Permit CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit #: PLM2012 -00231
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 08/13/2012
Parcel: 2S 104AC 12600
Jurisdiction: Tigard
Site address: 12620 SW 135TH AVE
Project: Beckham Subdivision: HANDY ACRES Lot: 32
Project Description: 40' water service from the home to the street
Contractor: PIPELINE PLUMBING Owner: BECKHAM, GARVE & MARILYN JOINT L
333 S STATE ST SUITE V -108 BY GARVE A & MARILYN B BECKHAM TRS
LAKE OSWEGO, OR 97034 12620 SW 135TH AVE
TIGARD, OR 97223
PHONE: 503 - 624 -1906 PHONE:
FAX: 503 - 624 -1926
FEES
Quantity Description Date Amount
40 If Water Service 08/13/2012 $62.54
Specifics: 1 12% State Surcharge - - 08/13/2012 $8.70
Plumbing
Type of Use SF 10 ea Minimum Fee Adjustment - 08/13/2012 $9.96
Plumbing
Class of Work: OTR
Type of Const:
Occupancy Grp:
Stories:
Total $81.20
Required Items and Reports (Conditions)
•
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work Is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: Permittee Signature:
.t.,Q � o_ PPE,I�i i ord.
Call 503.639.4175 by 7:00 a.m. for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
•
Mar 11 01 11:26p Adam Faren 50362 p.1 Plumbing Permit App ➢ication N , ,„) ��f n n t
D
ilding Fixtures � FOR OFFICE I:SE ONLY
City of Tigard AUG 13 2012 Iigs:tirOd 01 3112, PermitNcP 1J/e)_00013/
• 13125 SW Hall Blvd., Tigard, OR 97223 Plan Re :
C Phone: 503.639.4171 Fax 503.598.19 Plan Re
f Y °�r•
Other Permit No_:
1
T I G n P, Inspection Line: 503.639.41 75 t IO Date � ReadylBy: 'uric ®see Paw 2 for
AD MIN _iL]_:AU17�'A IU7A 1:; i71/tJL7��' ¢WJ F
OF'TIGARD ld
tad/Method: 11 co Supplemental Information
• TYPE OF WORK FEE* SCHEDULE
❑ New construction ❑ Demolition For special information use eletkllst
Description I Qty. I Ea. I Total
ReA cklition/a]teration/replacement ❑ Other New 1 2- artily dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (1) bath 312.70
[$'! - and 2- family dwelling I SFR (2) bath
S ! ❑ Commercial/industrial () 437.78
❑ Accessory building J ❑ Multi family
SFR (3) bath 500.32
❑ Master builder ❑ Other: Each additional bath/kitchen 25.02
Fire sprinkler ( sq. ft) Page 2
JOB SITE INFORMATION AND LOCATION • . _ Site utilities:
Job site address: ) a lo? e.3 1 R Catch basin or area drain 18.76
City/State/ZIP: - r' Drywall, leach line, or trench drain 18.76
t q re. • c, , gi-a a Footing drain (no. linear R: ) Page 2
Suite/bldgJapt. no.: 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 R: __) Page 2
Water service (no. linear IL: j ' Page 2
Subdivision: Lot no.: Fixture or item:
Tax map/parcel no.: Backflow premier 31.27
Pe-0/
DES OF WORK Backwater valve 12.51
(mac - l- /Yee - .- r- V n _ f)-it i ,Ili Dishwasher hher 25.02
(G ( � k D r in ki ner
g 25.02
oiri tr -e
(�'Lt.L � Drinking fountain I 25.02
.1 sv.e .J- - Ejectors/sump 25.02
❑ PROPERTY OWNER • • ❑ TENANT • Expansion lank 12.51
Name Fixturedsewer cap 25.02
Address: Floor drain/floor sink/hub 25.02
City/ State/ZIP:
Garbage disposal 25.02
Hose bib 25.02
Phone: ( ) Fax: ( ) Ice maker 12.51
Er APPLICANT . ❑ CONTACT PERSON interceptor/grease trap 25.02
$ ) Page 2
(value: Medical gas
Business name: P ,/J jl / , � � (value: _ k e (l o
Contact name: ��� Primer 12.51
Ft, A ( er1) 12.51
Address: S S. .S-la.f..e- S+' . S�,-;t , - 0 Sin / as in drain camme rc'
t, V � Sink/basllavatary 25.02
City / State/ZIP: Les 4 i.
