Permit , CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit #: PLM2011 -00374
TI CARD GAR 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 12/15/2011
Parcel: 2S112DB00200
Jurisdiction: Tigard
Site address: 15255 SW 72ND AVE
Project: Pittman & Brooks Subdivision: FANNO CREEK ACRE TRACTS Lot: 45
Project Description: Interior plumbing.
Contractor: RAYBORN'S PLUMBING INC Owner: BROOKS & PITTMAN RENTALS
19990 SW CIPOLE RD 15255 SW 72ND AVE
TUALATIN, OR 97062 PORTLAND, OR 97224
PHONE: 503 - 692 -4139 PHONE.
FAX: 503 - 691 -2328
FEES
Quantity Description Date Amount
3 ea Fixture /Sewer Cap 12/15/2011 $75.06
Specifics: 1 ea Tub /Shower /Shower Pan 12/15/2011 $12.51
1 ea Water Heater 12/15/2011 $37.52
Type of Use: COM 1 12% State Surcharge - 12/15/2011 $15.01
Class of Work: ALT Plumbing
Type of Const:
Occupancy Grp:
Stories:
Total $140.10
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: dleAr
A CO 1110
Call 503.639.4 .y 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.
04:04:16 p.m. 12 -14 -2011 1 /2
-503 691 2328 Rayborns Plumbing
Plumbing Permit Applicati CEIVED . '
Fixtures DEC a
Building DEC 1 4 ?_011 FOR 01:FIC l• 1,s I. 0N1.1
City of Tigard Received � r
13125 SW Hall Blvd., Tigard, o l�9b 2 GF TIG�RD Dalai : L. ®�� Permit No.: tli Ll �^
I ' Phone: 503.639.4171 Fax: Plan Review - WJ
Ins ec tion Li ne: 503.639.4175 ead
G DIVISIO Date /By: Other Permit No.:
T I t:, \, R 1 p Date Ready/By: hula See Page 2 for
Internet: www.tigard or.gov
Notified/Method: Read
ft Supplemental Information
TYPE OF WORK FEE* SCHEDULE
❑ construction (71 Demolition For special information use checklist.
(,Addition /alteration /replacement ❑ Other: Description Qty. Ea Total
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
❑ Accessory building C) Multi-family SFR (3) bath 500.32
❑ Master builder Each additional bath/kitchen 25.02
❑ Other: Fire sprinkler ( sq. ft.) Page 2
JOB SITE INFORMATION AND LOCATION g
e� 1 Site utilities:
Job site address: (5a 5 5u-) la - Ave Catch basin or area drain 18.76
City/State /ZIP: `r ` �� D� h ��� Drywell, leach line, or trench drain 18.76
Suite/bldg. /apt. no.: Project n P ! 4 7rov Il Footing drain (no. linear ft.: ) Page 2
I i/twrL , Manufactured home utilities 50.03
Cross street/directions to job site: Manholes
18.76
Rain drain connector 18.76
S ` )^ Sanitary sewer(no. linear ft
, ) Page 2
e Storm sewer (no. linear ft: •__ Page 2
Subdivision: 0)1,r'' 1t I Lot no.: Water service (no. linear ft.: �} Page 2
Fixture or item:
Tax map /parcel no.: ` Backtlow preventer 31.27
DESCRIPTION OF WORK �4 �,U 0 Backwater valve 12.51
Clothes washer 25.02
- re
- ,TelY / H� rot` P ( fffttt Dishwasher 25.02
" �� 1' \s i Drinking fountain 25.02
FtY 1 r p,(1 Ej ectors /sump 25.02
❑ PROPERTY OWNER ! ❑ TENANT Expansion tank 12.51
Name: Fixture/sewer cap 25.02 7 5- .
Address: Floor drain/Floor sink /hub 25.02
City /State /ZIP: Garbage disposal 25.02
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
Contact name: Primer 12.51
Address: Roof drain (commercial) 12.51
Sink/basin /lavatory 25.02
City /State /ZIP:
Solar units (potable water) 62.54
Phone: ( ) l Fax: : ( ) Tub/shower/shower pan ! 12.51 - «s S l
E -mail: Urinal 1
25.02
CONTRACTOR Water closet 25.02 �--**
� ��
Business name: � Hot t��L Water heater I 37 52 3?tJO'
} Water piping/DWV 56.29
Address: 1 99 5I) Cyoi(a d KUn 6Dx 69
Other:
f� II fiJJ U 25.02
City/State)ZIP:'n O R. 9 P7a )-- Subtotal el
( ) Fax: 603 t33a8 Io2S�.
Phone: �43 6 �� -1. f � 3 � ) 69 I � Minimum permit f ee: $ 72.50 -^ ,
CCB Lic.: 8 ?SS /y' 1 N / ") ' Plumbing Lic. no.: 3q.. 166 p5 Plan review (25 ° %of permit fee)
Authorized signature
`�
! 7/l �l� State surcharge (12% of permit fee) w
f TOTAL PERMIT FEE ) pit/ /0.
Print name: ; 4V1 N, i9V /
'Pi/ Date: l \ i f This permit application lication expires if a permit is not obtained within'i`An a,.,a -
P `I 1 i,,/ P
r after it has been accepted as complete.
*Fee methodology set by Tri -County Building Industry Service ti(fard!' ' v
I:-nuilding Permits PLMU.PmnitApp.doc IN) 09
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.503 691 2328 Rayborns Plumbing 12:37:27 p.m. 12 -15 -2011 2 /2
Plumbinss Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site Utilities Qty. Fee (es) Total Square Footage:. Permit Fee:
Footing drain - I a 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 Valuation: • Permit Fee:
Storm & Rain Drain - 1st 100' 62.54 $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 S t.52 for
Other Inspections or Fees Qt • 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 5100.00 or fraction thereof.
