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Permit r CITY OF TIGARD PLUMBING PERMIT :t. COMMUNITY DEVELOPMENT Permits PLM2011 -00322 Date Issued 10/27/2011 I1G,ARD 13125 SW Hall Blvd , Tigard OR 97223 503 718 2439 Parcel 2S104D601600 Jurisdiction Tigard Site address 13024 SW BROADMOOR PL Project Carey Subdivision AMESBURY HEIGHTS Lot 16 Project Description Bathroom remodel 10/27/11, reprinted to correct contractor name change Contractor A ABOVE ALL JOHN D PLUMBING Owner CAREY, STEVEN C & KAZUKO 7472 SW FIR STREET 13024 SW BROADMOOR PL TIGARD, OR 97223 TIGARD, OR 97223 PHONE 503- 620 -7600 PHONE FAX 503 -598 -9355 FEES Quantity Description Date Amount 2 ea Tub /Shower /Shower Pan 10/27/2011 $25 02 Specifics. 1 12% State Surcharge - 10/27/2011 $8 70 Plumbing Type of Use SF 47 ea Minimum Fee Adjustment - 10/27/2011 $47 48 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 question SUNG by calling 503 232 1987 or 1 800 332 2344 Issu: :: Perm rttee Sig ature � /y' 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 CITY OF TIGARD PLUMBING PERMIT COMMUNITY DEVELOPMENT Permit # PLM2011 -00322 Date Issued 10/27/2011 'TIGARD 13125 SW Hall Blvd , Tigard OR 97223 503 718 2439 parcel 251040B01600 Jurisdiction Tigard Site address 13024 SW BROADMOOR PL Project Carey Subdivision AMESBURY HEIGHTS Lot 16 Project Description Bathroom remodel Contractor JOHN D PLUMBING Owner CAREY, STEVEN C & KAZUKO 7472 SW FIR STREET 13024 SW BROADMOOR PL TIGARD, OR 97223 TIGARD, OR 97223 PHONE 503- 620 -7600 PHONE FAX 503 -598 -9355 FEES Quantity Description Date Amount 2 ea Tub /Shower /Shower Pan 10/27/2011 $25 02 Specifics: 1 12% State Surcharge - 10/27/2011 $870 Plumbing Type of Use SF 47 ea Minimum Fee Adjustment - 10/27/2011 $47 48 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 No ation Cen - Thos- des are set forth in OAR 952- 001 -0010 through OAR 952 -001 -0090 You may obtain a copy of the rules or direc questions to OUNC ry : ling 50 ' 1987 or 1 800 332 2344 issued ty - / /. , /z A - Permittee Signature Call 503 63 � 9 L41.// /J f 4175 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 Rece veil City of Tigard q Permd No n� 111 1 it 131 SW I Ial Blvd 'I'lgard,OR 97223 plait /ey �Q p{ 7 L pt�� Phone 503 718 2439 Fax 503 598 1960 Platt Review Other Permit No Inspection Line 503 639 4175 Dat Ry TIGARD Internet wwwn and -or gov Date e ReacbBy Juno ®See Page 2 for g g Notified/Method Supplemental lnformanon TYPE OF WORK FEE* SCHEDULE ❑ New construction I ❑ Demolition For special information use checklist. Al Description Qty I Ea Iotal Ali Addition /alteration/replacement ❑ Other New I -2 -family dwellings (includes 100 ft for each utility connection) / CATEGORY OF CONSTRUCTION SFR (1) bath 312 70 4 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 Fiec sprinkler ( sq ft) Page 2 JOB SITE INFORMATION AND LOCATION ,/� Site utilities. __ Job site address / 3c 5 W Lo 4 iq-b y k 009_,, Catch basin or area drain 18 76 �/ Drywell, leach lane, or trench drain 18 76 City/State /ZIP C � � Footing drain (no linear ft _) Page 2 Sunte/bldg /apt no I Protect name Manufactured home utilities 50 03 Cross street/directions to Job tic Manholes 18 76 Rain drain connector 18 76 ( �� l� � i��7 Sanitary sewer (no linear It Paget Storm sewer (no linear ft Page 2 Water service (no linear It _ ) Page 2 Subdivision Lot no Fixture or item Tax map /parcel no Backtlow preventer 31 27 DESCRIPTION OF WORK Backwater valve 12 Sl J ,, i ¢// Clothes washer 25 02 4, -, - rr" "Xk l � � ")f'� i - e.