Permit CITY OF TIGARD PLUMBING PERMIT
. COMMUNITY DEVELOPMENT Permit #: PLM2011 -00287
T 1GAR_D 13125 SW Hall Blvd., Tigard OR 97223 503.718 2439 Date Issued: 09/14/2011
Parcel: 1S133DD05700
Jurisdiction: Tigard
Site address: 12695 SW WINTER LAKE DR
Project: HILL Subdivision:'ILLAGE AT SUMMER LAKE PARK NO Lot: 97
Project Description: Replacing plug to shower
Contractor: WATSON PLUMBING CO. Owner: HILL, CATHY H
7935 E BURNSIDE ST 12695 SW WINTER LAKE DR
PORTLAND, OR 97215 TIGARD, OR 97223
PHONE: 503 - 256 -3720 PHONE:
FAX•
FEES
Quantity Description Date Amount
1 ea Tub /Shower /Shower Pan 09/14/2011 $12.51
Specifics: 1 12% State Surcharge - 09/14/2011 $8 70
Plumbing
Type of Use: SF 60 ea Minimum Fee Adjustment - 09/14/2011 $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 OUNC by calling 503.232 1987 or 1.800 332.2344.
Issued By: Permittee Signature:
C. I .•39.4175 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
*1 c AA
0 Received
City of Tigard " q �- 1 \ Date/By GI /t j /I , J �-- Permit No Like 1 /'{.Y7)
Phone 503 718 2439 Fax: 503 598.1960 JGG
II
'I 13125 SW Hall Blvd., Tigard, OR 97223 c .c. l . �� Plan Review
,„ o Other Permit No .
Inspection Line• 503 639 4175 C \t„
TIGARD Oa i ` Date Ready /By Juns ® See Page 2 for
Internet. www tigard -or gov 0 . A \C't Notified/Method 7 Supplemental Information
TYPE OF WORK 90 FEE* SCHEDULE
❑ New construction ❑ Demolition For special information use checklist.
Description I 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
"iit1- 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: / a 4 {t i(/ VI /MC f L f( f j fl Catch basin or area drain 18.76
7 ` / _ Y� Drywell, leach line, or trench drain 18.76
City /State /ZIP:
/ gd 1 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
e�O run f Le & Clothes Dishwasher her 25.02
washer 25 02
Ll �,n shwher
5 l! (_ " 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 9 12 51
E -mail: Urinal 25.02
. CONTRACTOR Water closet 25.02
Water heater 37 52
Business name: viA' f 0 , 4 I . (_ (� i1 K j' Water piping/DWV 56 29
Address: 3 0 �J S /' 6 Other. 25 02
City /State /ZIP: p 0an /w f1 7 . -`,r Subtotal
Phone: ( 3 2 3- 7 g Fax: (ST) )_f ZS-6 — I ` / Minimum permit fee: $72 50 '7 a St)
CCB Lie.: Etr!' 'lumbin Lie. no.: — &Ca •� Plan review (25% of permit fee) —
�1 St ate surcharge (12% of permit fee) r. "7€
Authorized signature: /O � TOTAL PERMIT FEE
Print name: 611 le 14e a GjU Datc:9 "1
This permit application expires if a permit is not obtained within 180 days
after it has been accepted as complete.
*Fee methodology set by To- County Building Industry Service Board
1 \ Budding \ 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 - is 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 Inspections or Fees Qty. Fee (ea) Total each additional $100.00 or fraction thereof, to
h 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
Re inspection 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/
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"
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
WaterCloset - Toilet fees assessed for the sewer increase must be paid before the
Urinal plumbing permit can be issued.
•
Other Fixtures:
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