Permit CITY OF TIGARD PLUMBING PERMIT
; COMMUNITY DEVELOPMENT Permit #: PLM2012 -00135
TIGA R D 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 05/23/2012
Parcel: 2S113AA01000
Jurisdiction: Tigard
Site address: 16578 SW 72ND AVE B9
Project: Gingerbread Traditions Subdivision: ROSEWOOD ACRE TRACTS Lot: PTS C,C
Project Description: TI
Contractor: MIKE PATTERSON PLUMBING Owner: PACIFIC REALTY ASSOCIATES
15028 S MITCHELL LN ATTN: N PIVEN
OREGON CITY, OR 97045 15350 SE SEQUOIA PKWY #300
PORTLAND, OR 97224
PHONE: 503 -624 -6300
HONE: 503 - 632 -7374
FAX: 503 - 632 -5647
FEES
Quantity Description Date Amount
1 ea Clothes Washer 05/23/2012 $25.02
Specifics: 2 ea Floor Drain/Floor Sink/Hub 05/23/2012 $50.04
1 ea Interceptor /Grease Trap 05/23/2012 $25.02
Type of Use: COM 1 ea Primer 05/23/2012 $12.51
Class of Work: ALT 3 ea Sink 05/23/2012 $75.06
Type of Const: 1 ea Water Heater 05/23/2012 $37.52
Occupancy Grp: 1 12% State Surcharge - 05/23/2012 $27.02
Stories: Plumbing
Total $252.19
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 ccalllllliin / fig 503.232.1987 or 1.800.332.2344.
Issued By: (�(JC Permittee Signatu
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.
2012 -05-21 14:03 MIKE PATTERSON PLUMB 5036325647» 5035981960 P 212
Plumbing,Permit ApplicatioRECEIVED
Building Fixtures 1(w , . 1 1, , 1,1 „, I ,
City of Tigard MAY 21 2012
Received
13W Hall Blvd. OR Date./13 o�3 42 D amn Na�L/f'�42 �i iii R . Ph125 S Blvd., Tigard, 97 OF TIGARD Plan Review
one: SW 503.718.2439 Blvd. Fax: OR ' ' • ,
Ins Line: 503.639.4175
1 ING DIVISION Date/By:
Permit 4- 4- 1 /4 2 4/A D009
I I c ., - 1 ;, I 1 ume Ready/By: Julia. ei See Page 2 for
Internet: www,tigard -or,gov Notified/Method: 7 supplemenat Information
TYPE OF WORK FEE* SCHEDULE Z(41 OS
Q New construction ❑ Demolition - For pedal information use cheekf.M
Description QtY J 1 I 'Total
Addition/alteraliunkeplaccment ❑ Other: New I- 2- family dwellings (includes 1 R. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (I) bath 312.70
❑ I- and 2- family dwelling Commercial/industrial SFR (2) bath 437.78
❑ Accessory building ❑ Multi - fancily SFR (3) bath 500,32
El Master builder Each additional bath/kitchen 25.02
❑ O ��' Fire sprinkler (___ sq. R.) Page 2
JOH SITE INFORMATION AND LOCATION Slte utilities:
Job site address- ' f / S eL ) 74 Ave Catch basin or area drain 18.76
L. it �/ Drywall, leach line, or trench drain 18.76
City /Stale/ZIP:
L / Z 1 e •/ .Ot: Q ?�? Footin drain (no. linear R.: ) Page 2
SuiIc/bldgJapt. tw,: !•f 1 Project name /„4.,t.)/ Manutacaued home utilities 50.03 •
C'rosy street/directions to job site: J � h2 Manholes 18.76
Rain drain connector - 18,76
- Sanitary sewer (no. linear R.: ) Page 2
Storm sewer (no. linear ft.: � ) _ Page 2
Water service (no. linear R.: _ ) Page 2
Subdi � 9- ---� Lot no Fixture or item:
Tax map /parcel no.: � �� i . / Beddow prcventcr • 31.27
(� r { D - / FSCRIPTION OF WORK Backwater valve I2,51
Clothes washer I 25.02 •I,5, Oa
Dishwasher 25.02
( h a 1 . :S.rl7t S , t'i) tt), . v Ace; M. Drinking fountain R _ 25.02
• z l r 'fy�,f'. -Ejectors/sump 25.02
❑ PROPERTY OWNER 4 1 / ' ❑ TENANT Expansion tank 12.51
...-....+• Nome: .] , 'r,j A /3 r:% vlJe,,! it er.'�C..
