Permit CITY OF TIGARD PLUMBING PERMIT
a COMMUNITY DEVELOPMENT Permit #: PLM2013 -00145
Date Issued: 05/09/2013
TIGARD 13125 SW Hall Blvd , Tigard OR 97223 503.718 2439 Parcel: 2S102CB02000
Jurisdiction: Tigard
Site address: 13320 SW PACIFIC HWY
Project: Pettijohn Subdivision:RTH TIGARDVILLE ADDITION, AMENC Lot: 32
Project Description: (1) catch basin
Contractor: HALS CONSTRUCTION INC Owner: PETTIJOHN, PAUL
20666 S HWY 213 18435 SW PACIFIC HWY
OREGON CITY, OR 97045 TUALATIN, OR 97062
PHONE. 503 - 656 -4999 PHONE: 503-692-1225
FAX' 503 - 656 -5961
FEES
Quantity Description Date Amount
1 ea Catch Basin or, Area Drain 05/09/2013 $18 76
Specifics: 1 12% State Surcharge - 05/09/2013 $8 70
Plumbing
Type of Use: COM 54 ea Minimum Fee Adjustment - 05/09/2013 $53 74
• 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 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: 1 ` Permittee Signature �,f42 ^ �v/� %�(•f Call ( 503..639.4175 by P 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 RECEIVED
Site Utilities FOR OFFICE USE ONLY
City of Tigard MAY 0 9 2013 Received e,/ permit No P � c o ,� Q/ 3 - / S
V 13125 SW Hall Blvd , Tigard, OR 97223 Date/By. �t
r Plan Review
C Phone. 503.718 2439 Fax 503.598 1966 OF T IGARD Date/By Other Permit No
TIGARD Inspection Line: 503 639.4175 BUILDING DIVISION Date Ready/By lures ® Sec Page 2 for
Internet www.tigard - or.gov Notified/Method
n Supplemental Information
TYPE OF WORK FEE* SCHEDULE
❑ 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 (t) bath 312 70
❑ 1- 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: 13320 SW PACIFIC HWY. Catch basin or area drain 1 8.76
Drywell, leach line, or trench drain 1 8.76
City /State /ZIP: TIGARD, OR 97224
Footing drain (no. linear ft.: ) Page 2
Suite/bldg. /apt. no.: 1 Project name: 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
catch basin Dishwasher 25.02
Drinking fountain 25 02
Ejectors /sump 25.02
® PROPERTY OWNER I ❑ TENANT Expansion tank 12 51
Name: Fixture /sewer cap 25.02
PAiIT. PPTTIJOHN Floor drain/floor sink/hub 25 02
Address: 18435 SW PACIFIC HWY. Garbage disposal 25.02
City /State /ZIP: TUALATIN, OR 97062 Hose bib 25.02
Phone:( 503 692 -1225 Fax: 692 -5652 Ice maker 1251
$] APPLICANT ❑ CONTACT PERSON Interceptor /grease trap 25.02
Business name: Medical gas (value: $ ) Page 2
Primer 12 51
Contact name: PAUL PETTIJOHN 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 12 51
E -mail: Urinal 25 02
CONTRACTOR Water closet 25.02
Water heater 37 52
Business name: HALS CONSTRUCTION INC. Water piping/DWV 56 29
Address: 20666 S. HWY. 21 3 Other: 25.02
City /State /ZIP: OREGON CITY, OR 97045 Subtotal
Phone: ( 503 6 5 6 - 4 9 9 9 Fax: ( 50 B 656-5961 Minimum permit fee $72.50
CCB Lic.: 34434 tl t 31 Plumbing Lic. n o.: s (� g 3 S 3-' .6 Plan review (25% of permit fee)
11(04' State surcharge (12% of permit fee)
Authorized signature: TOTAL PERMIT FEE g'_ a-o
Print nageaa � Date: 5-1.-13 This permit application expires if a permit is not obtained within 180 days
after it has been accepted as complete.
*Fee methodology set by Tn -County Building Industry Service Board
I \Building\Permus\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 - 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 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
Q ty. Fee (ea) Total each additional $100.00 or fraction thereof, to
Other Inspections or Fees 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 * .
Quantity by Fixture Type Plan Review for Plumbing Installations
Fixture Type for Replace/ Plan review is required for any of the following.
Performed: Capped Added Relocate 9 y g•
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.
-3"
Isometric or Riser Diagram
Car Wash Dram ❑ Isometric or riser diagram is required for new buildings
Garbage - Domestic- non -food g q g
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/Lay - Non -food related
- Bradley
- Commercial- 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
Water Closet - Toilet fees assessed for the sewer increase must be paid before the
Urinal plumbing permit can be issued.
Other Fixtures:
C: \Users\Paula\AppData \Local \Temp \PLMU - PermitApp -2.doc 2
Location:
Record Type:
Inspection Type:
Comments:
Inspection Date:
Record ID:
Result:
City of Tigard
13125 SW Hal Blvd.
Tigard, OR 97223 Tel: 503.718.2439
13320 SW PACIFIC HWY, TIGARD, OR, 97223
Commercial - Plumbing
345 Culvert/catch basin
05/30/2013 00:00
PLM2013-00145
PASS
Violation Summary:
Inspector Contractor
Location:
Record Type:
Inspection Type:
Comments:
Inspection Date:
Record ID:
Result:
City of Tigard
13125 SW Hal Blvd.
Tigard, OR 97223 Tel: 503.718.2439
13320 SW PACIFIC HWY, TIGARD, OR, 97223
Commercial - Plumbing
399 Plumbing final
05/30/2013 13:44
PLM2013-00145
PASS - No C of O
Violation Summary:
Inspector Contractor