Permit CITY OF TIGARD PLUMBING PERMIT
g COMMUNITY DEVELOPMENT Permit #: PLM2012 -00292
Date Issued: 10/09/2012
T IGARD 13125 SW Hall Blvd., Tigard OR 97223 503 718 2439 Parcel: 2S111DC12600
Jurisdiction: Tigard
Site address: 15950 SW OAK MEADOW LN
Project: RAUSCHKOLB Subdivision: SUMMERFIELD NO 11 Lot: 622
Project Description: Relocate existing clothes washer, ice maker, sink and water heater.
Contractor: CASCADE PLUMBING CO Owner: RAUSCHKOLB, FRANCES ROSELEE
2416 N HAYDEN ISLAND DR 1805 NE 226TH AVE
PORTLAND, OR 97217 FAIRVIEW, OR 97024
PHONE 503 - 289 -7095 PHONE
FAX • 503 - 283 -9514
FEES
Quantity Description Date Amount
1 ea Clothes Washer 10/09/2012 $25.02
Specifics: 1 ea Ice Maker 10/09/2012 $12.51
1 ea Sink 10/09/2012 $25.02
Type of Use: SF 1 ea Water Heater 10/09/2012 $37.52
Class of Work: ALT 1 12% State Surcharge - 10/09/2012 $12 01
Type of Const: Plumbing
Occupancy Grp:
Stories:
Total $112.08
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 Notific enter. 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 estions to O C b ailing 503.232.1987 or 1.800 332.2344.
Issued By: k Permittee Signal e: r ��
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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.
Plumibin permit A licatio ECEIVED
Building Fixtures OCT p 8 2012 FOR OFFICE USE ONLY
City of Tigard D Received / 17 ti Permit Ne . I Lllao/!! - ee019A
111 n I3125,SW Hall Blvd„ Tigard, OR 9722 Plan Review
■ Phone: 50 3.718.2439 Fax: 503 -598.1 �' ��{(�� Date/By t7rherPermit £'GC�(2,-0,57 2.
Inspection Line: 503.639.4175 �".V"'v EJI Y I V1" Date heady /By: Jims El See Page 2 for
T I G A K ii I nternet: www.tigard- or.gov Noufiedmethod: Supplemental information
•, E *. FRULE • : , . CH
' OF WOR1tC _ a ? °FE S _
❑ D For , octal in , madon use dim/disc New construction _ Descri•don MN Ea. Total
® Addition/alteration/replacement ❑ Other: New 1- 2 -famil dwellings (includes 100 ft for each utility connection)
- - '' ' .• CATEGORY" OF -CONSTRUCTION` . - - SFR (1) bath _ 312.70
SFR (2) bath 437.78
® 1- and 2- family dwelling ❑ Commercial/industrial SFR (3) bath 500.32
❑ Accessory building _ ❑ Multi- family Each additional bath/kitchen 25.0
❑ Master builder ❑ Ocher. Fire sprinkler ( sq. ft.) Page 2
• - • JOB SITE. INFORMATION: A11W.14 CATI9N,, , , , ,. Site utilities: 18.76
Catch basin or area drain
Job site address: 15950 SW OAK MEADOW LANE D,ywe11, leach line, or trench drain 18,76
City/State/ZIP: TIGARD, OR Footing drain (no. linear ft_: _) Page 2
Suite/bldg. /apt. no.: Project name: REsiDersee' ' A t e664 DL i - Manufactured home utilities 50.01
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-: ) I Page 2
Subdivision: Lot no.: Fixture or item:
Backflow preventer 31 27
Tax map/parcel no.: - 12.51
. - _. . Backwater valve _
A]escRlP [lax OF.'VVORK, - Clothes washer 1 25 02 25.02
RELOCATE EXISTING PLUMBING FIXTURES ---
Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
-- , ,.:i.,.. - '❑ TENAN'T .. ,' Expansion tank
0 PROPERTY OWNER"
Fixture /sewer cap 25 02
Name: Floor drain/floor sink/hub 25.02
Address: Garbage disposal 25.02
City /State/ZIP: Hose bib 25.02
Phone: ( ) Fax: ( ) Ice maker 1 12.51 12.51
25.02
' Q,. CO PERSON �erceptor /grease trap
• - Q; APPLICANT- �' -� - _ - - - - - - - - �
Medical gas (value: $ ) Page 2
Business name: SAME AS BELOW _ Primer 12.51
Contact name: _ - Roof drain (commercial) 12.51
Address: Sink/basin/lavatory 1 25.02 25.02
City /State/ZIP: _ Solar units (potable water) 62.54
