Permit CITY OF TIGARD PLUMBING PERMIT
s COMMUNITY DEVELOPMENT Permit #: PLM2012 -00081
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 04/10/2012
Parcel: 1S133DB02800
Jurisdiction: Tigard
Site address: 11581 SW SHEFFIELD CIR
Project: Rothenberger Subdivision: BRITTANY SQUARE NO.2 Lot: 52
Project Description: Replace 60' of water service.
Contractor: POWER PLUMBING CO Owner: ROTHENBERGER, THOMAS A & ROSALIN
PO BOX 19418 11581 SW SHEFFIELD CIR
PORTLAND, OR 97280 TIGARD, OR 97223
PHONE: 503 - 244 -1900 PHONE:
FAX: 503 - 244 -8825
FEES
Quantity Description Date Amount
60 If Water Service 04 /10/2012 $62.54
Specifics: 1 12% State Surcharge - 04/10/2012 $8.70
Plumbing
Type of Use SF 10 ea Minimum Fee Adjustment - 04/10/2012 $9.96
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 stions to O► : ca ' ig 503.232.1987 or 1.800.332.2344.
Issu By: PermitteeSi. W i,I
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.
APR /10 /2012 /TUE 07:40 AM POWER PLUMBING FAX No,503 244 8825 P.001
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Plumbing Permit AQpIicationR ECEIVED
Building Fixtures FOR CHTI(L USE ONI.V
City of Tigard APR 10 2012 Received V /o l a " Permit No.: 'e /%%o /2 -a o 8/
,IN 13125 SW Hall Blvd., Tigard, OR 97223 DatdBy: •
. . • ,,, Phone: 503.718 2439 Fax 503.598.1 1pn Remew Other Permit No.:
Inspection Line: 503.639.4175 'f OF T IG lSl P nat�/a y; _
c; i n
Internet: www.ligard-or.gov : UILDING D I VISI01 tYO•' hob ® Seepage a (or
t r
k '0‘ I ' _ 7, ¢ I ",,-,%::1,1:,,,,,:;, Bllpplam 111 •
� I . I 1, : .. I . .. Id ,.. II i 17 pl entel +
❑ New construction in Demolition - For special tnformaliorr use checklist:
uon/alterstion/repaoement Other Description • I Qty. I Ea. l Total
1 ►; dil ❑O New 1- 2-family dwellings (includes I00 ft. for each utility connection)
I
I ■ "1 t , 1 c J r +ti J I i SFR(1)bath 31230
7 - and 2- family dwelling 0 Cozame rcial/mdustrial SFR (2) bash 437.78
SFR (3) bath 500.32
❑ Accessory building 0 Multi-family
Each additional bath/kitchen 25,02
❑ Master builder 0 Other
Fire sprinkler , ft. ) Page 2
' I II J I ei X1 I 1 )1 . I j J 1L + I I „; y —r ' ),L 1 Site utilities:
Job site address: 11 5 g I litirinIAMTERIII Catch basin or area drain 18.76
City / State/ZIP- Drywall, leach line, or trench drain 18,76
r ey A rl� 3 Footing drain (no. linear R: ) Page 2
Suite/bldg./opt no.: Pr- Jed nail”: 6) u h i i &!AL A 'v > Manues:tared home utilities 50.03
Cross street/directions to job site: Manholes 18.76
•
Rain drain connector 18.76
r Sanitary sewer (no. linear ft.: ,_) Page 2
Storm sewer (no. linter ft.: _ ) Page 2
Water service (n l inear fL: 2) 1 Page 2
Lot r Y
Subdivision: Lo no.: Fixture or item;
TeX map/parcel no.: Bac tlaw preventer . 31.27
1 - 1P'7: vt ' To , +L �I �l �- - )' r :� BackWa�r valve .� 1251
s. Clothes washer 25.02
•' 4ex p I A L, Loo' (I LD / ill •lam a/li c.J Dishwasher • 25.02 '
Drinking fountain 25.02
Ejectors/sump 25.02
II
i r t� + l 7 ,L),,,,I , ,.. - , ., y; \1 t' 1 Expansion tank 12.51
1
Fixture/sewer ca
N
25.02
am" AA • i hi A. " 1 Ae, - *err - Floor drain/floor sink/hub 25.02
Address: Garbage disposal 25.02
City / State/ZIP: Hose bib 25.02
f Phone: ( ) Fax ( ) Ice maker 12.51
E ?_ _... -_. '.i..-.1.-",: I _: X11 ..,'. , ' ii — I C L.�i ul . \C 1=;r ! 4 O)i l ,_ i lnteTceptor /awet:Sp 25.02
Buss wore: 1p / Jr t,, nb Medical gas (value
ines $ _ ) Page 2
II L�(.� A '( Pear 12.51
Contact nee: Roof drain (commercial) .
Address: P 0 3rI i g qI� sink/basin/lavato 25.02
City /State/ZIP:- ....... Y �� .4 - - • b 7s 2� - .Solartmi (pomblewater) ................ _. __.. ....... , ....6234 _......._. ...._..
