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Permit CITY OF TIGARD PLUMBING PERMIT COMMUNITY DEVELOPMENT Permit #: PLM2011 -00089 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 03/23/2011 Parcel: 1 S135DB02800 Jurisdiction: Tigard Site address: 11475 SW 91ST AVE Project: SANDBO Subdivision: CHARBEN Lot: 13 Project Description: Shower replacement. Contractor: POWER PLUMBING CO Owner: SANDBO, JOHN & DONNA PO BOX 19418 TRAUBA, DONNA M PORTLAND, OR 97280 11475 SW 91ST TIGARD, OR 97223 PHONE: 503 - 244 -1900 PHONE: FAX: 503 - 244 -8825 FEES Quantity Description Date Amount 1 ea Tub /Shower /Shower Pan 03/23/2011 $12.51 Specifics: 1 12% State Surcharge - 03/23/2011 $8.70 Plumbing Type of Use: SF 60 ea Minimum Fee Adjustment - 03/23/2011 $59.99 Plumbing Class of Work: ALT Type of Const: Occupancy Grp: Stories: Total $81.20 Required Items and Reports (Conditions) This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. You may obtain a copy of the rules or direct questions to • . C by calling 503.232.1987 or 1.800.332.2344. Issued By - ermittee Signature: — — Call 503.639.4175 by 7:00 a.m. for the next available inspection date. This permit card shall be kept in a conspicuous place on the job site until completion of the project. Approved plans are required on the job site at the time of each inspection. MAR /22 /2011 /TUE 09:31 AM POWER PLUMBING FAX No, 503 244 8825 P.001 ) IE inbin� PerI>Ii<it A pp l icatio n Building Fixtures FOR OFFICE USE ONLY City of Tigard Receives A. Plan Review 114 a Detc/8 13125 SW Hall Blvd., Tigard, OR 97223 Phone: 503.639.4171 Fax 503.59$.1 96 Date/By: Other Permit No.: TIGARD Inspection Line: 503.639 Date Ready/By: brie: 5d See Page 2 for Internet: www.tigard- or.gov Notified/Method: '_,,,, Su. 17.t7:.:7; y : 1 1 y r t , rF l4 i t 7 � � t . - j 1r� I 't r F t.. 3` ` . °r'�a 7 rr• { 17 � l dl .? . 1b F , Ir.r ^b_^.^a- --- r: t :•.,1 .J - I ' ;;'t 1 - % 7d3 N y+ r ' ;.;f 1 � ,..itA r .i h hl �' s m y 1 y r -,..: �. 1`.! J n ..a 0. :i:7;...L:3.`'c.. ,1. { +�+ :.T.;;'TLu.. �S,,. P. wSllx....�,,, �` L:, 7.. _ 1 ..,,A2:iiulky,..,...uL . iySL LS_., -: : T.�z,_ �.ts�..:uL . t.5,..,!;, i7l U New construction ❑ Demolition For special irfjorm anon use checklist Description Qty. I Ea. I Total w Addition/alteration/replacement ❑ Other: New]. 2- family dwellings (includes 100 ft. for each utilittconnection) � .n, " r u '�- 7 * { " y , ' ' ""F u , :o Lr J' �" r 6T l!7' "3 'R'�"� a�'YWwu p' 1. ti w ; [_� �``'' 2 r - , !rl ` , : . '.� 1; : , - f� A -t»- ,•, -"'�: h . . ,, .'i SFR(1) bath 312.70 -and 2- family dwelling Commercial/industrial SFR (2) bath 437.7Commercial/industrial - ❑ Accessory building ❑ Multi - family SFR (3) bath 500.32 Each additional bath/kitchen 25.02 ❑ Master builder ❑ Other -, , m wa yx,w I M -� Fire sprinkler ( sq. ft.) Page 2 i,��"t�, "tip; t l_,5' : ; :t, 1.�� 4 R7 1 A � 6'411 1 1]� K; i .G,� iit �41 I K � 3. �"' ;. r ,L:;1 . '" iY ,. 