Permit CITY OF TIGARD PLUMBING PERMIT
111 1- COMMUNITY DEVELOPMENT P ermit #: PLM2012 00014
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 01/18/2012
Parcel: 1 S134CA00509
Jurisdiction: Tigard
Site address: 11055 SW 119TH AVE
Project: Geist Subdivision: PANORAMA NO.2 Lot: 20
Project Description: Water heater conversion.
Contractor: OWNER Owner: GEIST, DENISE E & DANIEL J
11055 SW 119TH AVE
TIGARD, OR 97223
PHONE:
PHONE: 503 - 853 -4532
FAX:
FEES
Quantity Description Date Amount
1 ea Water Heater 01/18/2012 $37.52
Specifics: 1 12% State Surcharge - 01/18/2012 $8.70
Plumbing
Type of Use: SF 35 ea Minimum Fee Adjustment - 01/18/2012 $34.98
Plumbing
Class of Work: ALT
Type of Const:
Occupancy Grp:
Stories:
Total $81.20
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Required Items and Reports (Conditions)
This permit ' • - = subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applica. - law. All work`vill be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issu• ce, or if work is suspended •r more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
U ity Notification Center. Tho' rul s .re set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. You may obtain a copy of the rules
direct questions to OUNC by g 514.232.1987 or 1.800.332.2344.
ssued By: .41i A r ,/ Permittee Signature: / ,
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4isr
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.
Plumbing Permit Application
Building Fixtures RECEIVEI FOR OFFICE ()SE ONLY
Cl of Tl and Received perm No.:
IN
'I 131 SW Hal Blvd., Tigard, OR 97223 JAN 1,8 201 Date/By: / /8//4A 4 fit-00 AO y
Z Date/By: By: Other Permit No.:
Ph one: 503.718.2439 Fax: 503.598.1960 DateBy:
TIGARD Inspection Line: 503.639.4175 CITY OF TIGARD Date Ready/By: Juris: 121 See Page 2 for
Internet: www.tigard - or.gov RIJli DING .pll/ISION Notified/Method: Supplemental Information
TYPE OF WORK L FEE* SCHEDULE
• l ition For special information use checklist
❑ New construction ❑ Demo
Description I Qty. I 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
C1 I- 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: / j () S S 1,-,..3 / / / �� Catch basin or area drain 18.76
City /State /ZIP: p G/�/' (0 , 6 �'� GI 7 -2-1.1 Drywell, leach line, or trench drain 18.76
Footing drain (no. linear ft.: ) Page 2
Suite/bldg. /apt. no.: I Project name: ( s / _ 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
Clothes washer 25.02
R-S ) b ff'/ - k Cs n- Dishwasher 25.02
Drinking fountain 25.02
. Ejectors /sump 25.02
zr PROPERTY OWNER ❑ TENANT Expansion tank 12.51
/ Fixture /sewer cap 25.02
Name:
��'� l 4..., �' C 4 1 Floor drain/floor sink/hub 25.02
Address: j / b 5 5 ,N,( / / q t �
Garbage disposal 25.02
City /State /ZIP: 85-3 � o
Go , 6,/L 9 Z1.., 7 ,3 Hose bib 25.02
Phone: (5? ) �5 7_ 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 12.51
E -mail: Urinal 25.02
CONTRACTOR Water closet 25.02
0 Water heater 37.52
Business name:
Water piping/DWV 56.29
Address: Other: 25.02
City /State /ZIP: Subtotal
Phone: ( ) Fax: ( ) Minimum permit fee: $72.50 7
CCB Lic.: Plumbing Lic. no.: Plan review (25% of permit fee) -
State surcharge (12% of permit fee) $.70
>, =�
Authorized signature: c i J` 4fr TOTAL PERMIT FEE g Oo
Print name: •4-n J- / .. 6 c t J T Date: / _/ p 2'l, This permit application expires if a permit is not obtained within 180 days
after it has been accepted as complete.
*Fee methodology set by Tri -County Building Industry Service Board.
I.\BuildingTermits\PLMU- PermitApp.doc 10/01/09 440- 4616T(10 /02 /COM/WEB)
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Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Scheduler 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
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 $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/
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"
4 " Isometric or Riser Diagram
Car Wash Drain ❑ Isometric or riser diagram is required for new buildings
Garbage - Domestic - non - food
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:
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