Permit „ CITY OF TIGARD PLUMBING PERMIT
: . g COMMUNITY DEVELOPMEN Permit #: PLM2011 -00294
13125 SW Hall Blvd., Tigard OR 97223 503 718.2439 Date Issued: 09/22/2011
TIGARD Parcel: 1S 134CB03700
Jurisdiction: Tigard
Site address: 12510 SW SUMMER CREST DR
Project: Seaver Subdivision: SUMMER HILLS PARK Lot: 35
Project Description: House remodel
Contractor: BRUNER PLUMBING Owner: SEAVER, DEBORA
PO BOX 23985 12510 SW SUMMER CREST DR
TIGARD, OR 97281 PORTLAND, OR 97223
PHONE: 503 - 484 -5105
PHONE 951- 231 -3157
FAX. 503 -624 -2173
FEES
Quantity Description Date Amount
1 ea Dishwasher 09/22/2011 $25.02
Specifics: 1 ea Garbage Disposal 09/22/2011 $25.02
1 ea Ice Maker 09/22/2011 $12 51
Type of Use: SF 1 ea Sink 09/22/2011 $25 02
Class of Work: ALT 3 ea Lavatories 09/22/2011 $75.06
Type of Const: 4 ea Tub /Shower /Shower Pan 09/22/2011 $50 04
Occupancy Grp: 3 ea Water Closet 09/22/2011 $75.06
Stories: 1 ea Water Heater 09/22/2011 $37 52
1 12% State Surcharge - 09/22/2011 $39.03
Plumbing
Total $364 28
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 Not 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 dire questions to OUN.0 by c- , g 503 232.1987 or 1 800 332.2344.
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Issu d By: / 4' Permittee Signature:
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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 o e • eject.
Approved plans are required on the job site at the time of each inspection.
Plumbing Permit App Heat' FT i
Building Fixtures CEIVED FOR OFFICE. USE ONLY
City of Ti F 2 2 2 p Received Permit No ,� a f ' i b �C+],LF
Ill 13125 SW Hall Blvd., Tigard, OR 9 Plan Review
Phone: 503 718.2439 Fax 50 Date/By Other Permit No •
T t G A R D Inspection Line 503.639.4175 uF TIGARD Date Ready/By luris ®See Page 2 for
Internet: www.tigard- or.gov BUILDING DIVISION Notified/Methods Supplemental Information
TYPE OF WORK 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
❑ 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: //15/6 6 !� z / � . /mm(K cp - NZ.- Catch basin or area drain 18 76
tJ '+.t/ tom" Drywell, leach line, or trench drain 18 76
City /State /ZIP: 77� ff 0/2 '7722 3
Footing drain (no linear ft.: ) Page 2
Suite/bldg. /apt. no.: Project name: S 7 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: Lot no.: Fixture or item:
Tax map /parcel no.: Backflow preventer 31 27
DESCRIPTION OF WORK Backwater valve 12 51
e mpe; / ` c t2 I
Clothes he sher 25.02
tIl'l � � Dishwasher ✓ 25.02
Drinking fountain 25.02
Ejectors /sump 25.02
❑ PROPERTY OWNER ❑ TENANT Expansion tank 12.51
L t r Fixture /sewer cap 25.0
Name: 0 �� V
Floor drain floor sink/hub 25.02
Address: /2 5 (7 6 Cx) 6 e r Cie, bt
Garbage disposal I 25.02
City/State/ZIP: 777 Q OP_ 9 72 2 3 Hose bib 25.02
Phone: (C S-,) 231 51,7 I Fax: ( ) Ice maker t 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 12 51
E -mail: Urinal 25 02
Water closet 12) 25.02
CONTRACTOR
Water heater i 37.52
Business namee4 :20/1 Cr P j tim h Water piping/DW V 56 29
Address: PC) ax 23�i S 4 Other: , 25 02
City /State /ZIP: � i- ')(2 e97 3 Subtotal
Phone: (5'13) ( 46150 F ax: ( ) " Pb Minimum permit fee • $72.50
CCB Lie.: b' � Plumbing Lic. no.: p2eV'4'46- Pb Plan review (25% of permit fee)
State surcharge (12% of permit fee) 11364 Authorized signature:9 D.4601,-Kr. j�,�r( p TOTAL PERMIT FEE as, Print name: Date: ,n / Thi permit application expires if a permit is not obtained within 180 days
< l- At- 9 /GGf �ilJ� after it has been accepted as complete.
J / *Fee methodology set by Tn- 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 - 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 Inspections or Fees' Qty. Fee (ea) Total each additional $100.00 or fraction thereof, to
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 any required for 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"
4 Isometric or Riser Diagram
Car Wash Dram ❑ Isometric or riser s
diagram is required for new buildings - Domestic- non -food 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
1:\Building \Permits \PLMF- PermitApp.doc 02/24/2011 2
Location:
Record Type:
Inspection Type:
Comments:
Inspection Date:
Record ID:
Result:
City of Tigard
13125 SW Hal Blvd.
Tigard, OR 97223 Tel: 503.718.2439
12510 SW SUMMER CREST DR, TIGARD, OR,
97223
Residential - Plumbing
399 Plumbing final
2013-11-07 00:00:00
PLM2011-00294
PASS - No C of O
Violation Summary:
Inspector Contractor