1,...v',�41 •, n �,.l,.4 , 17 `"" : rdir tt:.. i',,' �' lLt,C z l Rs Fi�in1:',4 .:. Site utilities: Job site address: (1441 5 s it) gig-T-- Gbvu Catch basin or arcs drain 18.7b Drywell, leach line, or trench drain 18.76 City /State/ZTP: ''l I c,1 0Y el r Footing drain (no. linear R.: ) Page 2 Suite/bldg. /apt. no.: I Project name: :5, L.,0 Manutraetured 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; Lot no.: Fixture or item: - Tax map /parcel no,: Back-flow preventer 3L27 1744 q F h L ° 1"t c • .r R F r v 11r � s r r' Backwater valve 1z.31 , a, , , , 6 p a F, N7 « r ,. u.: ) r ,, �1 � n 4 u � rxtw . w1 4 } r . ors n Clothes washer LLL,LA.. JAG S1 ' 123 25.02 . , JJ Dishwasher 25.02 Drinking fountain 25,02 • Ejectors /sump 25.02 w •'fft'i'ii `� d2 .Sir AY"t� ^t r' t. .0 r , --7..1. ` , r W 1 •l rx ' i J C 5 !1 -0t r) '� - r 4 Z nr. t� �, , '-- - Ex ansion tank «:*d: - .12; �,'i 12. '/ d 1 1 ,,t,,qu„ P,l - lti . aS 4, -1. ti, 4 :; 4, P 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 ^rte wp � � ✓i i:,, 7 t tre kt� seN +�e +; 5' t�s�°""' ?�Myy - " :ti ; 5, - , } �s( 9 T clyi , raw �a ,;``• , 3 fE�?�+il.� ti 1 17 0 , 3. `,1 l ,s' Interceptor /grease trap 25.02 , ....,.,.d.1'. •, ..}xlr:.iat�' u.. "�,._..1., F:,,, . .aa, '4a e i,. Business name:�� Medical gas (value: $ _) Page 2 Primer 12.51 Contact name: -. V i I 't• - -- Roof drain (commercial) 12.51 Addres . s; P t() J5 j q 4! £ Sink/basin /lavatory 25.02 City /State/ZIP: Puv°- J 0 -7�) - Solar units (potable water) 62.54 Phone: 603) �,14 4_,lei JU I Fax:: 6D5) t{q-'- g 2... Tub /shower /shower pan T 12.51 , I24l E-mail Urinal 25,02 , "% Y ➢"",1"Pf7't` t3' +£.."T""x .:�' m so-t; Water closet 1 4 r Sg� hf tg1i 7 1 a�I 1 et0 a r � i 25.02 y awl mo w{ ro , - r .. 1 r"x , t * t, .rtiz ti 7t W,asmilinY4sAt: .�5..,,';�,r ,. ... �., �tS .�� :!�,.�-�'�2M:�vi,�vr.,a�ai Water heater 37.52 Business name: 0 LPN-Pi , Water piping/DWV .. 56,29 Address: S#1, -.t- Other; 25.02 City /State/ZIP: . Subtotal r Phone: ( ) 4 ©(a Fax: ( -1.11-a --- _ 2 _ Minimum permit fee; $72.50 - 7 2 0 3 ry `f Flan review (25% of permit fee) CCB Lie.: t¢ 3 Plumbin g r Lic. no.: J State surcharge (12% of permit fee) ' y b Authorized signature: "� - �d^' 41 1• TOTAL PERMIT FEE 5 I 2 42t Print name: (^ e Date: This permit application expires ira permit is not obtained within 180 days f 5 �l ��'� N (� 1 1' � l I �1� after it has been accepted as complet 'Pee methodology set by Tri- County Building Industry Service Board. l; 1BuddinglPermiuPLMU- PuniltAmeoe l 0/01/09 440- 4516T(10/02/COM/WEB) MAR /22 /2011 /TUE 09:31 AM POWER PLUMBING FAX No.503 244 8825 F,002 r 7, Plumbing Permit Application - City of Tigard Page 2 - Supplemental Information Fee Schedule: Residential Fire Su . ression S stems: t. Y t.: f� � �^ -i�t^^ � C F 6 il IY' �:..... try R 'r ic. !o .._,.. i [.e'� it !i� 4 ' ;: I '� - - t !ii l t14Y 'Id Tpr •��r a e, {i �r ik; o '- . , +.! F-1 D Il;i , , iE r Footing drain -1 100' IIIII 50,03 0 to 2,000 $121.90 Foating drain - each additional 100' 3752 2,001 to 3,600 $169.69 1st 100' 62.54 3,601 to 7 200 1233.20 Sewer 54 7,201 and _rester $327.54 Sewer- each additional 100' 37.52 ME Water Service - 1st 100' 62,54 Medical Gas S stems: Water Service - each additional 100' 37.52 Storm & Rain Drain 1st ]00' 62.54 ��t- ai,j O gd,, " ' i'4'4 iL, ":,,,;,77-77;;;, =- '� u! ,,;;, {,; = $ � $5,001,00.00 $5,000.00 to $10,0 00.00 $72.50 for the Minimum fee $72.50 Storm & Ra $ m Drain -each additional 100' 5. to 10,0 first $5,000.00 and $1.52 for C .^ ^ ry i'' *� ! to r yr ' I M, 1l(��� it7�� " iM�w%(X „} each additional $100.00 or fraction thereof, to �. k. �•, .�._..b ......r, .,G,..,� ` and including $10,000.00. Inspection of existing plumbing or for $10,001.00 to $25,000.00 $148.50 for the first 510,000.00 and 51.54 for which no fee is specifically indicated III 90.00/hr (minimum charte -1/2 hour) each additional $100.00 or fraction thereof to and including $25,000.00. Inspections outside of normal business - 90.00/hr 1.111 $25,001.00 to $50,000.00 $379-50 for the first $25,000,00 and $I.45 for hours (minimum ch. _e -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 oh _e'- 1/2 hour each additional $100.00 or fraction thereof. Subtotal: Commercial Fixture Work: Are you capping, adding or replacing fixtures? If "yes", r " 3' - ' k3 "t ; • x'i r b' i fit% , r 1 L r °-�� ., a l„ please indicate work performed by fixture. Failure to e'°� s2.' or any t h e f o l lo " ''' '�` P P Y Plan review is required for any of the f accurately report fixtures could result in increased sewer fees Please check all that apply. -L-- r f } ,,y t1 : ,;;; MlatiR l'1�r , titiiiiiiiMMRE' RAM ❑ My new commercial building with water service 2" and n!' b ra . tYr +i,' ,-. e 4 e , �' l ' i `:�S'' ' �I 1 "3' ,� T u . y , c „ * y rP� . - t n � r , . :1' • greater, except systems designed and stamped by licensed r ,fix s , ,.ray, , 4 a . . , t . , . ,l, _, t S� , : • engineer. Baptistry/Font ❑ New exterior plumbing site utilities for any complex structure Bath - Tub/Shower as defined in OAR918 -7$0 -0040. 3acuzzifWhirlpool Car Wash - Each Stall 0 Medical gas and vacuum systems for health care facilities. Drive tall ❑ Any multipurpose fire sprinkler system. CuspidozJWate- Aspirator ❑ Any complex structure as defined in OAR918- 780 -0040. . Dishwasher - Commercial - Domestic _ Submit 2 sets of plans with any of the above. - Do p y Drinking Fountain � r 71 . i .r t, , Eye Wash * 4 4.ri.:W. � ! "ntia r' I nG 5 �g= 4oj2,. p .,.4!,k , �f ,1 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 Comments regarding fixture wor - Industrial Ice Mach. /Refrig, Drains L i . - !1 �4. ,. .,tie 451A.1.14- U 14./J14_ Oil Separator (Ga Sta tion Rec. Vehicle Dump Station `"- - Shower -Gang - -- -Stall _ . / Sink - 13arlLavatory _ - 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 plumbing ermit can be issued. p Water Extractor p g p Water Closet - Toilet Urinal Other Fixtures: http / /www.tigard- or.gov( city_ hall / departments /cd /docs/PLMF- PermitApedoc