Permit CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT 4 Permit 4: PLM2012 -00041
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T [ G ARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 02/28/2012
Parcel: 2S102AA01200
Jurisdiction: Tigard
Site address: 11895 SW GREENBURG RD
Project: Luke -Dorf Inc. Subdivision: Lot: 0
Project Description: Interior Plumbing for building A. 8/6/12, adding (1) water heater and (1) expansion tank.
Contractor: RON THOMPSONS PLUMBING LLC Owner: LUKE -DORF INC
15039 SE WYEAST AVE 11895 SW GREENBURG
DAMASCUS, OR 97089 -8833 PORTLAND, OR 97223
PHONE: 503 - 267 -1899 PHONE:
FAX:
FEES
Quantity Description Date Amount
3 ea Fixture /Sewer Cap 02/28/2012 $75.06
Specifics: 6 ea Sink 02/28/2012 $150.12
1 ea Tub /Shower /Shower Pan 02/28/2012 $12.51
Type of Use: COM 5 ea Water Closet 02/28/2012 $125.10
Class of Work: ALT 1 12% State Surcharge - 02/28/2012 $43.53
Type of Const: Plumbing
Occupancy Grp: 1 ea Expansion Tank 08/06/2012 $12.51
Stories: 1 ea Water Heater 08/06/2012 $37.52
0 12% State Surcharge - 08/06/2012 $6.01
Plumbing
Total $462.36
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 -0' • I. You ma . obtain a copy of the rules
or direct scions to O • by ca ' . 503.232.1987 or 1.800.332.2344.
Issue By: // Permittee Signature: S
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 oft e project.
Approved plans are required on the Job site at the time of each Inspection.
111 CITY OF TIGARD PLUMBING PERMIT
2 • COMMUNITY DEVELOPMENT Permit #: PLM2012 -00041
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 02/28/2012
Parcel: 2S102AA01200
Jurisdiction: Tigard
Site address: 11895 SW GREENBURG RD
Project: Luke -Dorf Inc. Subdivision: Lot: 0
Project Description: Interior Plumbing for building A.
Contractor: RON THOMPSONS PLUMBING LLC Owner: LUKE -DORF INC
15039 SE WYEAST AVE 11895 SW GREENBURG
DAMASCUS, OR 97089 -8833 PORTLAND, OR 97223
PHONE: 503 - 267 -1899 PHONE:
FAX:
FEES
Quantity Description Date Amount
3 ea Fixture /Sewer Cap 02/28/2012 $75.06
Specifics_ 6 ea Sink 02/28/2012 $150.12
1 ea Tub /Shower /Shower Pan 02/28/2012 $12.51
Type of Use: COM 5 ea Water Closet 02/28/2012 $125.10
Class of Work: ALT 1 12% State Surcharge - 02/28/2012 $43.53
Type of Const: Plumbing
Occupancy Grp:
Stories:
Total $406.32
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 .btain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: / `- Permittee Signature:
.f/
Igo.
- Call 503439.4175 by T:OO 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 y "_
rrrt� }��4h�9
City of Tigard L *.if ' Received
Iiii Permit No.: / eg a.� / t f /
U 131 SW Hall Blvd., Tigard,OR 972211 U 6 ZO� Plan Review " - r `
C Phone: 503.718.2439 Fax: 503.598. 9' G _ A) Date/By: Other Permit No.:
Inspection Line: 503.639.4175 �, t Date Ready/By: kris: El See Page 2 for
I G n It a Internet: www.tigard- or.gov CV Y' 3 c � 1 6 „ , ,�?�� �tI
�� Notified/Method: Supplemental Information
'
TYPE OF WO 11 , ;ji r C � �-'
�' 1 " t 1 FEE* SCHEDULE
❑ New construction ❑ Demolition For special information use checklist
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
❑ 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: (I f p6 (.57„,c) 6.; &_ee4 1 Catch basin or area drain I I 18.76
I Drywell, leach line, or trench drain 18.76
City/State /ZIP:
Footing drain (no. linear ft.: ) Page 2
Suite/bldg. /apt. no.: I Project name: 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
Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
❑ PROPERTY OWNER I 0 TENANT Expansion tank / 12.51
Name: Fixture /sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address:
Garbage disposal 25.02
City/State /ZIP: 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
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 25.02
CONTRACTOR
Water heater / 37.52
Business name:�t3 ( 4 , /4/ 2 &) Art J. Water piping/DWV / 56.29
Address: Other: 25.02
City/State /ZIP: Subtotal
Phone: ( ) Fax: ( ) Minimum permit fee: $72.50
Plan review (25% of permit fee)
CCB Lic.: ize Plumbing Lic. no.:
State surcharge (12% of permit fee)
Authord signature: • TOTAL PERMIT FEE I
Print name: Date: 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.
I1Building \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 - I" 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 ec
Ins tions or Fees Qty. Fee (ea) Total each additional $100.00 or fraction thereof, to
Inspections 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 ", 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 (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
Bath - Tub /Shower ❑ New exterior plumbing site utilities for any complex structure
-Tub/Shower as defined in OAR918- 780 -0040.