loot drain/
floor � Fixturdsewer cap 25.02
Address: f "� ��
` floor sink /hub 25.02 fo.oq
City/State/ZIP:
J7[P STYE 4-2 a age disposal 25.02
6e7r- ' hrg ose bib 25.02
Phone: ( ) - Fax: ( ) Al y . 72.-0 - 6,4,A._ Ice maker 12.51
❑ APPLICANT ❑ CONTACT / ' PERSON Irlerccptor /grease trap 25.02
Business name: _Medical gas (value; S Page 2
- Contact name: Primer 12.51 / -S
Address:
Roof drain (commercial) 12.51
Sink/basin/lavatory 25.02 -7 ' v(
('icy /State/71P: Solar units (potable wale) 62.54
Phone: ( ) Fax:: ( ) - Tub/ shower/shower pan 12.51
E -mail: Urinal 25.02
CONTRACTOR _ Watt closet 25.02
P
Bt Water heater
toss name: jut Ke t ti r ?CSY1 C.IIy) h,t b 37.52 j,, r
USi
Water piptng/DWV 56.29
Address: / 54 ;:)9 a /la (' l7C'I ( Li. i _ Other: 25.02
City /State Subtotal
/� '_ •
Phone: ( op . i
60 2 - 7 3 7 I � Plumbing Li
c. I P.F'ax: (, -; � 6 32 - �� t / 7 Minimum permit fee: $72.50
C.FB Lic.: �' - a- la -C ng c. nu. :3 .'-5�' Plan review it fee)
(25 %ofperm
Authorized signature: � �S; pi J State surcharge (12% of permit fce) 27. Q
. r2. • t .f.- /
TOTAL 1'FRM[7' F'FF I!►L -
•, •wry ). 1 • ,••• j( 4 , - -, {}( l Ian pat em memo Wins if a permit is not obtained within D80 days
mar It has boom accepted a complete.
� 7-4-1.4._y TV / , C � "Fes methodology set by Tri�oumy Building Industry Service Board.
5/2 )" L� /
di/Z_ -.T�NA/ y G)...c3 - tail 9 er/O 6 .fi- &
- --- o2- �7
2012 -05-22 11:59 MIKE PATTERSON PLUMB 5036325647» 5035981960 �j y� P 111
Plumbing Permit Application - City of Tigard
Paige 2 - Supplemental Information Pf, l 57g S•k� 7c' 1 � .
Fee Schedule: Residential Fire Suppression System
Site Utilities Qty. Fee (ea) Tot al Square Footage: Permit Fee:
Footing drain - 1 50.03 0 to 2,000 $121.90
Footing drain • each additional 100' 37.52 2.001 to 3,600 $ Ifi9.69
Sewer • 1st 100' 62.54 3.601 to 7,200 $233.20 �"
7 201 and painter $327.54
Sewer - each additional 100' 37.52
Water Service - I st 100' 62.54 Medical Gas Systems:
Water Serv - each ad ditional
Sturm & Rain Drain • 1st 1110' 62.54 Valuation: Permit Fee:
Strum & Rain Drain -each additional 100' 37.52 $1.00 to $5,000.00 Minimum fee $72.50
r $5.001.00 to S10.000.00 $72.50 for the first 55.000,00 and S 1.52 for
Other Inspections or Fees Qty. Fee t ai Total - each additional $100.00 or fraction thereof. to
is i Inspection of existing plumbing or for and . 50 f $10,000.00.
which no fee e specifically indicated 90.00/hr $10,001,00 to S25,000.00 $148.50 fo the first $10,000.00 and $1.54 for
(minimum s s e - 1/2 hour) each additional $100.00 or fraction thereof. to
Inspections outside of normal husiness 90.00/hr ' and including $25,000.00,
hours (minimum charge - 2 hours 525,001,00 to $50,000.00 $379.50 for the first $25.000.00 and $1.45 for
each additional $100.00 or fraction thereof, to
Rctnspectiun 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 - 1/7 hater)
_ 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 * . _
Quaotly by Fixture Type Plan Review for Plumbing Installations
Future Type for Replace/
Work Performed: Capped Added R Plan review is required for any of the following.
1,3fftistry/Font - Please check all that apply.
Bath - Tub/Shower ❑ Any new commercial building with water service 2" and
lacthzzi/Whirlpnol greater, except systems designed and stamped by licensed
- Car Wash -Each Stall engineer.
-Drive ❑ New exterior plumbing site utilities for any complex structure
CuspidoNWatcr A spirator as defined in OAR91 &780 -0040.
Dishwasher -Commercial ,t,� ❑ Medical gas and vacuum systems for health care facilities.
- Domestic ❑ Any multipurpose lire sprinkler system.
_ brinkin Fo untain ❑ Any complex structure as defined in OAR9I8-780 -0040.
f-; c Wash
Floor Drain sink • 2" 02 Submit 2 sets of plans with any of the above.
3 .,
-4"
Car Wash Drain Isometric or Riser Dia ram
Garbage - Domestic nonfood u isometric or riser diagram is required for new buildings
Disposal - Domestic - food related _ that meet the qualifications above.
- Commercial -food related - -
- Industrial -food related
Ice Mach /Rainy„ Drain
Oil Separator (Gas Station) Comments regarding fixture work:
Rec. Vehicle Dump Station
Shower -Gang
-Stall _ --
Sink/lav - Non -food related
-Bradley -
- Commercial - food related A ✓ '
- Service
Swimming Pool Filter ' . -
Washer - Clothes - I ,/ - *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
I h " ""h plumbing permit can be issued.
Other Fixtures: 3 '