Permit ' , CITY OF TIGARD PLUMBING PERMIT
�
' ` 7'. COMMUNITY DEVELOPMENT Permit #: PLM2011 -00210
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 07/07/2011
Parcel: 2S102CCO3200
1 Jurisdiction: Tigard
Site address: 10340 SW HILLVIEW ST
Project: Westover Subdivision: Lot: '
Project Description: Barthroom remodel.
Contractor: GEORGE DAVIDSON CONSTRUCTION Owner: WESTOVER, CHRISTINE
2265 NW 113TH AVE 10340 SW HILLVIEW ST
PORTLAND, OR 97229 TIGARD, OR 97223
P
PHONE: 503 - 620 -6846
HONE: 503 - 643 -8611
FAX: 503 - 643 -0633
FEES
Quantity Description Date Amount
1 ea Lavatories 07/07/2011 $25.02
Specifics: 1 ea Tub /Shower /Shower Pan 07/07/2011 $12.51
1 ea Water Closet 07/07/2011 $25.02
Type of Use: SF 1 12% State Surcharge - 07/07/2011 $8.70
Class of Work: ALT Plumbing
Type of Const:
10 ea Minimum Fee Adjustment - 07/07/2011 $9.95
Plumbing
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 N. .• , -nter. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 -001 -0090. You may obtain a copy of the rules
or d' -ct questions to 011 C • calling 503.232.1987 or 1.800.332.2344.
Issued By: / i f Permittee 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.
Plumbing Permit Application .
Building Fixtures FOR OFFICE USE ONLY
City of Tigard R Received Permit • I� y,/ .....66.2.,/ T
25 SW Hal and Blvd., Tigard, OR 97223 y Date/By: 7 7 /'/ P it N C./ /p�l! CJ
t '� 131
. • Phone: 503.718.2439 Fax: 503.598.1960 JUL O 1 Z O � Plan Review
Date/By: Other Permit No.:
T I G A R D Inspection Line: 503.639.4175 Date Ready/By: Juris: EZI See Page 2 for
Internet: www.tigard - or.gov tt ��CITYOFTIGARD Notified/Method: Supplemental Information
TYPE OF WORI8UILDING DIVISION; FEE* SCHEDULE
❑ New construction ❑ Demolition For special information use checklist
DescriItion Q . 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
[9 '1- 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: 11)&4 SA) 141. MI tW CT Catch basin or area dram 18.76
City /State /ZIP: 1 6/12,1) 91 ZZ• D oting leach line, or trench drain
l Footing drain (no. linear ft.: ) Page 2
Suite/bldg./apt. no.: Project name: U1tSTt:Nit Manufactured home utilities 50.03
Cross street/directions to job site: Manholes
1 O4' ? S.T� C, ' _ Rain drain connector
1 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
� to Clothes washer 25.02
Dishwasher 25.02
Drinking fountain 25.02
Ejectors /sump 25.02
Ri PROPERTY OWNER 0 TENANT Expansion tank
A.�n ,S 1 , ��� Fixture /sewer cap 1
Name: u'ULI Vl/ n 1p`
u3A() au) lAtAl v I �'Io ct- Floor disposal sink /hub 1
Address:
Garbage .. 25.02
City /State /ZIP: 7-16, CL. of i Z23 Hose . • 25.02
Phone: ( ) Fax: ( ) Ice maker 12.51
❑ APPLICANT ❑ CONTACT PERSON Interceptor/grease trap 25.1
Business name: gas
Primer 12.51
Contact name:
Roof drain ,
Address:
City /State /ZIP: (
Phone: ( ) Fax: : ( ) Tub/shower/shower Tub/shower/shower pan t
Urinal E -mail:
Water closet 1
I 25.02
CONTRACTOR
Water heater 37.52
Business name: 6e /14e tL1SO4..) 0..0 >VST L LL Water piping/DWV 56.29
Address: 2265 Uw U 31 411- • 1
City/State/ZIP: O(JL" qq � 7..2
al '
Phone: (St/3) 31 S CV 14. Fax: (5) MS 37 1
Plan review (25% of permit fee)
CCB Lic.: Plumbing Lic. no.: 34. -Is 013
State surcharge (12% of permit fee)
Authorized si /l �� cr0 TOTAL PERMIT FEE , l , .le"
Print name: �!- j+L'r t..77iskis„SJ J Date: 7-1 - 2,017 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 - 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
Storm & Rain Drain - 1st 100' 62.54 Valuation: Permit Fee:
$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
Inspections 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 Installation
Fixture Type for Replace/
Work Performed: Capped Added Relocate Plan review is required for any of the following.
Baptistry/Font Please check all that apply.
Bath Tub /Shower ❑ 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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