Permit CITY OF TIGARD PLUMBING PERMIT
' COMMUNITY DEVELOPMENT Permit #: PLM2012 00308
T I G ARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 10/24/2012
Parcel: 2S 111 AC06600
Jurisdiction: Tigard
Site address: 14825 SW 92ND AVE
Project: Koppler Subdivision: 2004 -021 PARTITION PLAT Lot: 1
Project Description: Repipe waste lines for two bathrooms.
Contractor: JACK HOWK PLUMBING /RESCUE ROOTER Owner: KOPPLER, KENNETH J
PO BOX 2830 14825 SW 92ND AVE
CLACKAMAS, OR 97015 TIGARD, OR 97224
PHONE: 503 - 235 -8784 PHONE: 971 - 285 0450
FAX: 503 - 491 -2932
FEES
Quantity Description Date Amount
1 ea Water Piping /DWV 10/24/2012 $56.29
Specifics: 1 12% State Surcharge - 10/24/2012 $8.70
Plumbing
Type of Use SF 16 ea Minimum Fee Adjustment - 10/24/2012 $16.21
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 a••pted by the Oregon
Utility N. • ion - - Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. You may obta • + a copy of • es
or dir- questions to OUNC ca ling 503.232.1987 or 1.800.332.2344.
Issue By: / ;0 Permittee Signature:
Call 503.639.4175 by 7:00 a.m. for the next available i pection d.
This permit card shall be kept in a conspicuous place on the job site un • pletion of the project.
Approved plans are required on the job site at the time of each inspection.
•
Pltimbina Permit Apnlicati E D
Building Fixtures F oR . O FEIICE USE ONLY
City of Tigard r,.' T t Received // n �1 ti /; ? �
2 4 2012 Date/By: (O�/ Permit No : Grl, � -60 " y�
rr •x 13125 SW Hall Blvd., Tigard. OR 97223 Plan Review aid p--.00,,474?
Phone: 503.639.4171 Fax: 503.�q�r �If}��; �p� Oilier Peimil No
11 j �JI TIGl11lL Date /By
TIGARD Inspection Line: 503.639 BUILDING DIVISION Date Ready /By. tuns, 0 See Page 2 for
Internet: www.t or_gov Notified /Method Supplemental Information
TYPE OF WORK FEE* SCHEDULE
❑ New construction ❑ Demolition For special information use checklist.
Description I Qty. Ea. Total
NI Addition /alteration /replacement ❑ Other: New I - 2 - family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (I) bath 312.70
e l- and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 437.78
❑ Accessory building SFR (3) bath 500.32
❑ 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: / S g AV( 1 ( , 14 Catch basin or area drain 18.76
City /State /ZIP: •• f7 � q'72 Drywell, leach line, or trench drain 18.76
�� Footing drain (no. linear ft.: ) Page 2
Suite /bldg. /apt. no.: I Project name: J.l L am' _ ) Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
Rain drain connector 18.76
Sanitary sewer (no. linear ft.: )��I� �/ Page
Storm sewer (no. linear ft.: )
Water service (no. linear ft.: ) Page 2
Subdivision: I Lot no.: Fixture or item:
Tax map /parcel no.: Backflow preventer 31.27
DESCRIPTION OF WO1;tK Backwater valve 12.51
J./ y/4 10a,./2_1- /� /'a /-r Clothes washer 25.02
�� 2_ � ��/� f�r�/ Dishwasher 25.02
/, �i%` � �7rli eft , / Drinking fountain 25.02
Ejectors /sump 25.02
APROPERTV OWNER
� {�j� ❑ TENANT Expansion tank 12.51
Name: / Fixture/sewer cap 25.02
/40 5 pm )9 - Floor drain /Floor sink /hub 25.02
Address: 6'Q' Garbage disposal 25.02
City /State /ZIP: t 44,44P v/ t/ Hose bib 25.02
Phone: ( A 2 ii; rt �' �� Ice maker 12.51
APPLICANT• � ❑r CONTACT` PERSON:` - Interceptor /grease trap 25.02
' Business name: ARS dba JACK HOWK/RESCUE ROOTER Medical gas (value: $ ) Page 2
Primer 12.51
Contact name: JOYCE DENNIS
Roof drain (commercial) 12.51
Address: P.O. BOX 2830 Sink/basin/lavatory 25.02
City /State /ZIP: CLACKAMAS, OR 97015 Solar units (potable water) 62.54
Phone: (503) 850 - 3100 Fax: : (503) 491 - 2932 Tub /shower /shower pan 12.51
E -mail: JDENNIS @ARS,COM Urinal 25.02
Water closet 25.02
. - CONTRACTOR:_ .
Water heater 37.52
Business name: ARS dba JACK HOWK/RESCUE ROOTER Water piping/DWV I' 56.29
Address: P.O. BOX 2830 Other: 25.02
City /State /ZIP: CLACKAMAS, OR 97015 Subtotal 6307-LC
Phone: (503) 850 -3100 Fax: (503) 491 -2932 Minimum permit fee: $72.50 - 7, 1
CCB Lie.: 127325 Pluglbing Lic. no.: 34 -168PB Plan review (25% of permit fee)
• 1
\`- J40 �'4J State surcharge (12% of permit fee)
Authorized signature: 7
TOTAL PERMIT FEE i 3 v
Print name: JOYCE DENNIS Date: � /'2- This permit application expires if a permit is not obtained within 0 ays
I � l(� after it has been accepted as complete.
*Fee methodology set by Tri- County Building Industry Service Board.
t. \Bmlding \Permits \PLMU- PermiiApp do 10 0 /0 440 4616T(10/0 OM/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 - I" 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
C A , 7,201 and greater $327.54
Sewer -each additional 100' � f % 37.52 /�
• Water Service - 1st 100' 62.54 (y 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 7.rispections or Fees • Qty• . • Fee (ea) Total each additional $100.00 or fraction thereof; to
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 $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: �� L/
Commercial Fixture Work:
Are you capping, adding or replacing fixtures? If "yes ", Plan Review for Pluinliin'g:liistallations
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: • - Repla greater, except systems designed and stamped by licensed
Previous. Capped Added Existing engineer.
Baptistry/Font
Bath Tub /Shower 111 New exterior plumbing site utilities for any complex structure
Jacuzzi /Whirlpool as defined in OAR918- 780 -0040.
111 Car Wash Each Stall Medical gas and vacuum systems for health care facilities.
Drive Stall ❑ Any multipurpose fire sprinkler system.
Cuspidor /Water Aspirator 111 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
:r 4 1 , I•o1.).1et icfr, ; sryD iagram.i
Floor Drain /sink - 2" ❑ Isometric or riser diagram is required for new buildings
- 3"
4 .. that meet the qualifications above.
Car Wash Drain
Garbage - Domestic
Disposal - Commercial
- Industrial Comments regarding fixture work:.
Ice Mach. /Refrig. 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 p
Water Extractor plumbing permit can be issued.
Water Closet - Toilet
Urinal
Other Fixtures:
http: / /www. tigard- or.gov /city_hal I/ departments /cd /dots /PLMF -Fermi tAP15Zdoc