2011 $25.02
Specifics: 1 ea Lavatories 03/01/2011 $25.02
1 ea Tub /Shower /Shower Pan 03/01/2011 $12.51
Type of Use: SF 1 ea Water Closet 03/01/2011 $25.02
Class of Work: ALT 1 12% State Surcharge - 03/01/2011 $10.51
Type of Const: Plumbing
Occupancy Grp: 1 ea Tub /Shower /Shower Pan 03/01/2011 $12.51
Stories: 0 12% State Surcharge - 03/01/2011 $1.50
Plumbing
Total $112.09
Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State .f OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire wor is not started within 180 days of
issuance, or • is suspended for more the 180 days. ATTENTION: Oregon aw requires you t. o11ow e rules adopted by the Oregon
Utility I cation Center. Those les are set forth in OAR 952-001-0010 throu.h OAR 952 - 001 -00'.. You ay obtain a copy of the rules
or dir ct questions to OUNC b • • ing 503. .1987 or 1.800.332.2344. a
Iss ed By: _ � / Permittee Sig ature.
Call 503. 639.4175 by 7:00 a.m. for the next availabl 'nspecti. d.
This permit card shall be kept in a conspicuous place on the job site 'I co < etion of the project.
Approved plans are required on the job site at the time of each inspection.
Plumbing Permit Application RECEIVED
Building Fixtures FOR OFFICI; l si: ONI.)
_ 1 7 r` 11 Received
City of Tigard MAR Date/By: 3 A PermitNo.• b
/40:, -m
• 13125 SW Hall Blvd., Tigard,OR 97223.. rl
.II II Phone: 503.718.2439 Fax: 503.598.19 OF TIGARD Plan Review Other Permit No.:
Inspection Line: 503.639.4175 BUILDING DIVISION Date/By: T 1 G A R D 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 I Qty. I 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
j g'i- 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: / 3 7 5 5 ,i . \ OA r iv{ te
Drywell, leach line, or trench drain 18.76
Catch basin or area drain 18.76
City /State /ZIP: t l?y�(1 w e,-g--
Footing drain (no. linear ft.: Page 2
Suite/bldg. /apt. no.: I 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 i 25.02
0 ) 0 1)e- LA"-"'" / (i) -S 1%a Y14 Dishwasher 25.02
R r - ✓ xrc ti-- C , - ) 0 1 4 - 1 4 - ( - 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 ,J° CONTACT PERSON Interceptor /grease trap 25.02
T' ,,1 , , t p l (, �,,, , .
Medical gas (value: $ ) Page 2
Business name: /V i
J _ Primer 12.51
Contact name: V� (" ,�
S L
_,-
� ' " "�'" , y'� Roof drain (commercial) 12.51
Address: 7C) -3 7 Zrin .2 - )dam - 'vt , , Sink/basin/lavatory ( 25.02
City /State /ZIP: p [ j x __ Solar units (potable water) 62.54
Phone: (s 5Z 9 ' Fax: : ( / ) Tub /shower /shower pan I ( 12.51
E -mail: tg_ S17(� -S �-e? VV1�T:rL t P( (.t yy' Lc� - i1 e ` Urinal 25.02
✓ J Water closet 25.02
CONTRACTOR
Water heater 37.52
Business name: / - Attn,Ll ,d) P/ Lvw Water piping/DWV 56.29
Address: 70 j i1 12 ( S afyi It V Other: 25.02
City/State /ZIP: P(A2..it$/i( () / CY1--- "f) c71-0'. Subtotal cl
Phone: ( Z'3 C /' 7> Fax: ( ) Minimum permit fee: $72.50 /00 ' v D
CCB Lic.: 1 / 5 Si ( Agkti>. j 6 Plumbing Lic. nc a 0 \ �\ Plan review (25% of permit fee)
State surcharge (12% of permit fee) (2,4 r
Authorized signature: ' TOTAL PERMIT FEE / p( i.e.) 9
Print name: Date: / This permit application expires if a permit is not obtained within 1880 days
� `( after it has been accepted as complete.
,3
U W W i () 6 + � "Fee methodology set by Tri -County Building Industry Service Board.
I:\ Building \Permits\PLMU- PennitApp.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 ",
please indicate work performed by fixture. Failure to
accurately report fixtures could result in increased sewer fees
Quantity by Fixture Type Plan Review for Plumbing Installations
Fixture Type for Replace/ Plan review is required for any of the following. Performed: Capped Added Relocate s re 9 y g
Baptistry /Font Please check all that apply.
Bath Tub /Shower CI Any new commercial building with water service 2" and
Jacuzzi/Whirlpool greater, except systems designed and stamped by licensed
Car Wash -Each Stall engineer.
-Drive Thru ❑ New exterior plumbing site utilities for any complex structure
Cuspidor/Water Aspirator as defined in OAR918- 780 -0040.
Dishwasher - Commercial ❑ Medical gas and vacuum systems for health care facilities.
- Domestic ❑ Any multipurpose fire sprinkler system.
Drinking Fountain ❑ Any complex structure as defined in OAR918- 780 -0040.
Eye Wash
Floor Drain/sink -2" Submit 2 sets of plans with any of the above.
-3"
4„ Isometric or Riser Diagram
Car Wash Drain ❑ Isometric or riser diagram is required for new buildings - Domestic - non -food s
g q g
Disposal - Domestic -food related that meet the qualifications above.
- Commercial -food related
- Industrial -food related
Ice Mach./Refrig. Drains
Oil Separator (Gas Station) Comments regarding fixture work:
Rec. Vehicle Dump Station
Shower -Gang -
-Stall
Sink/Lav - Non -food related
- Bradley
- Commercial -food related
- Service
Swimming Pool Filter *Note: If the fixture work under this permit results in an
Washer - Clothes
Water Extractor increase of sewer EDUs, a sewer permit will be issued and
Water Closet Toilet fees assessed for the sewer increase must be paid before the
Urinal plumbing permit can be issued.
Other Fixtures:
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