Permit CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit #: PLM2012 -00073
T [ G A R D 13125 SW Flail Blvd., Tigard OR 97223 503.718.2439 Date Issued: 03/30/2012
Parcel: 151260000300
Jurisdiction: Tigard
Site address: 9573 SW WASHINGTON SQUARE RD B06
Project: The Limited Subdivision:VASHINGTON SQUARE ESTATES NO. Lot: 108
Project Description: Interior Plumbing.
Contractor: RAYBORN'S PLUMBING INC Owner: PPR WASHINGTON SQUARE LLC
19990 SW CIPOLE RD BY THOMSON PROPERTY TAX SERVICES
TUALATIN, OR 97062 ATTN HILARY RAYMOND
2235 .FARADY AVE, STE 0
CARLSBAD, CA 92008
PHONE: 503 - 692 -4139 PHONE:
FAX: 503 - 691 -2328
FEES
Quantity Description Date Amount
1 ea Floor Drain/Floor Sink/Hub 03/30/2012 $25.02
Specifics: 1 ea Primer 03/30/2012 $12.51
1 12% State Surcharge 03/30/2012 $8.70
Type of Use: COM Plumbing
Class of Work: ALT 35 ea Minimum Fee Adjustment - 03/30/2012 $34.97
•
Type of Const: Plumbing
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: / •1111 Permittee Signature:
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.
-503 691 2328 Rayborns Plumbing 04:10:35 p.m. 03 -29 -2012 1 /3..-
Plumbing Permit ApnlicatiBEC ER/ED
Building Fixtures MAR 29 2012 rt,lt t)rrlc t: I Vii: 0.1.,
City of Tigard ���/ Received
13125 SW Hall Blvd., Tigard, OR 9717811 t OF TIGARD DateB /l> : ► 8 3
; � vd, B Plan Review
Phone: 503.718.2439 Fax: 503.m1' '� lNG DIVISION pool : Outer Permit No.: 4 , A a � a
T I t ; ' 11i. t Inspection Line: 503.639.4175 Date Ready /By: 121 See page 2 for
Internet: www,tigatdor.gov NaifiedlMethod: ` Suppkmental Information
• TYPE OF WORK . FEE* SCHEDULE
❑ New construction ❑ Demolition For spedal information use checklist
Description I Qty. I Ea. I Total
I! Addition/alteration/replacement ❑ Other. New 1 - 2 - family dwellings (includes 1 ft. for each utility connection)
CATEGORY OF CON SFR (I) bath 312.70
II4 SFR (2) bath 437.78
❑ 1- and 2- family dwelling Commercial/industrial
❑ Accessory building ❑ Multi- family SFR (3) bath 500.32
Each additional bath/kitchen 25.02
❑ Master builder ❑ Other:
Fire sprinkler(_ sq, ft.) _ Page 2
q4 JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address sod % ,fA ..i e - ' ; 0
Catch basin or area drain 18.76
City/State/ZIP: J '�� Q n Drywell, leach line, or trench drain 18.76
q Ql e s Footing drain (no. linear ft.: _ ) Page 2
Suite/bldgJapt. no.: Project name:lite t4(MI Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
O {Ae Flaw brq; N 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
31.27
12.51
ubdivision:
I Lot no.: Fixture or Rain
Item:
x map /parcel ter.: Backflow preventer
DESCRIPTION OF WORK Backwater valve
Clothes washer 25.02
Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
❑ PROPERTY OWNER I ❑ TENANT Expansion tank 12.51
Name: Fixture/sewer cap 25.02
Address:
Floor drain/floorsink'hub 1 25.02 'Da
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
Contact name: Primer ( 12.51 OS(
Roof drain (commercial) 12.51
Address:
Sink/basin/lavatory 25.02
City/StateiZIP: Solar units (potable water) 62.54
Phone: ( ) Fax: : ( ) Tub /shower /shower pan 12.51
E -mail: Urinal 25.02
CONTRACTOR Water closet 25.02
Water heater 37.52
Business name: RAYBORN'S PLCMBING INC
Water piping/ DWV 56.29
Address: P.O. BOX 69 Other. 25.02
City /State /ZIP: TUALATIN. OR 97062 Subtotal 3'7 S
Phone: (503) 692 -4139 Fax: (503) 691 -2328 Minimum permit fee: $72.50
CCB Lie.: 87852 & Plumbing Lie. no.: 34 - 166PB
Plan review (25% of permit fee) ' re
State surcharge (12% of permit fee) ; • g
Authorized signature:' S^ -„ TOTAL PERMIT FEE I-: .3 s - I , 7-()
gil4 Date: This permit application expires if a permit Is not obtained thin : 1 days
after It has been accepted as complete.
*Fee methodology set by Tri - County Building Industry Service Board.
I: nu4dingPmniIsPLMtlt- PcnnitApp.duc 10'01.09 44f)- 44IATiId02. CON VWEB)
503 691 2328 Rayborns Plumbing 04:10:55 p.m. 03 -29 -2012 2 /3��
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 - l 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 7200 $233.20
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' 3732 $5,001.00 to $10,000.00 $72.50 for the first $5,000.00 and $1.52 for
Other Inspections or Fees QtJ • 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 $134 for
which no fee is specifically indicated 90.00/hr
(minimum charge — )/2 hour) each additional $100.00 or fraction thereof, to
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 fast $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 by (Fixture) Work Performed ❑ Any new commercial building with water service 2" and
Fixture Type: Replace greater, except systems designed and stamped by licensed
Previous Copped Added Extatlaa engineer.
Baptista iFont
Bath -Tub/Shower ❑ New exterior plumbing site utilities for any complex structure
Tub/S rWhirlpool as defined in OAR918- 780 - 0040.
Car Wash Each Stall ❑ Medical gas and vacuum systems for health care facilities.
-Drive Thtu ❑ 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" ` f 0 Isometric or riser diagram is required for new buildings
3' q
that meet the qualifications above.
Car Wash Drain
Garbage - Domestic
Disposal - Commercial
Industrial Comments regarding fixture work:
Ice MachfRefrig. 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
+ p
Washer - Clothes fees assessed for the sewer increase must be paid before the
Water Extractor plumbing permit can be issued.
Water Closet - Toilet
Urinal
Other Fixtures:
http : / /www.tigard- or.govlcity_hal I /departmentslcd /dots /P F-Perm i t Apedoc