Permit , CITY OF TIGARD PLUMBING PERMIT
1111 2 COMMUNITY DEVELOPMENT Permit #: PLM2012 -00061
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 03/16/2012
Parcel: 2S111CC08400
Jurisdiction: Tigard
Site address: 15755 SW GREENS WAY
Project: KEMMERER Subdivision: SUMMERFIELD NO.2 Lot: 111
Project Description: Relocate fixtures for remodel.
Contractor: NORTH STAR PLUMBING Owner: KEMMERER, ROBERT L REVOCABLE TRU
1445 SE OREGON STREET KEMMERER, ZOE A REVOCABLE TRUST
SHERWOOD, OR 97140 15755 SW GREENS WAY
TIGARD, OR 97224
PHONE: 503 - 625 -2679 PHONE:
FAX: 503 - 625 -4567
FEES
Quantity Description Date Amount
1 ea Clothes Washer 03/16/2012 $25.02
Specifics: 1 ea Sink 03/16/2012 $25.02
2 ea Lavatories 03/16/2012 $50.04
'Type of Use: SF 2 ea Tub /Shower /Shower Pan 03/16/2012 $25.02
Class of Work: ALT 1 ea Water Closet 03/16/2012 $25.02
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Type of Const: 1 12% State Surcharge - 03/16/2012 $18.01
Occupancy Grp: Plumbing
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Stories:
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Total $168.13
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, • • • • - ' suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility ••otification Center. Tho ules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. You may obtain a copy of the rules
or ect questions to OUNC b callin.. -; .232.1987 or 1.800.332.2344.
I-- ued By: ' ,i,„th Permittee Signatu
_ c f_A-41-
Call 503.639.4175 by 7:00 a.m. for the next available inspectio 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 FOR of i ici-: list: ONLY
City of Tigard Date/By: r9 /4 , - ' . " Permit No.: Mpg - 40 6 1
III 13125 SW Hall Blvd., Tigard,OR 97223
G Phone: 503.718.2439 Fax: 503.598.1960 D an Review
: ate/By:
Other Permit No.:
T I G r� It D Inspection Line: 503.639 Date Ready/By: orris: ® See Page 2 for
Internet: www.tigard - or.gov Notified/Method: Supplemental Information
TYPE OF WORK FEE* SCHEDULE
❑ New construction 0 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 ❑ Comerciallindustrial SFR (2) bath 437.78
m
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:
Catch basin or area drain 18.76
Job site address:
7555' 6 PP w A-
5 y Drywell, leach line, or trench drain 18.76
City/State /ZIP:
776,e f / Q ' Footing drain (no. linear ft.: ) Page 2
Suite/bldg. /apt. no.: Project name: Manufactured home utilities 50.03
Cross street/directions to job site: I Aw 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 „gy .
AI f Pt� L 1�_5 plipmbih5 Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
❑ PROPERTY OWNER I ❑ TENANT Expansion tank 12.51
Fixture /sewer cap 25.02
Name: C.a I • - - ii ' c - (---
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
Medical gas (value: $ ) Page 2
Business name: r) f f K.S /A r n 1 4 v �'j 1 v5 ! .,,
Pri
Contact name: , , l Yv1 Ca fl,,� `! r Ro mer 12.51
Roof drain (commercial) 12.51
Address: w 1 air V : IN ` Sink/basin/lavatory ? 25.02 7
City /State /ZIP: ► 1 e r ...... tlr 1 a7 . Solar units (potable water) 62.54
Phone: • ) o. - , 0 - Fax: : .v ) e.g. _ q _6 Tub /shower /shower pan a 12.51 X'. °9 '
E -mail: Urinal 25.02
CON CTOR
Water closet / 25.02 250?
Water heater 37.52
Business name: Water piping/DWV 56.29
Address: . \ / Other: 25.02
City/State /ZIP: Subtotal /5h +. 04
Phone:( ) Fax: ( ) Minimum permit fee: $72.50
7' Plan review (25% of permit fee) 7
CCB Lic.: e y • ^ g �mbing Lic no X5 j
_, , ' State surcharge (12% of permit fee) / '.( ,
Authorized signat t TOTAL PERMIT FEE
Print name: \ \o� , Date: 3 �� 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.
1: \ Building \Permits\PLMU- PermitApp.doc 10/01/09 440- 4616T(I0 /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
p 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
Baptistry/Font ❑ Any new commercial building with water service 2" and
greater, except systems designed and stamped by licensed
Bath: -Tub/Shower engineer.
- Jacuzzi/Whirlpool
Car Wash: Each Stall ❑ New exterior plumbing site utilities for any complex structure
Drive tall 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: - Lav/Bar 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 fees assessed for the sewer increase must be paid before the
Water Extractor
Water Closet Toilet plumbing permit can be issued.
Urinal
Other Fixtures:
1: \Building\Permits\PLMF- PermitApp.doc 08/04/2011 2
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Location:
Record Type:
Inspection Type:
Comments:
Inspection Date:
Record ID:
Result:
City of Tigard
13125 SW Hal Blvd.
Tigard, OR 97223 Tel: 503.718.2439
15755 SW GREENS WAY, TIGARD, OR, 97224
Residential - Plumbing
399 Plumbing final
05/01/2013 00:00
PLM2012-00061
PASS - No C of O
Violation Summary:
Inspector Contractor