Permit CITY OF TIGARD PLUMBING PERMIT
111 ' 111. COMMUNITY DEVELOPMENT Permit #: PLM2011 -00290
TIGARD 13125 SW Hall Blvd , Tigard OR 97223 503.718.2439 Date Issued: 09/20/2011
Parcel: 2S110DCO2300
Jurisdiction: Tigard
Site address: 11525 SW DURHAM RD D -3
Project: Pacific Breeze Subdivision: 1998 -128 PARTITION PLAT Lot: 1
Project Description: Remove existing grease trap, install new grease trap, reconnect existing fixtures. No new fixtures added.
Contractor: REALISTIC PLUMBING INC Owner: HIP WILLOWBROOK LLC
PO BOX 22206 BY HARSCH INVESTMENT CORP
MILWAUKIE, OR 97222 PO BOX 2708
PORTLAND, OR 97208
PHONE. 503 - 319 -0010 PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Dishwasher 09/20/2011 $25.02
Specifics: 3 ea Floor Drain /Floor Sink/Hub 09/20/2011 $75.06
1 ea Interceptor /Grease Trap 09/20/2011 $25 02
Type of Use: COM 4 ea Sink 09/20/2011 $100.08
Class of Work: ALT 1 12% State Surcharge - 09/20/2011 $27 02
Type of Const: Plumbing
Occupancy Grp:
Stories:
Total $252 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 No . ion - -r. Thos- rules are set forth in OAR 952 - 001 -0010 through OAR 952 -00 -0090. You may obtain a copy of the rules
or dir- questions to OUN► b alli • '3.232 1987 or 1 800 332.2344.
Issued By: ` � � Permittee Signature: / k 1 ,
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 proje.
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
Date/By 7 Q 21) // -a'h Permit No. d /J // 9
-
II 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review �-+ •
11111
Phone 503 718 2439 Fax 503 598 1960
Date/By Other Permit No
T I G A R D Inspection Line. 503 639 4175 Date Ready/By lens ® See Page 2 for
Internet. www.tigard- or.gov Notified/Method Supplemental Information
TYPE OF WORK FEE* SCHEDULE
❑ Ne construction ❑ Demolition For special information use checklist.
Description I Qty. 1 Ea Total
Addition/alteration /replacement ❑ Other: New 1 dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (1) bath 312.70
❑ 1- and 2- family dwelling IJd't onunercial /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 (____, sy ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: i < 5 iA o- -fr1Y' N. Catch basin or area drain 18.76
City /State /ZIP: / t' � 2 Z,L, Drywell, leach line, or trench drain 18 76
Footing drain (no linear ft.• ) Page 2
Suite/bldg. /apt. no : 9,-3 Project name: PI �� 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: 1 Lot no.: Fixture or item:
Tax map /parcel no.: Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
��` j � Clothes washer 25.02
�-- (,1-,{(_FA�h"��-W � l , .IST� , ( 4-4A i I.W 1`�" "" Dishwasher 25.02 5'02
I t) 64er/st$t 1-. f-- i1 Drinking fountain 25.02
F �e, , N N �t X u Q0, . Ejectors /sump 25.02
❑ PROPERTY OWNER I ' TENANT Expansion tank 12.51
Name: wAl ` ix,K.( Ni 6,tJ`t Fixture /sewer cap 25.02
'n Floor drain /floor sink/hub 25.02 75;
Address: 11 5.,,,i pvi +v . g , Garbage disposal 25.02
City /State /ZIP:` LrA at - • q 17 24--- Hose bib 25 02
Phone: (66 ?) 631-3-i $ b Fax: ( ) Ice maker 12.51
❑ APPLICANT Er6ONTACT PERSON Interceptor /grease trap j 25.02
y" _, , �� N V / Medical gas (value $ ) Page 2
Business name: CJti T "L 1 j 4� E i "V)
11).4 0(L PA t Primer 12.51
Contact name: Roof dram (commercial) //ff 12.51
Address: -- 7/to IJ ,. ( i1() "Ir. Sink/basin/lavatory i f 25 02 /L6.0g
City /State /ZIP: e '14 s4j(7 U� .€ . q 4 2...1 9-" Solar units (potable water) (( 62.54
Phone: 6 ) C 7,4 -,u-(( .Fme ---(c 3) 23 / _ d i I) Tub /shower /shower pan 12.51
E -mail: l (.. W I LIA A-na c t, / dl- • &VI Urinal 25.02
Water closet 25 02
CONTRACTOR
Water heater 37.52
Business name: - C.15`i (C, f Ltt1 ?h•1'.!(a Water piping/DWV 56 29
Address: P- D 6 D)( ZzD(p Other 25 02
City /State /ZIP: MA-WA-0 le--j AL, Q *?i&f Subtotal
Phone: ( 6 '; I q Dp 1 b Fax: ( ) Minimum permit fee $72.50 S, /'
CCB Lic.: t z1 D Z - (h4 17. Plumbing Lic. no.:._ 3-241q12 Plan review (25% of permit fee)
S tate surcharge (12% of permit fee) c .7.G2-
Authorized signature: ' 6 ' / � �
i TOTAL PERMIT FEE ,p 2_, se
Print name: W lA - wh i�L L{- Date: -lb permit ermit application expires if a permit is not obtained within 180 days
t
after it has been accepted as complete.
*Fee methodology set by Tn- County Building Industry Service Board
I \Huddmg\Permits\PLMU- PermitApp doe 10/01/09 440- 4616T(10 /02/COM/WER)
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 &Ram 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
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 9 y g'
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 /Refng. Drains
Oil Separator (Gas Station) Comments regarding fixture work:
Rec Vehicle Dump Station
Shower -Gang
-Stall
Smk/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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