�,J �e"`10 e Ca. t 6 1 - 10S c i Solar units (potable water) 62,$4
Phone:
633 ) (at4-'clap I Fax:: W3 tiat4 - 1e ( a Tub /shower /shower pan 12.51
E-mail: �QD1 P u C
iurniA ✓fit 3(�l .f"iel- Urinal 25.02
,' " r C O CTOR Water closet 25.02
Business name: f� Water heater 3732
0 1 I.t✓1^ �lr? Waterpiping#DWV 5629
Address: srp n- .. _ j_ abov_c__ Other:
25.02
City /State/ZIP: ., Subtotal, $1{
Phone: ( ) . - Fax: ( ) ` ' Minimum permit fee: $72.50
9. q - b
CCB Lic.: ice _ • Plumbing Lic. no.: 310_10E, Plan review (25% of permit fee)
Authorized signature:
State surcharge (12% of permit fee) $,7 G
TOTAL PERMIT FEE g
I Print name: 6J N�, ' - 1 it D p3 t o J j 1 This permit application expires if a permit is tat obtained within 180 days
� rJ after it has been accepted as complete.
° Fee methodology set by I'd-County Batlding Industry Service Board_
L• 1 Badmg ''J Pvmmr.9pp.dae 10/01;09 140-4616Te1CI ;02/COM/WEBI
Mar 11 01 11:27p Adam Faren 5036241890 p.2
•
.bins Permit Application - City of Tigard
2 Supplemental Information
•
ee Schedule: Residential Fire Suppression Systems:
Qty ` Fee(ca) T� S uare:Foo e: Permit Fee:
Site Utilities .. � 9 � -
Footiag drain - 1" l00' 50.03 0 to 2,000 $121.90
Footing drain - each additional 100' 3752 2. to 3,600 S169.69
3,6601 0] to 7.200 S233.20
Sewer -1st 100' 62.54 7,20] and greater $327.54
r Sewer - each additional 100' 37.52
Water Service -1st 100' 1 62.54 Medical Gas Systems:
Water Service - each additional 100' 37.52
Valuation: Permit Fee:
Stnnn & Rain Drain - i st 100' 62.54 $1.00 to 55.000.00 Minimum fee 572.50
Storm & Rain Drain - each additional 100' 37.52 55,001.00 to $10,000.00 $72.50 for the first $5,000.00 and $1.52 for
Qt Fee (ea) each Total ea additional 5100.00 or fraction thereof. to
Other Inspections Or Fees and including 510,000.00.
Inspection of existing plumbing or for $ 10,001.00 to $25,000.00 $148.50 for the first $10,000.00 and 51.54 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 525,000.00.
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 550,000.00 and $1.20 for
(minimum charge - 1/2 howl 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 futures could result in increased sewer fees * . Please check all that apply_
Qum • by () Work Performed ❑ Any new commercial building with water service 2" and
Fhdrre Type: _ Replace greater, except systems designed and stamped by licensed
• Previous Capped - Added Ecistinn engineer.
Baptistry/Font ❑ New exterior plumbing site utilities for any complex structure
Bath - Tub/Shower as defined in OARS] 8- 780-0040.
-Jacuza/whirlpool ❑ Medical gas and vacuum systems for health care facilities.
Car Wash -Each Stall 0 Any multipurpose fire sprinkler system.
-Drive Thru ❑ Any complex structure as defined in OARR918 -780 -0040.
Cuspidor/Water Aspirator
Dishwasher -Commercial Submit 2 sets of plans with any of the above.
- Domestic
Drinking Fountain
Eye Wash • • 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 hoal
- Industrial Comments regarding fixture work:
Ice Mach./Re0ig_ 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:
http: / /www.ti:gard- or.gov /city hall / departments /cd/docs/PLMF- PetmitApp2doc