Permit CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit #: PLM2012 -00248
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 08/28/2012
Parcel: 2S 115AA05000
Jurisdiction: Tigard
Site address: 10903 SW CHATEAU LN
Project: Loeb Subdivision: REBECCA PARK Lot: 7
Project Description: (1) hot water heater replacement
Contractor: OWNER Owner: LOEB, RANAE L
10903 SW CHATEAU LN
TIGARD, OR 97224
PHONE: PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Water Heater 08/28/2012 $37.52
Specifics: 1 12% State Surcharge - 08/28/2012 $8.70
Plumbing
Type of Use: SF 35 ea Minimum Fee Adjustment - 08/28/2012 $34.98
Plumbing
Class of Work: ALT
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: p pp I l i t v rl Q , `
Call 503.639.4175 by 7:00 a.m. for the next available inspection date. f f 1�L
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.
From: 08/23/2012 14:44 . #558 P.002/004
Plumbing Permit ApplicationRECE
Site Utilities AUG 2 3 2012
City g Received - jai //a P�l�ota -0a25/5-
lq Ci of Tigard Receive Permit No
n 13125 SW Hall Blvd., Tigard, OR 97223Ci� D Plan Review
C Phone: 503.718.2439 Fax: 503.598 y . Other Permit No.:
Inspection Line: 503.639.4175 � rd-or. ov
1 11 N Q 11,11 h pate R eady/By: H See Page 2 for
TIGAItD Internet: www.ti g Notified/Method: �`r Supplemental Information
TYPE : ?;OF WORK FEE SCHEOTILE,,
❑ New construction ❑ Demolition For special information use checklist
Description I Qty. 1 Ea. I Total
0 Addition /alteratioiL lacement . ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
CATEGORY )OF CONSTRUCTION SFR (1) bath 312.70
0 1- and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 437.78
SFR (3) bath 500.32
❑ Accessory building ❑ Multi - family
Each additional bath/kitchen 25.02
❑ Master builder ❑ Other: Fire sprinkler ( sq. ft.) Page 2
• JOB SITE, INFORMATION:rAND LOCAT IO N: . ;,,, Site utilities:
Job site address: 10903 SW Chateau Lane Catch basin or area drain 18.76
Drywell, leach line, or trench drain 18.76
City/State/ZIP: Tigard, OR 97224
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: 103 and Chateau Lane 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 R: _ ) Page 2
Subdivision: Rebecca Park Lot no.: Fixture or item:
Tax map /parcel no.: Backflow preventer 31.27
Backwala valve 12.51
DESCRIPTIONIOF WORK
Clothes washer
25.02
Hot water tank replacement Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
.0 PROPERTY OWNER 1 E TENANT ' Expansion tank 12.51 ` .
Fixture/sewer cap 25.02
Name: Ranac Loeb
Floor drain/floor sink/hub 25.02
Address: 10903 SW Chateau Lane Garbage disposal 25.02
City/ State/ZIP: Tigard, OR 97224 Hose bib 25.02
Phone: (503)515 -4050 Fax: ( ) lee maker 12.51
® APPLICANT _ 12:1 ; 'CONTACT PERSON Interceptor /grease trap 25.02
Medical gas (value: S ) Page 2
Business name:
Primer 12.51
Contact name: Ranae Loeb Roof drain (commercial) 12.51
Address: 10903 SW Chateau Lane Sink/basin/lavatory 25.02
City/State/ZIP: Tigard, OR 97224 Solar units (potable water) 62.54
Phone: (503) 515 -4050 Fax: : ( ) Tub /shower/shower pan 12.51
Urinal 25.02
E -mail: rloeb®mtgxps.com
25.02
•CONI7ti1CTOR _ Water heater ' 37.52
Business name: 0 k/A/ `- Se ! riv-e i- Water piping/DWV 56.29
Address: )C Ctf/b. Other 25.02
City /State/ZIP: 4152,fri Subtotal
Phone: ( ) Fax: ( ) Minimum permit fee: $72.50
Plan review (25% of permit fee)
CCB Lic.: Plumbing Lic. no. o
�I State surcharge (12% of permit fee)
Authorized signature/ d t � -Y igo�,./ TOTAL PERMIT FEE 8/.2.0
This permit application expires if a permit is not obtained within 180 days
Print name: Ranae L. Loeb Date: 08 -23 -2012 after it has been accepted as complete.
