Permit `-0 H - .,-- II - CITY OF TIGARD PLUMBING PERMIT
1 ` a COMMUNITY DEVELOPMENT Permit #: PLM2012 -00194
'TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 10/03/2012
Parcel: 1 S 136DB02400
Jurisdiction: Tigard
Site address: 11642 SW, PACIFIC HWY 160
• Project: Amazing Auto Detailing Subdivision: AZOIC TERRACE Lot:, 1
' Project Description: Site utility work for auto detailing shop
Contractor: HALS CONSTRUCTION INC Owner: CHAMPION, RONALD V & ROBERTA E
20666 S HWY 213 16449 LEXINGTON CT
OREGON CITY, OR 97045 LAKE OSWEGO, OR 97034
P
PHONE: 503 - 997 -1608
PHONE: 503 - 656 -4999
FAX: 503 - 656 -5961
FEES
Quantity Description Date Amount
1 ea Catch Basin or Area Drain 10/03/2012 $18.76
Specifics: 100 If Storm and Rain Drain 10/03/2012 $62.54
25 Misc Other Fee 10/03/2012 $25.02
Type of Use: COM 1 12% State Surcharge - 10/03/2012 $12.76
Class of Work: ALT Plumbing
Type of Const:
Occupancy Grp:
Stories:
•
• Total $119.08
Required Items and Repoits (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 k • ification =■ter. Those rules are set forth in OAR 952- 001 -0010 through OAR 952 - 001 -0090. You may obtain a copy of the rules
or di —ct questions to O C by c ' 503.232.1987 or 1.800.332.2344.
Issu d By: Permittee Signature: eel I /�
,.4..!!■' "Al0 411P - i.%,:heid,
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
Site Utilities RECEIVED LT FOR OFFICE USE ONLY , L
City of Tigard L Received ' ? Permit N
e rmo.:. I }y/ /� 7
Date/By: f f / y L (20 (�- ex,/
14
n 13125 SW Hall Blvd., Tigard, OR 9� Plan Review n ^
C , Phone: 503.718.2439 Fax: 503.5 60� 7 2 0 2 Date/By: Other Permit No.: �
'2
Inspection Line: 503.639.4175 Date Read ruris: 10 See Page 2 for
TIGARD Ready/By:
www.tigard or.gov CITYOFTIGARD Notified/Method: Supplemental Information
TYPE O9L461ANGDIVISION FEE* SCHEDULE
CI 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
ID 1- and 2- family dwelling 1:1 Commercial/industrial SFR (2) bath 437.78
El Accessory building SFR (3) bath 500.32
ry g ❑ Multi- family
Each additional bath/kitchen 25.02
❑ Master builder ❑ Other: Fire sprinkler ( sq. ft.) Page 2
JOB SITE INFORMATIO A` LOCA ION Site utilities:
Job site address: jWP q ^rii. N �M-� �f Catch basin or area drain / 18.76 �� 7 / l j
City/State/ZIP: i 1i,�,G Drywell, leach line, or trench drain 18.76
Cit
y 7 ` ' ��-� ` Footing drain (no. linear ft.: ) Page 2
Suite/bldg./apt. no.: , / i, Protect n e: AliorX A.) A , % /� ' 1 14 Manufactured home utilities 50.03
Cross stye directions` (. (L/ 7, to job site: '�, �- C l � Manholes 18.76
Rain drain connector 18.76
Sanitary sewer (no. linear ft.: ) Page 2
Storm sewer (no. linear ft. /0'a) Page 2 (
Water service (no. linear ft.: ) Page 2
�
Subdivision: I Lot no.: Fixture or item:
/- Tax map /parcel no.: • Backflow preventer 31.27
4 DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 25.02
Dishwasher 25.02
Drinking fountain 25.02
r. Ejectors /sump 25:02
S I ❑ ,1,' E OW I - ❑ TENANT Expansion tank 12.51
Fixture /sewer cap 25.02
k/ Name: _C1/ / /af _i 1. /rA �� Floor drain/floor sink/hub 25.02
Address: 4 �, ��'�/ �Lo r. ,
I
" MI - Garbage disposal 25.02
rc Cit y /State /ZIP :�-/ � i `� /a Hose bib 25.02
i
^ Phone:603) /- /6d: " F. : ( ) Ice maker 12.51
, ` c o l ❑ APPLICANT ❑ CONTACT PERSON Interceptor /grease trap 25.02
I--� Medical gas (value: $ ) Page 2
Business name:
I Contact name: �I , k„ Jd Primer I I 12.51
\l Roof drain (commercial) 12.51
Address: Sink/basin/lavatory 25.02
City /State /ZIP: Solar units (potable water) 62.54
Phone: (spa) 793 - mg'°j Fax: : ( ) Tub /shower /shower pan 12.51
E -mail: Urinal 25.02
CONTRACTOR Water closet 25.02
Water heater 37.52
Business name: ! 5 ,2ti.cTio4J /AX
.S (i�/v T Water piping/DWV 56.29
Address: Apt cl c4tAsi al Other: L7/G /14.41/2 I 25.02 015. °P-
City /State /ZIP: 0/24.444.) Cat , D e.- F s t-Pft og--- Subtotal /p(9.3 �
Phone: (o) 456- 4791 Fax: ( 05 ) 654-5f4/ Minimum permit fee: $72.50
CCB Lic.: 3 Plan review (25% of permit fee)
K � 3� 3 Plumbi Lic. no.: 3 - 0 Vb
y S surchar (12% of permit fee) /A .7ss
Authorized signature: e ._ , , , �4 7l� /f' / TOTAL PERMIT FEE I / 9,0$
Print name: i t•�� Date: a/ This permit application expires if a permit is not obtained within 180 days
A IM - . after it has been accepted as complete.
"Fee methodology set by Tri -County Building Industry Service Board.
I:\ Building \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 - 100' 50.03 0 to 2,000 $121.90
Footing drain - each additional 100' 37 2,001 to 3,600 $169.69
Sewer - 1st 100' 3,601 to 7,200 $233.20
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
Other Inspections or Fees Qty. Fee (ea) Total each additional $100.00 or fraction thereof, to
Inspection of existing plumbing or for and including $10,000.00.
which no fee is specifically indicated 90.00/hr $10,001.00 to $25,000.00 $148.50 for the first $10,000.00 and $1.54 for
(minimum charge- 1/2 hour) each additional $100.00 or fraction thereof, to
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 $50,00Q.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
Quantity by Fixture Type Plan Review for Plumbing Installations
Fixture Type for Replace/
Work Performed: Capped Added Relocate Plan review is required for any of the following.
Baptistry/Font Please check all that apply.
Bath Tub /Shower ❑ Any new commercial building with water service 2" and
Jacuzzi/Whirlpool greater, except systems designed and stamped by licensed
Car Wash -Each Stall engineer.
-Drive Thru ❑ New exterior plumbing site utilities for any complex structure
Cuspidor/Water Aspirator as defined in OAR918 -780 -0040.
Dishwasher - Commercial ❑ Medical gas and vacuum systems for health care facilities.
- Domestic ❑ Any multipurpose fire sprinkler system.
Drinking Fountain ❑ 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.
4 Isometric or Riser Diagram
Car Wash Drain g
Garbage Domestic- non -food ❑ Isometric or riser diagram is required for new buildings
Disposal - Domestic-food related that meet the qualifications above.
- Commercial -food related
- Industrial -food related
Ice Mach./Refrig. 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
Washer Clothes *Note: If the fixture work under this permit results in an
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:
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