Permit q CITY OF TIGARD PLUMBING PERMIT
13 • COMMUNITY DEVELOPMENT Permit #: PLM2012 -00261
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 09/10/2012
Parcel: 1S 136DB02502
Jurisdiction: Tigard
Site address: 11634 SW PACIFIC HWY
Project: Subway Subdivision: AZOIC TERRACE Lot: 1
Project Description: Relocating (2) lays, (1) hand sink & (1) hub drain for soda machine.
Contractor: PHOENIX PLUMBING Owner: KESSLER, JULES
28455 SW BOONES FERRY RD, #27 BY KAREN LILLEBO
WILSONVILLE, OR 97070 6312 SW CAPITOL HWY #443
PORTLAND, OR 97239
PHONE: 208 -413 -3880 PHONE:
FAX:
FEES
Quantity Description Date Amount
4 ea Fixture /Sewer Cap 09/10/2012 $100.08
Specifics: 1 ea Floor Drain /Floor Sink/Hub 09/10/2012 $25.02
1 ea Sink 09/10/2012 $25.02
Type of Use: COM 2 ea Lavatories 09/10/2012 $50.04
Class of Work: ALT 1 12% State Surcharge - 09/10/2012 $24.02
Type of Const: Plumbing
Occupancy Grp:
Stories:
Total $224.18
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
applica. - - All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
iss :nce, or if wor • suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
ility Notification Center. Tho ules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. You may obtain a copy of the rules
•r direct questions to OUNC b ailing 596'232.1987 or 1.800.332.2344.
.sued By: I / , r I • 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 of the project.
Approved plans are required on the job site at the time of each inspection.
Plumbing Permit Application
RECEIVED .
EI r ED I : OR (_)l : S C I : t is l : (:)
City of Tigard
Date/By: Received /� //� w� d r ! Permit No.: Q I °'G�.124
III a 13125 SW Hall Blvd., Tigard,OR
97223 Plan Review / / lIl Phone: 503.718.2439 Fax: ,3 ,9 8114020 Date/By: Other Permit No.:
Inspection Line: 503.639.4175 Daze Read B ta ®Se Pa e 2 for
l 1 � D Internet: www.ti ardor. e
erryOO FTIGARD y o g
g g Notified/Method: Supplemental Information
TYP , DIVISION 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
❑ 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: I / h 3 9 S6J a c' c. 0 Catch basin or area drain 18.76
Drywell, leach line, or trench drain 18.76
City/State /ZIP: t'y o ✓ j. / 0,/e� 6 1711
Footing drain (no. linear ft.: _) Page 2
Suite/bldg. /apt. no.: i I Project name: St„,4,)ay _-r,-1/4, _-,� G iJ- 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
Clothes washer 25.02
✓e '^., C ne. I Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
❑ PROPERTY OWNER I ❑ TENANT Expansion tank 12.51
Fixture/sewer cap 9 25.02
Name:
Sl�
Floor drain/floor sink/hub ` 25.02
Address:
Garbage disposal 25.02
City /State /ZIP: Hose bib 25.02
Phone: ( ) Fax: ( ) Ice maker 12.51
❑ 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
City /State /ZIP: Solar units (potable water) 62.54
Phone: ( ) Fax: : ( ) Tub /shower /shower pan 12.51
E -mail: Urinal 25.02
Water closet 25.02
CONTRACTOR
/ Water heater 37.52
Business name: pt, 6 e yt;x �I ud , Is',.) Water piping/DWV 56.29
Address: 2945 3 (,) . 1344.. 4,. iI, *2.7 Other: 25.02
City/State /ZIP: . ),'1 }0,,,1./; )j e/ d 97670 Subtotal
Phone: (2a jj) 9 3 _ 38 Fax: ( ) Minimum permit fee: $72.50
CCB Lic.: 213 '7 Plumbing Lic. no.: p6.,,,,96-- Plan review (25% of permit fee)
State surcharge (12% of permit fee)
Authorized signature: /3444A t-./ "I .� TOTAL PERMIT FEE
This permit application expires if a permit is not obtained within 180 days
Print name: `1 v ..; c„,... 1 � - t a iJ Date: after it has been accepted as complete.
iFee methodology set by Tri -County Building Industry Service Board.
1:\ Building \Permits\PLMi1- PermitApp.doc 10 /01/09 440.4616T(10/02/COM/WEB)
Plumbing Permit Application - City of Tigard `
Page 2 - Supplemental Information
, r
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
Sewer - I st 100' 62.54 3,601 to 7;200 $233.20
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
p 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 $100.110 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 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" •
• I -❑ 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 J *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:
I:\ Building \Permits\PLM- PermitApp.doc 2