Permit CITY OF TIGARD PLUMBING PERMIT
IL
:91'g COMMUNITY DEVELOPMENT Permit #: PLM2013 00064
Date Issued: 02/21/2013
TI GARD 13125 SW Hall Blvd., Tigard OR 97223 503.718 2439 Parcel: 2S104BCO3700
Jurisdiction: Tigard
Site address: 14363 SW WINDSONG CT
Project: Barrera Subdivision: HILLSHIRE WOODS Lot: 48
Project Description: Fire repair: remove all finishes including drywall and insulation, flooring, etc Then smokeseal and install new
Contractor: KEITH CARTER PLUMBING Owner: BARRERA, ADELINA T
6722 SE MAPLEHURST RD 14363 SW WINDSONG CT
MILWAUKIE, OR 97222 TIGARD, OR 97223
PHONE: 503 - 890 -0670 PHONE: 503-713-7957
FAX: 503 - 654 -9768
FEES
Quantity Description Date Amount
2 ea Tub /Shower /Shower Pan 02/21/2013 $25 02
Specifics: 1 12% State Surcharge - 02/21/2013 $8 70
Plumbing
Type of Use SF 47 ea Minimum Fee Adjustment - 02/21/2013 $47 48
Plumbing
Class of Work: ALT
Type of Const:
Occupancy Grp:
Stories:
Total $81 20
Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR Specialty Codes and all other
applicable law All work will be done in accordance with approved plans This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility 'cation Cen - Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090 You may obtain a copy of the rules
or ect questions to OUNC . - - in. .03.232.1987 or 1 800 332 2344
•
Issued By: �. il „ ° , / Permittee Signature: A . 1 40. 11111 11111.
Call 503.639.4175 by 7:00 a.m. for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Plumbing Permit Annlicati
Building Fixtures FOR OFFICE USE ONLY
Dat
III City of Tigard e Received d` /� R/ , i PermitNo.. L��13.. Cfe
rQ/Gf
U 13125 SW Hall Blvd., Tigard, OR 972 3 EB 2 1 2013 Dat Plan Review
2 Phone. 503 718.2439 FaX 503.5 8 Date/By Other Permit No
Inspection Line. 503.639.4175 �. i$ ° OF TIGARD p g g BU ILDING DIVI..II�� Date Ready/By: tuns See age 2 for
Internet: www.ti aril - or. ov Notified/Method. S od. Su ementalInformation
TYPE OF WORK FEE* SCHEDULE
El New construction ❑ Demolition For special information use check list
re Description I Qty. I Ea. I Total
"S.Addition/alteratio placement ❑ Other: New 1- 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
❑ Accessory building ❑ 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: 6 11t76 3 Catch basin or area drain 18.76
�� W i. �� �� D Drywell, leach line, or trench drain 18.76
City /State /ZIP:
I . 14-y2e, Footing drain (no. linear ft.: ) Page 2
Suite/bldg. /apt. no.: Project name: aec_a_pr 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
��p /i4-c--e- 't Pi u. 6 e''v A9- 6 L -0C --, Dishwasher 25.02
11 Drinking fountain 25.02
Ejectors /sump 25.02
[PROPERTY OWNER I 0 TENANT Expansion tank 12.51
Name: 1 Fixture /sewer cap 25.02
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 25.02
City/State /ZIP: Solar units (potable water) 62.54
Phone: ( ) Fax: : ( ) Tub /shower /shower pan a 12 51
E -mail: Urinal 25.02
CONTRACTOR Water closet 25.02
Water heater 37.52
Business name: / '(ei (�,A a1 iE < /1 /6
Water piping/DWV 56.29
Address: el 7 J s ! ' 1 0 e / 5i _ ' c c) 1 Other: 25.02
City /State /ZIP: /" i L , v , , g 7 a a Subtotal
Phone: 45•63) 41 _ ( 0 Fax: ( 5 - o7 6 641-q2/"5 Minimum permit fee: $72.50 rfa,, 6
CCB Lic.: `!7 g 96/ /'g,�/ t f Plumbing Lic. no. . G�9/ 4P� Plan review (25% of permit fee)
_ / State surcharge (12% of permit fee)
Authorized signature: 2
1. a 7 TOTAL PERMIT FEE I ( � Print name: 7- .. _�L Date -,/, � I' u This permit application expires if a permit is not obtained within ISO days
i� 1 G e -- ,c2 1 after it has been accepted as complete.
"Fee methodology set by Tn -County Building Industry Service Board.
1 \ Building\Permits\PLMU- PennitApp doc 10/01/09 440 -4616T(I0 /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 - 1' 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
A 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:
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 * . Plan Review for Plumbing Installations
Quantity by Fixture Type Plan review is required for any of the following.
Fixture Type for Replace/ Please check all that apply.
Work Performed: Capped Added Relocate
❑ Any new commercial building with water service 2" and
Baptistry/Font greater, except systems designed and stamped by licensed
Bath: - Tub /Shower
-Jacuzzi/Whirlpool engineer.
❑ New exterior plumbing site utilities for any complex structure
Car Wash. -Each Stall
Drive as defined in OAR918- 780 -0040.
Cuspidor/Water Aspirator ❑ Medical gas and vacuum systems for health care facilities.
Dishwasher: Commercial ❑ Any multipurpose fire sprinkler system.
Domestic ❑ Any complex structure as defined in OAR918 -780 -0040.
Drinking Fountain
Eye Wash Submit 2 sets of plans with any of the above.
Floor Drain/sink: - 2"
3" Isometric or Riser Diagram
4 " ❑ Isometric or riser diagram is required for new buildings
- Car Wash Drain
Garbage Domestic non - food that meet the qualifications above.
Disposal: - Domestic food related
- Commercial food related
- Industrial food related
Ice Mach /Refrig Drains Comments regarding fixture work:
Oil Separator (Gas Station)
Rec. Vehicle Dump Station
Shower: -Gang
-Stall
Sink: -LavBar non -food related
- Bradley
- Com/Serv/Util food related
- Service *Note: If the fixture work under this permit results in an
Swimming Pool Filter increase of sewer EDUs, a sewer permit will be issued and
Washer - Clothes fees assessed for the sewer increase must be paid before the
Water Extractor
Water Closet - Toilet plumbing permit can be issued.
Urinal
Other Fixtures:
I:\Building\Permits\PLMF- PermitApp.doc 08/04/2011 2