Permit q CITY OF TIGARD PLUMBING PERMIT
: • COMMUNITY DEVELOPMENT Permit #: PLM2012 -00052
T I GAR.D 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 03/08/2012
Parcel: 2S 110DD90451
Jurisdiction: Tigard
Site address: 10845 SW MEADOWBROOK DR 45
Project: Bothwell Subdivision: SUMMERFIELD BROOKSIDE CONDO Lot: 45
Project Description: Tub to shower conversion.
Contractor: BATH FITTER (BATHTUB SOLUTIONS) Owner: BOTHWELL, PATRICIA M
11747 NE SUMNER 10845 SW MEADOWBROOK DR
PORTLAND, OR 97220 TIGARD, OR 97224
PHONE: 503 - 968 -2567
HONE: 503 - 595 -8827
FAX: 503 - 595 -6051
FEES
Quantity Description Date Amount
1 ea Tub /Shower /Shower Pan 03/08/2012 $12.51
Specifics: 1 12% State Surcharge - 03/08/2012 $8.70
Plumbing
Type of Use: MF 60 ea Minimum Fee Adjustment - 03/08/2012 $59.99
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 questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: Permutes Signatur .
cc Q �
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.
03/07/2012 09:19 5035956051 BATHFITTER PAGE 01/03
.. •. Plumbin Permit A iicati EC EI\/ ED
Building Fixtures OFFICE USE ONLY q
City of Tigard 012 teis" e2 -71). �i�-V) PenmtNe.: biL / /A04,q -06051'
in 13125 SW Hall Blvd, Tigard, OR 97223 MAR 7 2012 Review
i 0 Phone: 503.718.2439 Fax: 503.598.1960 Date/B . Other Permit No.:
T I r;.aRD Inspection Line: 501639.4175 CITY OF TIGAfD Daps Reedy /By: Avis; El See Page 2 for
Internet: www.tigard- or ; eov Notified/Method: Su • plemental lofotmatioo
❑ New construction r Demolition : ! f For special information use checklist
0 Description •u . Ea. Total
'e Addition /alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
K�; t k.. e„ :e.: - :•r. .: ;i bath 312.70
;:.� w> SY�)F�� (JET ;�! ;u:z- �i ; ....�.�,., : ,.,. ,�, SFR 1 ba
�':'(::::. �` f '�' W ..f'��., /..A �_ ...•. �.•Y. "* 1:..-1 1.. 1 ,_.... �1.. !r ,:. � M . C:�i:l�.. . . :�i.:. , 1. ���.
❑ 1- and 2- family dwelling 3,ommercialPmdustrial SFR (2) bath 437.78
SFR (3) bath 500.32
❑ Accessory building Y ❑ Multi-family
Each additional bath/kitchen 25.02
0 Master builder ❑ Other: Fire sprinkler ( sq. ft.) Page 2
K - . f.'4 fi 0 =:A 10.;,4C , if .:'- : : r ,:'H . site utilities:
. , � ;: .:. I •, ....a'� r 1j�.,,,.�'ossA�ti ... .n,...�.��b' -1.. r. h. :.:: .: : i'.;
Job site address: 0: S (� Catch basin or area drain -- I &76
;l - s a Drywall, leach line, or trench drain 18.76
City/State/ZIP: Ti cu c, q7 Footing drain (no. linear ft.: Page 2
Suite/bldg./apt. no.: Project came: 4 10 • IA - 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 &: _„_,) Page 2 •
Subdivision: I Lot no.: Fixture or item:
Tax map /parcel no.: Backflow preventer 31.27
r � 4 ' • s`e •'}t•,. «,> :. Backwater valve 12.51
>: 7 �•G:�: , rc .t :'•' r ; `', ' _F r. ,'I l ,'j 1•'F!'Y7✓ACll7 " ° i.
Clothes washer 25.02
. 4b a h isw e - Cam• ve.r$ i at _ Dishwasher 25.02
r'o- U'1 • ` L • Drinking fbuntain ■ 25.02
I Ejectors/sump 254
”{{_ :, i- n ': - r• y ' ;;.' : ;: ??. Expansion tank MI 12.51
r � t w^ ( Fixture/sewer cap 25.02
Name: E Y( Gf
D e t S S w M e a - 01. .510 1 fr Garbage ge disposal sink/hub 25.02
Address: �'j k I* Garbage disposal 25.02
City / State/ZIP: 1 r " I - 7 .3-Z Hose bib 25.02 -
Phone (5 . _ ',..0-:°'' : ( m _
y (�(p a Fax: -, , ice maker 1251
; x , :. : , ' ; z; „;: %m' `)' iti hY{i . :' l `,. - �:, ' QII1TAC; ARR.