*Fee methodology set by Tri -County Building Industry Service Board.
1 \Boi ]ding\ Permits\PLMU.PermsApp.dnc 10 /01/09 440- 46161110+02/COM/WEB)
From: 08/23/2012 14:44 #556 P.003/004
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site Utilities FCC (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
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 - I st 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 S10,000.00 $72.50 for the first $5,000.00 and $1.52 for
OtherinspeetiOninirIed;,'Y:'".20-, , Fce Total each additional 5100.00 or fraction thereof, to
and including $10,000.00.
Inspection of existing plumbing or for S10,001.00 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 S1.45 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 S742.00 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",
please indicate work performed by fixture. Failure to
accurately report fixtures could result in increased sewer fees*.
Qunnti by Flitture Type Plan Review for Plumbing Indallations
Capped Added Rocate Plan review is required for any of the following.
Please check all that apply.
Baptistry/Font
0 Any new commercial building with water service 2" and
Bath -Tub/Shower
- Jacuzzi/ Whirlpool greater, except systems designed and stamped by licensed
Car Wash - Each Stall engineer.
- Drive Thru 0 New exterior plumbing site utilities for any complex structure
Cuspidor/Water Aspirator as defined in OAR918
Dishwasher - Commercial 0 Medical gas and vacuum systems for health care facilities.
-Domestic 0 Any multipurpose fire sprinkler system.
Drinking Fountain 0 Any complex structure as defined in OAR918-780-0040.
Eye Wash
Floor Drain/sink - 2" Submit 2 sets of plans with any of the above.
Isometnc or Riser „ .
Diagra
Car Wash Drain
0 Isometric or riser diagram is required for new buildings
Garbage -Domestic-non-food
Disposal -Domestic-food related that meet the qualifications above.
-Commercial-food related
-Industrial-food related
Ice MachiRefrig. Drains
Oil Separator (Gas Station) Comments regarding fixture work:
Rec. Vehicle Dump Station
Shower -Gang
-Stall
Sink/Lav -Non-food related
-Bradley
-Commercial- food related
-Service
Swimming Pool Filter *Note: If the fixture work under this permit results in an
Washer - Clothes
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
Urinal plumbing permit can be issued.
Other Fixtures:
C:\Documents and Settings\rloeb\My Documents\Downloads\PLMU-PenItApp.doc
From: 08/23/2012 14:44 #556 P.001 /004
To: City of Tigard - Permit Division
503 - 598 -1960
From: Ranae Loeb
10903 SW Chateau Lane
Tigard, OR 97224
503 -515 -4050
Re: Request for permit for private party hot water tank
installation. Thank you.
CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit #: PLM2012 -00248
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 08/28/2012
Parcel: 2S 115AA05000
Jurisdiction: Tigard
Site address: 10903 SW CHATEAU LN
Project: Loeb Subdivision: REBECCA PARK Lot: 7
Project Description: (1) hot water heater replacement
Contractor: OWNER Owner: LOEB, RANAE L
10903 SW CHATEAU LN
TIGARD, OR 97224
PHONE: PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Water Heater 08/28/2012 $37.52
Specifics: 1 12% State Surcharge - 08/28/2012 $8.70
Plumbing
Type of Use: SF 35 ea Minimum Fee Adjustment - 08/28/2012 $34.98
Plumbing
Class of Work: ALT
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: p pp I l i t v rl Q , `
Call 503.639.4175 by 7:00 a.m. for the next available inspection date. f f 1�L
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.