Subtotal:
Commercial Fixture Work:
Are you capping, adding or replacing fixtures? If "yes ", Plan Review for Plumbing Installations
please indicate work performed by fixture. Failure to Plan review is required for any of the following.
accurately report fixtures could result in increased sewer fees *. Please check all that apply.
Quantity by (Fixture) Work Performed . ❑ Any new commercial building with water service 2" and
Fixture Type: Replace greater, except systems designed and stamped by licensed
Previous Capped Added Existing engineer.
Baptistry/Font ❑ New exterior plumbing site utilities for any complex structure
Bath - Tub/Shower as defined in OAR918 -780 -0040.
- Jacuzzi /Whirlpool
-Each Stall ❑ Medical gas and vacuum systems for health care facilities.
Car Wash
Each Stall - 1=i Any multipurpose fire sprinkler system.
Cuspidor /Water Aspirator Et Any complex structure as defined in OAR918- 780 -0040.
Dishwasher - Commercial
Domestic Submit 2 sets of plans with any of the above.
Drinking Fountain
Eye Wash Isometric or Riser Diagram
Floor Drain/sink - 2" ❑ Isometric or riser diagram is required for new buildings
that meet the qualifications above.
Car Wash Drain
Garbage - Domestic
Disposal -Commercial ar
Comments regarding fixture work:
- Industrial g g
Ice Mach. /Refrig. Drains
Oil Separator (Gas Station)
Ree. Vehicle Dump Station
Shower -Gang
-Stall f
Sink - Bar /Lavatory
- Bradley
- Commercial 3 *Note: If the fixture work under this permit results in an
- Service increase of sewer EDUs, a sewer permit will be issued and
Swimming Pool Filter fees assessed for the sewer increase must be paid before the
Washer - Clothes lumbin permit can be issued.
Water Extractor P g P
Water Closet - Toilet
Urinal
Other Fixtures:
http: / /www, tigard- or.gov /city_hal l /departments /cd/docs/ PLMF- PermitApedoc
C� Accumulative Sewer Tally
14 A_r ' -
Tenant Name: P1'ITMAN & BROOKS SWR #
Site Address: 15255 SW 72ND AVE PLM # PLM2011 -00374
Parcel #: 2S112DB00200
Fixture Value Previous Previous Credits Capped Fixture Fixture ' New New
# value count capped #s value count added # added value total #s total values
Baptisery /Pont 4 0 0 0 1 0
Bath: - Tub /Shower 4 0 0 0 0 0
- Jacuzzi /Whirlpool 4 0 0 0 0 0
Car Wash: - Each Stall 6 0 0 0 0 0
- Drive through 16 0 0 0 0 0
Cuspidor /Water Aspirator 1 0 • 0 0 0 0
Dishwasher: - Commercial 4 0 0 0 0 0
- Domestic 2 0 0 0 0 0
Drinking Fountain 1 0 • 0 0 0 0
Eye Wash 1 0 0 0 0 0
Floor Drain /Sink: - 2 inch 2 0 0 0 0 0
-3inch 5 0 0 ,. 0 0 0
-4inch 6 0 .. 0 0 0 0
- Car Wash 6 0 0 0 0 0
Garbage Disposal:
- Domestic (to 3/4 HP) 16 0 0 0 0 0
- Commercial (to 5 HP) • 32 0 - 0 - 0 0 0 ..
- Industrial (over 5 IIP) 42 , . 0 , -, - , 0 -_ ' • .. 0 0 0
Ice Machine /Refrigerator Drain 1 - 0 - . •-• 0 0 0 0
Oil Sep (Gas Station) 6 . . , „ _ 0 0 • ` - aj 0 0
Rec. Vehicle Dump station 16 0 - 0 0 0 0
Shower: - Gang (per head) 1 0 0 0 0 0
- Stall 2 0 0 1 2 1 2
Sink:
Lay/Bar - Non-Food Related 2 0 0 0 0 0
- Bradley 5 0 0 ' • . . 0 0 0
- Com /Sery /Util - Food Related 3 0 3' ° 9 0 -3 -9
Swimming Pool Filter 1 ! 0 1 . 0 0 0 0
Washer - Clothes 6 _ 0 0 0 0 0
Water Extractor 6 0 0 0 0 0
Water Closet - Toilet 0 0
Urinal 6 0 0 0 0 0
Previous EDU Count •. 0 0
Capped EDU Credit ' - - . 0
TOTALS 0 0 3 _ 9 1 2 -2 -7
Current Fixture Value -7 divided by 16 = -0.4 Current EDU 1 EDU = ' $4,500.00 -
Previous Fixture Value 0 divided by 16 = 0.0 Previous EDU
Change -7 divided by 16 = -0.4 over (under) $ (180.00)
Enter EDU Change I -Iere- -0.04
Notes: ** *CREDIT * **
Authorized Name /Signature: BRANDEN'TAGGART,X2449 . Date:: 12/15/2011 . •
Building Division
Note: The property owner shall the ORIGINAL sewer tally record. If credits exist, this document will serve as a voucher which must 'be
submitted to the City of Tigard Building.Division'to redeem credits towards future system development charges.
I: \Building \Sewer Tally \SewerTallySheet- 4500.xls 07/01/11