Permit -, CITY OF TIGARD PLUMBING PERMIT
- COMMUNITY DEVELOPMENT Permit #: PLM2012 -00011
1 IGAD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 01/17/2012
R,
Parcel: 2S104DCO3400
Jurisdiction: Tigard
Site address: 13167 SW CLEARVIEW WAY
Project: HENIFF Subdivision: BENCHVIEW ESTATES Lot: 34
Project Description: Master bathroom remodel.
Contractor: CLASSIC PLUMBING LLC Owner: HENIFF, DAVID E & MELLANIE M
521 S BALINE ST 13167 SW CLEARVIEW WAY
NEWBERG, OR 97132 TIGARD, OR 97223
PHONE: 503 - 554 -1605 PHONE.
FAX: 503 - 538 -8570
FEES
Quantity Description Date Amount
1 ea Fixture /Sewer Cap 01/17/2012 $25.02
Specifics: 2 ea Sink 01/17/2012 $50.04
1 ea Tub /Shower /Shower Pan 01/17/2012 $12.51
Type of Use: SF 1 ea Water Closet 01/17/2012 $25.02
Class of Work: ALT 1 12% State Surcharge - 01/17/2012 $13.51
Type of Const: Plumbing
Occupancy Grp:
Stories:
Total $126.10
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 ma obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: ..... AHHIA mo , 411 111111P Permittee Signature: ` 1
Call . • • . 5 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 COS) FoR OFFICE USE ONLY
i
City of Tigard �� �^ Date /B / / 7 ` Permit No.n f , ��.r.- �\ I (
n 1 3125 SW Hall Blvd., Tigard, OR 9 1. y rr `' �� tt VV 1
Plan R eview
. M : Phone: 503.718.2439 Fax: 503.5 �' ": t, ti Other Permit No.:
Date/By:
Inspection Line: 503.639.4175 �\
T I GA R D � 4� �` ' Date Ready/By: kids: H See Page 2 for
ww
Internet: w.tigard- or.gov Notified/Method: Trz, Supplemental Information
TYPE OF WORK ® I S) ` FEE* SCHEDULE
■ ❑ Dem�1 For special information use checklist
‘, Descri.tion Qt Ea. Total
'�.. Addition/alteration/replacement ❑ Oth 11 ft. for each utility connection)
CATEGORY OF CONSTRUCTION 1
V ' 1- and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 437.78
bath 500.32
❑ Accessory building ❑ Multi - family
Each additional bath/kitchen 25.02
❑ Master builder ❑ Other:
.
JOB SITE INFORMATION AND LOCATION Site utilities:
Catch basin or area 18.76
Job site address: \‘...?s\ b (___X .1 � to '1 drain
Drywell, leach line, City /State /ZIP: el - 1. - 17 Footing drain (no. linear ft.: _.) Page 2
' ' • 18.76
Suite/bldg. /apt. no.: N I Project name: Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
drain Rain
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
Tax map /parcel no.: ' '
A DESCRIPTION ` OOF y` WOORK �`�QJ ,��
Backwater valve 12.51
\`s `�r���o.)� \ ...)h . ` 1 lam',\ `v �i ` `
Dishwasher , 1
Drinking fountain 25.02
% � 9 . A Q � c R . . _ % . \ - - - v 3V J 2 r i l k e d N& 2 L ,v S 25.02
0 PROPERTY OWNER I ❑ TENANT Expansion tank II ®� Fixture/sewer cap Name: �. K._ �Th fit- 1'I•�Y \‘ C (
T
` .. a s 25.02
Address: \�`\Cfk �� kj‘�W W44. .._ disposal 1
City /State /ZIP: \ ,` O� l
c it -) Hose bib 25.02
Phone:( ) Fax:( ) Ice maker 12.51
0 APPLICANT 0 CONTACT , PERSON Interceptor/grease trap 25.02
Medical gas (value: $ ) Page 2
Business name:
Primer 12.51
Contact name:
Roof drain (commercial) 12.5 I
Address:
I. I 1
(potable City/State/ZIP: • Solar units
Phone: ( ) Fax: : ( ) Tub/shower/shower pan V 12.51 /4 51
Urinal E -mail:
Water closet 1. 1
1
CONTRACTOR
Water heater 37.52
Business name: L \=4• t` \n.J,�� + ••■ C \— LL piping/DWV
Address: \ ' , . l '
Mt.. � L . Other: 25.02
City /State /ZIP: 'tom 0I(� t • Z Subtotal o
Phone: ( r — l r , i 4 �► Minimum permit fee: $72.50 --- CCB Lic.: \.�1Sko ' A _ Plan review (25% of permit fee)
' State surcharge (12% of permit fee) / , 5
Authorized signature: ` 7 �" l TOTAL PERMIT FEE 01# g 1 1
Print name: ---`� v \ Date: , \ 1 1'� � This permit application expires if a permit is not obtained withi 180 days
1 after it has been accepted as complete.
*Fee methodology set by Tri- County Building Industry Service Board.
C\ Building\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
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 . . 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 pp y'
❑ Any new commercial building with water service 2" and
Bapti stry/Font
Bash Tub /Shower greater, except systems designed and stamped by licensed
- Jacuzzi /Whirlpool engineer.
Car Wash: Each Stall ❑ New exterior plumbing site utilities for any complex structure
Drive Thru as defined in OAR918- 780 -0040.
Cuspidor /Water Aspirator ❑ Medical gas.and vacuum systems for health care facilities.
Dishwasher: Commercial ❑ Any multipurpose fire sprinkler system.
Domestic ❑ 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
❑ 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. /Refrig. Drains Comments regarding fixture work:
Oil Separator (Gas Station)
Rec. Vehicle Dump Station
Shower: -Gang -
Stall
Sink: - LavBar non -food related
- Bradley
- Com/Serv/Util food related . .
- Service *Note: If the fixture work under this permit results in an
Swimming Pool Filter increase of sewer EDUs, a sewer permit will be issued and
Washer - Clothes
Water Extractor fees assessed for the sewer increase must be paid before the
Water Closet- Toilet plumbing permit can be issued.
Urinal
Other Fixtures:
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