`Y - 2 Dishwasher 25 02 Drinking fountain 25 02 Ejectors /sump 25 02 ❑ PROPERTY OWNER ❑ TENANT Expansion tank 12 51 Name Fixture /sewer cap 25 02 • OA) Floor drain/floor sink/hub 2502 Address / - jO 2 4 O / K fj /' Q ()/^ f Garbage disposal 25 02 City /State /Z1P N I �. �� Hose bib 25 02 Phone ( ) Fax ( ) Ice maker 12 51 ❑ APPLICANT ❑ CONTACT PERSON / Interceptor /grease trap 2502 Business name it 60 (,/ /L �� , / .f,,,Me dical gas (value $ ) Page 2 J ' I ' mer 12 51 Contact name 70 /IA/ Air e0 fig ht p Roof drain (commercial) 12 51 Address 7/- y 2 - ,'y( Smk/basivlavatory 25 02 City /State /ZIP �` p ` Y O/ 9 /�� i 9 �' J 6_ 2:2.; ) Solar units (potable water) 62 54 Phone ([ 'L) / ) G 6 76 0 0 Fax ( ) Tub showe' ower pan - 12 51 E-mail �S Urinal - 25 02 Water closet 25 02 I' CONTRACTOR Ago heater 37 52 Business name - `f`t p � 17;14-(,)1D P Loan 6/ N� Water piping/DWV 5629 Address Other 25 02 City /State /ZIP Subtotal Phone ( ) Fax ( ) •/ �1 Minimum permit fee $7250 72- CCB Lie g9g3 .3/ 0749.- Plumbing Lie no JY -a57 Df.2 Pl review (25% of permit fee) / 1 , 9 State surcharge (12 %of permit fee) 8. 70 Authorized signature In if----- ( TOTAL PERMIT FEE '(, 0 `_i/ )� Ddte � ) This permit application expires if a permit is not obtained within ISO days Print name Joi i 9 �{7 Z 7,C [J et after it has been accepted as complete `Fee methodology set by in-county Building Industry Service Board I Bu'tdirg \Permns\PL PermitApp doe 10/01/09 440- 46161(Io /02/COMAvEB) 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' 5003 0 to 2000 $12190 Footing drain - each additional 100 37 52 1001 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 6254 Medical Gas Systems: Water Service - each additional 100 37 52 Valuation: Permit Fee: Stout & Rain Drain - 1st 100' 62 54 $1 00 to$500000 Minimum fee $7250 Storm & Rain Dram - 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 * . Plan Review for Plumbing Installations Quantity by Fixture Type Plan review is required for any of the following Fixture Type for Replace/ Please check all that apply Work Performed: Capped Added Relocate Baptistry /Font ❑ Any new commercial building with water service 2' and Bath - rub/Shower greater except systems designed and stamped by licensed - JawinJWhrrlpool engineer Car Wash -Each Stall ❑ New exterior plumbing site utilities for any complex structure - Drive Iall as defined in OAR918- 780 -0040 Cuspidor/Water - Drive or ❑ Medical gas and vacuum systems for health care facilities Dishwasher -Commercial ❑ Any multipurpose fire sprinkler system Domestic El Any complex structure as defined in OAR918 780 - 0040 Drinking Fountain Eye Wash Submit 2 sets of plans with any of the above. Floor Drain/sink - 2" - 3 Isometric or Riser Diagram - 4 ❑ Isometric or riser diagram is required for new buildings -Car Wash Drain Garbage - Domestic non -food that meet the qualifications above Disposal -Domestic food related - Commercial food related - Industrial food related Ice Mach /Refng Drains Comments regarding fixture work: Oil Separator (Gas Station) Rec Vehicle Dump Station Shower -Gang _ - Stall Sink -Lay /Bar non -food related - Bradley - Com/Sery /Unl food related - Service *Note: If the fixture work under this permit results in an Swimming Pool Pilfer _ increase of sewer EDUs, a sewer permit will be issued and Washer - Clothes fees assessed for the sewer increase must be paid before the Water Extractor Water Closet - Toilet plumbing permit can be issued. Urinal Other Fixtures I \B 'Ming \ Permits \PLMF- PermrtApp doe 08/04/2011 2