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Permit
1 y q CITY OF TIGARD PLUMBING PERMIT 7 ' COMMUNITY DEVELOPMENT Permit #: PLM2012 -00322 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 11/01/2012 Parcel: 1 S133AD02200 • Jurisdiction: Tigard . Site address: 10730 SW 130TH AVE Project: Westgate Baptist Church Subdivision: HAWK'S BEARD TOWNHOMES Lot: 62 Project•Description: Plumbing for 2nd story TI /Elevator • Contractor: SHARPEI?LUIVIBING Owner: WESTGATE BAPTIST CHURCH PO BOX 2 12930 SW SCHOLLS FERRY RD TIGARD, OR 97281 TIGARD, OR 97223 PHONE: 503 - 590 -7050 PHONE: 503 524 -3500 FAX: 503 - 400 -6714 • FEES Quantity Description Date Amount 1 ea Drinking Fountain 11/01/2012 $25.02 Specifics: 2 ea Floor Drain/Floor Sink/Hub 11/01/2012 $50.04 4 ea Lavatories 11/01/2012 $100.08 • Type of Use: COM 2 ea Urinal 11/01/2012 $50.04 Class of Work: ALT 4 ea Water Closet 11/01/2012 $100.08 Type of Const: 1 12% State Surcharge - 11/01/2012 $39.03 Occupancy Grp: Plumbing • Stories: 1 ea Sink 11/01/2012 $25.02 0 12% State Surcharge - 11/01/2012 _ $3.00 Plumbing Total $392.31 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: \ — C/A1.4 v 7C . 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 Building Fixtures RECEIVED City of Tigard Received // � / a� Daty: / j- Permit N .A__Oa Zj`Z 7 1 13125 SW Hall Blvd., Tigard, OR 97N `/ 0 1 2��2 Plan Review Phone: 503.718.2439 Fax: 503.598.1960 TIGARD Date/By: Other Permit No.: ej /24.0 0,90 T l G A R D Inspection Line: 503.639.4175 CITY TIGARD Date Ready/By: Juris: El See Page 2 for Internet: www.tigard or.gov Notified/Method: Supplemental Information TYPE OF MAP FEE* DIVISION FEE* SCHEDULE Xi New construction ❑ Demolition For special information use checklist Description I Qty I Ea. I Total ❑ Addition/alteration/replacement ❑ Other: New I - 2 - family dwellings (includes 100 ft. for each utility connection) CATEGORY OF CONSTRUCTION SFR (1) bath 312.70 ❑ I- and 2- family dwelling Commercial /industrial SFR (2) bath 437.78 SFR (3) bath 500.32 I ❑ Accessory building ❑ Multi - family Q Each additional bath/kitchen 25.02 4 ❑ Master builder ❑ Other: Fire sprinkler ( sq. ft.) Page 2 ^� JOB SITE INFORMATION AND LOCATION Site utilities: Catch basin or area drain 18.76 Job site address: /6 7 30 5 120th City /State/ZIP: Drywell, leach line, or trench drain 18.76 T i GA-n sb i a 6 '7 2 Footing drain (no. linear ft.: _) Page 2 Suite/bldg. /apt. no.: Project name: tr � � GA•(L 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.: / t / 3 3 r/ D (y pbd Backflow preventer 31.27 DESCRIPTION OF WORK Backwater valve 12.51 Clothes washer 25.02 Z / errt 2q (ti 5 . Dishwasher 25.02 15,0 7 Drinking fountain L 25.02 Ejectors /sump 25.02 z gi PROPERTY OWNER I ❑ TENANT Expansion tank 12.51 Fixture/sewer cap 25.02 Name: bJ T - GA'rr 2,ei9 C ltx d 4f Floor drain/floor sink/hub 2. 25.02 50 Ay Address: tz57v0 i,., 5cAtexcs FC Ez _ ( � Garbage disposal 25.02 City /State /ZIP: - 1'I6,cnt, •(2 VS Cf 77.ZS Hose bib 25.02 Phone: ( 663 ) 57z. 739 Z Fax: ( ) Ice maker 12.51 0 APPLICANT ❑ CONTACT PERSON Interceptor /grease trap 25.02 n Medical gas (value: $ ) Page 2 Business name: (f V r70 (',NS - I - . .-flt G Contact name: ,( Primer 12.51 L�4) by-Man) Roof drain (commercial) 12.51 Address: /6)75 Ste% Ler< e gc,i% Sink/basin/lavatory if dM l-$1, L fr 25.02 E.gp..p$..... City /State /ZIP: ` sk it 075/J457,6 Ones ' 7odc Solar units (potable water) 62.54 Phone: (5o3) S 7 z '>3 5 Z Fax: : ( ) Tub /shower /shower pan 12.51 E -mail: /f d J 0 6 © y /t*„, C are, Urinal 25.02 gyp, 04 ��++ CONTRACTOR Water closet 1-I 25.02 i 00 .0`a Water heater 37.52 Business name: s ita2 Quovq1,36 Water piping/DWV 56.29 Address: P , d. Qva x z335 Other: 25.02 ',d City /State /ZIP: 71 t ' dQ CI7251' Subtotal Phone: (s 5'jO `7060 Fax: ( ) Minimum permit fee: $72.50 - - CCB Lic.: i /,tic t Plumbing Lic. no.: (46,2,3 P [; Plan review (25 % of permit fee) o g �f State surcharge (12% of permit fee) 03 "1 Authorized signature ( �M 0` TOTAL PERMIT FEE • x v ! Date: This permit application expires if a permit is not obtained within 180 days Print name: /CJ t �/1 //rl1) U ¢!C after it has been accepted as complete. 34'. *Fee methodology set by Tri- County Building Industry Service Board. I:\ Building \Perrnits) 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 - 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 - 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 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: Other Fixtures: I I I 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 Fixture Type for Replace/ Plan Review for Plumbing Installations Work Performed: Capped Added Relocate Baptistry/Font Plan review is required for any of the following. Bath - Tub /Shower Please check all that apply. - Jacuzzi /Whirlpool ❑ Any new commercial building with water service 2" and Car Wash -Each Stall greater, except systems designed and stamped by licensed -Drive Thru engineer. Cuspidor /Water Aspirator ❑ New exterior plumbing site utilities for any complex structure Dishwasher - Commercial as defined in OAR918- 780 -0040. - Domestic ❑ Medical gas and vacuum systems for health care facilities. Drinking Fountain ( ❑ Any multipurpose fire sprinkler system. Eye Wash ❑ Any complex structure as defined in OAR9I8- 780 -0040. Floor Drain/sink - 2" Z 3" Submit 2 sets of plans with any of the above. -4" Car Wash Drain Isometric or Riser Diagram Garbage - Domestic -non -food Disposal - Domestic related ❑ Isometric or riser diagram is required for new buildings - Commercial - food related that meet the qualifications above. - Industrial -food related Ice Mach. /Refrig. Drains Oil Separator (Gas Station) Rec. Vehicle Dump Station Comments regarding fixture work: Shower -Gang -Stall Sink/Lav - Non -food related - Bradley - Commercial -food related - Service Swimming Pool Filter Washer - Clothes Water Extractor *Note: If the fixture work under this permit results in an Water Closet - Toilet increase of sewer EDUs, a sewer permit will be issued and Urinal fees assessed for the sewer increase must be paid before the C:\ Users\ BDutton. WBCINTRA \AppData \Local\Microsoft \Windows \Tem2orary Internet Files \Low \Content.IE5\AU7E2CCF \PLMF - PermitApp[1].doc