. , .Tub/shower /shower.pan :. ..... :.12.51
•Pho>ae: (..:
. ...:) .. �, .Fax •.(.. :. .: ). . _
Urinal 25.02
E-mail if/ ✓ / A LI Alit is r _, —11...0 i
i ... �1 iit l I ■ �1 �f I Il 7i, _ Watt C10SR 25.02
]t .I...:: , .....� Water heater 37.52
Business name: � O P Water piping/13WV 56�
Address: f a Ubc / 4 4 J e Other. ' 25.02
City /State/ZIP: 5 f C/ / 7�� Subtotal 6,9 5'4
Phone: ( ) 2 LH-- .' `t 1 v Pam( ) t.-. 4 ry riS Minimum permit fie: $72.50 --12, sv
Plan review (25% of permit fee)
CCB I.,ia: � � � Plumbing Lie. no.: �� � e� .
State sumbarge (12% of peamit fee) (e " b
A u t h o r i z e d sigaamre: T O T A L PERMIT F E E g 1 d a y s 7 - 0 alppic canes Ir o perm it is abtataed within 180
Print name: - � i s ���Q, j- Date: 44 _ � -2, T after ation it hen in been aee sptrq „ co m pleia
*Fee methodology set by •hi- County Building Industry Service Bowl.
liVnearepenel ell- PermitAppdoc 10101 440•4616Tporca/Cwylwan)
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APR /10 /2012 /TUE 07: AM POWER PLUMBING FAX No. 503 244 8825 P. 002
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Su' ' ression stews:
I; .: i U Y F •Y ` ■ -i1 1 i r_: 7 X ' J . 1
I: lil 11 ,1±'f I I . ..:+� I ;[_14-';.' ' y
, 1,.;; L , tl _•, lj 1 C I , ,!• ■ I +1 , � + 1 •
Footing drain -1" 100' 50.03 O to 2 000 $121.90 �_. ..
Footing drain - each additional 100' - 37.52 001 to 3 600 $1 F' .69
Sewer - 1st 100' 62.54 3 601 to 7 I J' $233.20
_ 7 11 and , :: er $327.54
Sewer - each additional 100' 37.52
Water Service -1st 100' N. 62.54 II Medical Gas stews:
Water Service - each additional 100' 37.52 1 r..' u ; +
+ " ,. 7 + 1 1 �� 1J i : , i I (, fi + . I ; ._
Storm & Rain Dram -1st IOO' 6234 $I.00 to $5,00000 Minimum fee $72,50
Storm & Rain Drain - each additional 100' 37.52 $5,001.00 to $1',000.00 $7250 for the r rst 55.000.00 and $1.52 for
_ I > I ' "' ; r, , a , I , + ` each additional $100.00 or fraction thereat to
I, r J I ,' ,_b (c -t . + I . -i.__.-.:_,..i end kid .11 : $10.000.00.
Inspection of existing plumbing or for $10,001.00 to $15,000.00 $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 ., .: -1/2 hour) and includi, : $25 000.00.
Inspections outside of normal business 90.00/ - $25,001.00 to $50,000.00 $379.50 for the fist $25,000.00 and $1.45 for
hours (minimum char; -2 hours each additional $100.00 or fraction thereof, to
Reinspection Fees 90.00/1a mid includin: 550.000.00.
Additional plan review for revisions - 90.00/hr 11111 $50,001.00 and up $742.00 for the first $50,000.00 and $120 for
minimum char: -1/1 hour each additional $100.00 or fraction thereof.
Subtotal:
■ .•w AIM
Commercial Fixture Work:
Are you capping, adding or replacing fixtures? If "yes ",
please indicate work performed by fixture. Failure to
accurately re . ort fixtures could result in increased sewer fees *.
a r I re r 4 .1 1 L � ) --;''-,;7 4 ( I. I ' ':
... �I n � 3. �� 7 + J, /n :.� )C,...( Ir 1 [ I Iric �• t
" . ' I ' _ 1:;,L.,. 1 :_ 4 44 Plan review is required for any of the following.
aI. Please heck all that apply.
Bath - Tub /Shower El Any new commercial building with water service 2" and
_J, /Whirl ■ , ,} greater, except systems designed and stamped by licensed
Car Wash -Each Stall engineer.
, eve Thar r -- ❑ New exterior plumbing site utilities for any complex structure
C , .'dor/Water . irator as defined in OAR918- 780- 0040.
Dishwasher - Commercial ❑ Medical gas and vacinim systems for health care facilities.
-Domestic ❑ Any multipurpose fire sprinkler system.
Drinlcn: Fountain ❑ My complex structure as defined in OAR918 - 780 - 0040.
e Wash
Floor Drain/sink - 2" illill Submit 2 sets of plans with any of the above.
-3 "
-4" I 1 ' t Vii ., i • 7:7? 'i I � FI , I , I r , '
Car Wash Drain ❑ Isometric or riser diagram is required for new buildings
Garbage - Domestic - con - food
that meet the . uallfications above.
-Commercial-food related
• - Iiiihibiarfood *elated
IceMad►JRefri: Drains - -�
Oil ; : (Gas Station Comments regarding fixture work:
Rec. Vehicle Dam, Station IMIIM
Shower -Gang
-Stall w�� -
Sink/Lav -Non-food related
-Bradley IMIll L.
-Commercial-food related
' - Service MM.
Swi ' • : Pool Filter I *Note: If the fixture work under this permit results in an
washer - Extractor
WatWater Clost increase of sewer EDUs, a sewer permit will be issued and
Water Closet • t • Toilet � paid assessed for the sewer increase be aid before the
� - reasemus .
Urinal plumbing permit can be issued.
Other Fixtures:
http://www.tigard-or.gov/city hall/departments/cd/docs/PLM-F-PermitAp2d0c