P..E :C'' Interceptor /grease trap 25.02
Business name: = Medical gas (value: $ ) Page 2
. � 1 • . a Gam Primer � Mil
Contact name: M • • •.1.i _ 4_
Roof drain (commercial) � 12.51
Address: A L- IN e ; � sink/basiMavatory 25.02
City /State/ZIP: ate► A. Ejt I 4 )4-.,,5 Solar units (potable water) 62.54
'
( _ _ Fax :: (gb - _ Tub /shower/shower pan ( 12.51 /$OI
Phone: • , ,
-� � Urinal 25.02 MI
E -mail: . a , • __ ., 1_ _it. e. i ' r W c loset
pi 25.02
-^`)
a ''��� v��r�'i'lra t '' �.e }12`�x '� , '.'�',��� � f�: .� °if:�� � �,NJ•� ;: , �`t'� k %:
:..s :- .4 • : . 4.... ± :: : :,tv :. �•°' ... :. '. p . ,_ ,. - . ? '� ' ` '� ° > ; �� c• , � ' " :,. ;,;. Water heater 37.52
Business name: Mb /. d . • IA. in (...- Water piping/DWV 56.29
Address: u-7 4-7 N , p Other: 25.02
City/State/ZIP: Po r4- and i D 941-.4-0.0 • Subtotal Millil
Minimum permit fee: $72.50
Phone: (Z� - _ - Fax: (SD 6 . • S Plan review (25% of permit fee) a.
4 P , bing Lie. no.: Mal ---
State surcharge (12% of permit fee)
Authorized signatur ilPr ffr I Sr ' r / TOTAL PERMIT FEE `!, PPO
Print name: U kr% 01 / Q e Date: 3 .r6, -/ Tbis permit application expires if a permit is not obtained within t' days
after it has been accepted as complete.
'Fee methodology set by Tri-County Budding industry Service Board.
I: TuildINAPermiis \PLMU- PmnitApp.doC 10/01/09 440-4616T(10/02/COM/WEB)
e
03/07/2012 09:19 5035956051 BATHFITTER PAGE 02/03
.:.• • Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Su ression Systems:
»,.:.,.,:� t� "•:.' ' . pill ..- , " sF
tier h'es. ... '
�: ..:. �; .,1 e4),". .... :..� ; ,
•i.... ''tea ._..�... .: •,� - .':�,.,:;..;, :�:,:::�'_ ' �' .., ..... q ... : �`':�- , .. ,
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
Sewer 1st 100' 62.54 • 3,601 to 7,200 $233.20
7,201 end 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 z � :'. :: ' '. s; • °: 4:iii''?.��: _ >- :, ,
-��-
: .:` '. "'.`." .�',' .
Storm & Rain Drain - 1st 100' 62.54 $1.00 4,L , " to $5,000.00 Minimum fee $72.50
Storm & Rain Drain - each additional 100' 37.52 55.001,00 to 510,000.00 $72.50 for the first $5,000.00 and $1.52 for
��< - each additional $100.00 or fraction thereof, to
LI'J<StX Pee ji s) �, .
„';�? "�.. �� �. �", �.' : ..:.....:.:.•, �'�: ..::•:.,
and including $10,000.00.
Inspection of existing plumbing or for $10,001.00 to 525,000,00 5148.50 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 - I/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 * .
S: `• .k > r,� ^�. �" 'r" �?':rtti . 'a +�n.!CX:b`.'::%i:��e
F
lt9tlti �1S[rlFk'�, yy,,��``
,rak;�' ;�t',- ..r•, - : :Q f�'. .b�',' Y pe; :., ..:, �JI � M� , ,., - --- -. .. ,...a...'., 1)!IIS�ws <'
yi:? �: . q i u3. : -, ' r < •:fit
• .... $1? ie Plan review is required for any of the following.
Ba sttiirj:ote "_ Please check all that apply,
Ba
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 Tutu ❑ 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.
-tCar Wash Drain - • ;,.`�I. ISO .. § 'D x
Garbage - Domestic - non-food - Isometric or riser diagram is required for new buildings
Disposal - Domestic -food related , that meet the qualifications above.
-Commercial -tbod related
-Industrial-food related
Ice Mach/Refrig. Drains
Oil Separator (Gas Station) Comments regarding fixture work:
Rec. Vehicle Dump Station
Shower -Gang ( fl - S
-Stall X S
Sink/Lav -Non -food related
- Bradley rok 1 W t II/
- Commercial -food related
-Service
Swimming Pool Filter
Washer • Clothes *Note: If the fixture work under this permit results in an
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:
C :IDOCUME -I \profile\ LOCALS-- 1\Temp1PLMF- PermitApp.doc 2
. n