Permit CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit 4: PLM2012 -00177
T t G A R D 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 06/25/2012
Parcel: 2S103BC08100
Jurisdiction: Tigard
Site address: 12242 SW TIPPITT PL
Project: Harris Subdivision: 2000 -077 PARTITION PLAT Lot: 1
Project Description: Bathroom remodel
Contractor: DAVID LOGGINS LLC Owner: HARRIS, JOHN
489 S 17TH ST 12242 SW TIPPITT PL
ST HELENS, OR 97051 PORTLAND, OR 97223
PHONE: 503 - 313 -6351 PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Lavatories 06/25/2012 $25.02
Specifics: 1 ea Tub /Shower /Shower Pan 06/25/2012 $12.51
1 12% State Surcharge - 06/25/2012 $8.70
Type of Use: SF Plumbing
Class of Work: ALT 35 ea Minimum Fee Adjustment - 06/25/2012 $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 - . • • all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not sta •d within 180 • : s of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you t. •low the les dopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 -001 -I.90. You m. o• ain a copy of the les
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issue. By: , ,/ - ,1 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 •f the project.
Approved plans are required on the job site at the time of each inspection.
Plumbing Permit Application
()R OFFICE USE ONLY
R eceived / / ha/AM I , n - e " 77
City of Tigard (,( .l Permit No.: �Q /�
1
n 13125 SW Hall Blvd., Tigard,OR 97223 Plan Review Phone: 503.718.2439 Fax: 503.598.1960 view
Date/By: ReateBy: Other Permit No.:
Inspection Line: 503.639.4175 Date Ready/By: Juris: ® See Page 2 for
T I G A It D B Internet: www.tigard or.gov Notified/Method: Supplemental Information
TYPE OF WORK FEE* SCHEDULE
❑ New construction ❑ Demolition For special informal "on 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
/_41 1- 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: (22)-1 7- 54 77 PP/ Ti- PL Catch basin or area drain 18.76
City /State /ZIP: p Drywell, leach line, or trench drain 18.76
/ ((/ ' a IC- (? ZZ3 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: I Lot no.: Fixture or item:
Tax map /parcel no.: Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
D Clothes washer 25.02
SA - feern t) L2 - Ndtil Slld l.l•`el / / Dishwasher 25.02
4), 1(L /gam '
,,/ o/.4941 Sc /7 /k 4f)rinkin fountain 25.02
Ejectors /sump 25.02
bib PROPERTY OWNER I ❑ TENANT Expansion tank 12.51
Q e_ Y Q( t s Fixture /sewer cap 25.02
Name: { 7
r� { Floor drain/floor sink/hub 25.02
Address:
(22c{ Z S U/ In t re t 1 ( Garbage disposal 25.02
City /State /ZIP: Ti 6 et,2 �� 9223 Hose bib 25.02
Phone: ( ) Fax: ( ) Ice maker 12.51
'r APPLICANT ❑ CONTACT PERSON Interceptor /grease trap 25.02
Business name: d/� /D 66? Civ $ L� Medical gas (value: $ ) Page 2
Contact name: / / Primer 12.51
d)r 11 L_ � ws Roof drain (commercial) 12.51
Address: If (9 5. (??7- St Sink/basin/lavatory I 25.02 g5 0 2 -
City/State/ZIP: Si- 1"...4✓ S Qty `t ? 0 S1 Solar units (potable water) 62.54
Phone: ( 5 i3 ) 3(? - (9 3S) I Fax: : ( ) Tub /shower /shower pan jl 12.51 1 7
E -mail: fill b , i- �J ,� �T�/ -f L- (h. , Urinal 25.02 1
''"`� Water closet 25.02
CONTRACTOR
Water heater 37.52
Business name: See- A riedoe. Water piping/DWV 56.29
Address: Other: 25.02
City/State/ZIP: Subtotal 37 5�
Phone: ( ) Fax: ( ) Minimum permit fee: $72.50 7 2
CCB Lic.: a5 z Plumbing Lic. no.: P 6 6 0 _ Plan review (25% of permit fee) �`
State surcharge (12% of permit fee)
Authorized signature: TOTAL PERMIT FEE & ( Z..-°-
Print name: ! A ���+ �� Date: 4, f Z. 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.
I: IBuitding \Permits \PLMU- 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
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
Inspection of existing plumbing or for
and including 50 ot $10,000.00.
first $
$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 includin $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
Bath -Tub/Shower ❑ New exterior plumbing site utilities for any complex structure
Tub /S i/Whirlpool as defined in OAR918- 780 -0040.
Car Wash Each Stall ❑ Medical gas and vacuum systems for health care facilities.
-Drive tall ❑ 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" ❑ Isometric or riser diagram is required for new buildings
that meet the qualifications above.
-4
Car Wash Drain
Garbage - Domestic •
Disposal - Commercial
- Industrial Comments regarding fixture work:
Ice MachJRefrig. 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 plumbing permit can be issued.
Water Closet - Toilet
Urinal
Other Fixtures:
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