T1tb/shower/Shower pan 12.51
Phone: ( ) Fax: ( ) Urinal 25.02 -
l✓ - mail: Water closet 25.02
CONTRA&OR - .. ' Water heater 1 37.52 37.52
Business name: CASCADE PLUMBING COMPANY Water piping/UWV 56 29
Address: 2416 N HAYDEN ISLAND DRIVE Other: _ 25.02
Subtotal 100 07
City/State/ZIP: PORTLAND, OR 97277 -
Mmitnum permit fee. 572.50
Phone: (503) 289 -7095 _ Fax: (503) 283 -9514
Plan review (25% of permit fee)
CCB Lie.: 120893 Plumbing Lie. no.: 34 -412PB State surcharge (12% o of permit fee) 1 2. 01 1
Authorized signature: / TOTAL PERMIT FEE 11 f. Date: 10/08/2012 This permit appluation expires If a permit Is not obtained within 1 8e days
Print name: CRYSTAL DONE after it Ills been Accepted as eomptete-
"Pee methodolog=y set by Tt.County Building Industry Service Board.
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Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site Utilities . , - . ' ;: ' Fee Os)", :-• Total . S Sure Foot e ' , - Permit Fie: . _
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
Sewer - ] st 100' . 62.54 3,601 to 7,200 5233.72
- 7201 and a eater $327.54
Sewer - each additional 100' 3752
"water Service -1st 100' 62.54 _ Medical Gas Sistems
Water Service - each additional 100' 37.52
Swan &Rain Drain 1st 100' 62.54 Vah*atioii .`.' ::::Permit Fee:. . .- .
$1.00 to $5,000.00 Minimum fee $72.50
Storm & Rain Dram - 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 . 9' . 172 (ea) ' `Total each additional $100.00 or Suction thereof; to
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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 $100.00 or fraction thereof, to
_ (minimum charge -1/2 hour) and including $25,000.00.
Inspections outside of normal business 90.00/hr r— $25,001.00 to $50.000.00 $379.50 for the first $25,000.00 and 5145 for
hours (minimum c .. :, e - 2 hours) each additional $100.00 or fraction thereof to
Reinspection Fees 90.00/br 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 $120 for
• (minimum charge -1/2 hour) each additional $100.00 or fraction thereof.
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Subtotal:
- a
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 - ' . Pla R f - - -
Fixtur Type for Plan review is required any ired for an of the following.
Work Performed: , ' . Capped . Added Relocate "
Please check all that apply.
13apti + /Font
Bath rub✓Showet ❑ Any new commercial building with water service 2" and
- Jacuzzi/Whirlpool J 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 0 Medical gas and vacuum systems for health care facilities.
-Domestic _ ❑ Any multipurpose fire sprinkler system.
Dnnldng Fountain _ ❑ Any complex structure as defined in DAR918 -780 -0040.
Eye Wash
Floor Drain/sink - 2" Submit 2 sets of plans with any of the above.
- 3 „
Car Wash Drain S0111 OI Riser Al � ram'
Garbage - Domesuo -non-food Isom or riser diagram is required for new buildings
Disposal - Domestic-food related that meet the qualifications above.
-Commercial -food related
- Industrial -food related
Ice MachiRefrig. Drains 1
Oil Separator (Gas Station) Comments regarding fixture work:
Ctec. Vehicle Dump Station
Shower -Gang
-Stall
Sink/Lay - Non -food related 1
- Bradley
.Cottunercial -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
e paid before the
f ees assessed for the sewer increase must be
Water Closet • Toilet p
Urinal _ 1 plumbing permit can be issued.
Other Fixtures:
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