Permit CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit #: PLM2012 -00167
T [GARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 06/11/2012
Parcel: 1 S 133C D 16800
Jurisdiction: Tigard
Site address: 13832 SW ASHBURY LN
Project: Bewersdorff Subdivision: PEBBLECREEK NO.3 Lot: 58
Project Description: Master bath remodel.
Contractor: HAPPY JACKS PLUMBING Owner: BEWERSDORFF -BARON FAMILY TRUST
418 SE 89TH AVE 13832 SW ASHBURY LN
PORTLAND, OR 97216 PORTLAND, OR 97223
PHONE: 503 - 590 -0847
HONE: 503 - 788 -6947
FAX:
FEES
Quantity Description Date Amount
3 ea Lavatories 06/11/2012 $75.06
Specifics: 1 ea Tub /Shower /Shower Pan 06/11/2012 $12.51
1 ea Water Closet 06/11/2012 $25.02
Type of Use: SF 1 12% State Surcharge - 06/11/2012 $13.51
Class of Work: ALT Plumbing
Type of Const:
Occupancy Grp:
Stories:
Total $126.10
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 rules
or dir uestions to O by ling 503.232.1987 or 1.800.332.2344. ,'
Is ued By: � n Permittee Signature. � /�.'I��
_¢ f/ CN
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.
Plumbing Permit Application
R eceived y:
City of Tigard co it r Permit No.: 0 /044.40 /67
V 13125 SW Hall Blvd., Tigard,OR 97223 Plan Review Phone: 503.718.2439 Fax: 503.598.1960 eview
Date/By: RateBy: Other Permit No.:
FIG A R u Inspection Line: 503 • Date Ready/By: runs: la See Page 2 for
Internet: www.tigard or.gov Notified/Method: Supplemental Information
TYPE OF WORK FEE* SCHEDULE
❑ New construction ❑ 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
0 - and 2- family dwelling ❑ Commercial/industrial SFR (2) bath 437.78 •
building SFR (3) bath 500.32
❑ Accessory g ❑ Multi- family
Each additional bath/kitchen 25.02
❑ Master builder ❑ Other: Fire sprinkler (- sq. ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: / 7R 2....5 \A) A5 HZ t)Z.Y LAN Catch basin or area drain 18.76
/State /ZIP: Cr Drywell, leach line, or trench drain 18.76
City/State/ZIP: (G � 2 1j 7 Z Z3 Footing drain (no. linear ft.: ) . Page -2
Suite/bldg. /apt. no.: I Project name: 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 ft.: ) Page 2
Subdivision: F& - , 3c.., 1� a rz,- 1G I Lot no.: Fixture or item:
Tax map /parcel no.: Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
X Clothes washer 25.02
Xi-7 H F ri l (T L' Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
jg PROPERTY OWNER I ❑ TENANT Expansion tank • 12.51
Name: Fe A q 2 v �,Eyv L , eSDD g. 1J= Fixture/sewer cap 25.02
Address: )3 83 2.. SCE ) )4 33v R-1_ L� Garbage drain/floor ddisposal sink/hub 25.02
Gazbage disposal 25.02
City/State /ZIP: - Fr - 66 r.) OR_ C f' 7 Z 3 Hose bib 25.02
Phone: - 3) 6 --0 $C f 7 Fax: ( ) Ice maker 12.51
pi APPLICANT ❑ CONTACT PERSON Interceptor /grease trap 25.02
Business name:
- Medical gas (value: $ ) Page 2
Primer 12.51
Contact name: Roof drain (commercial) 12.51
Address: Sink/basin/lavatory 3 25.02 7.04
DY'
City/State /ZIP: . Solar units (potable water) 62.54
Phone: ( ) Fax: : ( ) Tub /shower /shower pan l 12.51 /A.97
E -mail: Urinal . 25.02
CONTRACTOR Water closet , 25.02 11) 9"
Water heater 37.52
Business name: /4H pi, -y f �_ l` S Pt v y71 e n y6
Water piping/DW V 56.29
Address: *so a 9't-` fi d e, • Other: 25.02
City /State /ZIP: I L. D 2 9,7�/ 4 Subtotal al i 57
Phone: (3 ) -7943.-1 Fax: ( ) Minimum permit fee: $72.50
CCB Lic.: t PI. 11 •. in Lic. no.: 4 ' : _ 7 Mt Plan review (25% of permit fee)
State surcharge (12% of permit fee) /3. yr
Authorized signatu , „ � ,. i
Utz rI� TOTAL PERMIT FEE (/,,k, , /Q
Print name: i Chi if P-- l.> OP e-/ ., 5j)C J Date: - - //- /Z
This permit ap 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\Pr.Ml1- PermitApp.doc 10/01/09 440- 4616T(10 /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
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' 37.52 $5,001.00 to $10,000.00 $72.50.for the first $5,000.00 and $1.52 for
Qty. Fee (ea) Total each additional $100.00 or fraction thereof, to
Other Inspections or Fees 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", 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 Capped Added Existing engineer.
Baptistry/Font
-Tub/Shower ❑ New exterior plumbing site utilities for any complex structure
Bath - hower
Tub/S erlpool as defined in OAR918- 780 -0040.
Car Wash -Each
W Stall ❑ Medical gas and vacuum systems for health care facilities.
Drive Stall ❑ 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 Wasp Isometric or Riser Diagram
Floor Drain/sink - 2" ❑ Isometric or riser diagram is required for new buildings
3„ that meet the qualifications above.
-4"
Car Wash Drain
Garbage - Domestic'
•
Disposal - Commercial
- Industrial - Comments regarding fixture work:
Ice MachiRefrig. 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 fees assessed for the sewer increase must be paid before the
Washer - Clothes
Water Extractor . plumbin permit can be. issued. , • ; •
Water Closet - Toilet
Urinal
Other Fixtures:
I:\ Building \Permits\PLM- PermitApp.doc 2