Car Wash -Each Stall ❑ Medical gas and vacuum systems for health care facilities.
Drive Stall ❑ Any multipurpose fire sprinkler system.
Cuspidor/Water Aspirator ❑ 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
- 3 that meet the qualifications above.
Car Wash Drain
Garbage - Domestic
Disposal - Commercial
- Industrial Comments regarding fixture work:
Ice MachiRefrig. Drains
Oil Separator (Gas Station)
Rec. Vehicle Dump Station
Shower -Gang
-Stall
Sink - Bar/Lavatory
- Bradley
- Commercial *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
Water Extractor plumbing permit can be issued.
Water Closet - Toilet
Urinal
Other Fixtures:
I:\ Building \Permits\PLM - PermitApp.doc 2
Plumbing Permit Application O , Ji a . 4; ,_ g� 30
Building Fixtures FURR OFFICE ush: ONLY
City of Tigard f :+ � ived
O1� • , ,ea, ; y . d _ I , . I� Permit No.: PL(r) go (r d( � / , /
71 n 13125 SW Hall Blvd., Tigard,OR 972 ' Q � �� ,dll �I
C an Rev
Phone: 503.718.2439 Fax: 503.5 q, �V Date/By: Other Permit No.: pp. lO_amii
T I G n R D Inspection Line: 503.639.4175 �� .� \ �� Date Ready/By: Jurie: ® See Page 2 for
��//
Internet: www.tigard-or.gov (_` ,,....,f,,,„ Notified/Method: 7736 Supplemental Information
TYPE OF WORK `� C...# For FEE* SCHEDULE
El New construction ❑ Demolition For special information use checklist
Description I Qty. I Ea. I Total
V Aildition/alteration/replacement ❑ Other: <INT New 1- 2- family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (1) bath 312.70
❑ 1- and 2- family dwellingCotnmercial/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: I r 4 5 5-c t•, ?'- Catch Drywell, In or h li n a drain 18.76
City /State /ZIP: � Drywell, leach line, or trench drain 18.76
` /S 4- v Footing drain (no. linear ft.: _) Page 2
Suite/bldg. /apt. no.: I Project name: L(4 kc.-dU f-4._ 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
1 Clothes washer 25.02
- t!4∎Pir_Ari i) r p �1M6 Yv) - qv, I /D7 thro 1A Dishwasher 25.02
Drinking fountain 25.02
Ejectors /sump 25.02
❑ PROPERTY OWNER ❑ TENANT Expansion tank 12.51
Name: Fixture/sewer cap 25.02 7 57,C-(1?
Floor drain/floor sink/hub 25.02
Address:
Garbage disposal 25.02
City /State /ZIP: Hose bib 25.02
Phone: ( ) Fax: ( ) Ice maker 12.51
A PPLICANT ❑ CONTACT PERSON Interceptor /grease trap 25.02
Business name: S4„,,,,, c f �/_ { Medical gas (value: $ ) Page 2
�o�ivw Primer 12.51
Contact name:
Roof drain (commercial) 12.51
Address: Sink/basin/lavatory C 25.02 (
City/State /ZIP: Solar units (potable water) 62.54
Phone: ( ) I Fax: : ( ) Tub /shower /shower pan I 12.51 !dam
E -mail: Urinal 1 25.02
Water closet 5 25.02 I b
CONTRACTOR /� Water heater 37.52
Business name: /<_p� � t p� 5D,v f / N f � Water piping/DWV 56.29
Address:/ 52 3 9 54: ��,, s T A . Other: 25.02
City /State /ZIP: atl 5 9 7 0 0 5 I Subtotal 3(� 7A
Phone: ( 26 7 / 5C Fax: ( ...)----- Minimum permit fee: $72.50
CCB Lic.. :: / ? Fc eV 3 Plumbing Lic. no.://4,7 r _ _ Plan review (25% of permit fee)
State surcharge (12% of permit fee) 1 3 , 53
Authorized signature: ..,____ -7-1,7...___- TOTAL PERMIT FEE 116 3a
Print name:? This application expires if a permit is not obtained within 180 days
7e Date: z y � J� s permit d
after it has been accepted as complete.
/ *Fee methodology set by Tri -County Building Industry Service Board.
1:\BuildingWmnits\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 $1 0,001.00 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: - Tub /Shower
greater, except systems designed and stamped by licensed
engineer.
- Jacuzzi/Whirlpool
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
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./Refrig. Drains Comments regarding fixture work:
Oil Separator (Gas Station)
Rec. Vehicle Dump Station
Shower: -Gang
-Stall
Sink: -LavBar non -food related // / f. /11/
- 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 fees asse for the sewer increase must be paid before the
Water Extractor P
WaterCloset Toilet / /1/ r plumbing permit can be issued.
Urinal
Other Fixtures:
I: \Building\Permits\PLMF- PermitApp.doc 08/04/2011 2