Permit a CITY OF TIGARD PLUMBING PERMIT
' C -- COMMUNITY DEVELOPMENT Permit #: PLM2013 -00163
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 06/03/2013
Parcel: 2S110BB01500
Jurisdiction: Tigard
Site address: 14405 SW HAZELHILL DR
Project: Subdivision: AMES ORCHARD Lot: 10
Project Description: Add (1) bar sink and replace existing kitchen fixtures.
Contractor: KRAFTSMAN PLUMBING LLC Owner: HOUELAND, DUSTIN L & ELIZABETH N
2606 A ST 14405 SW HAZELHILL DR
FOREST GROVE, OR 97116 TIGARD, OR 97224
PHONE: 503 - 793 -4338 PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Dishwasher 06/03/2013 $25.02
Specifics: 1 ea Garbage Disposal 06/03/2013 $25.02
1 ea Ice Maker 06/03/2013 $12.51
Type of Use: SF 2 ea Sink 06/03/2013 $50.04
Class of Work: ALT 1 12% State Surcharge - 06/03/2013 $13.51
Type of Const: Plumbing
Occupancy Grp:
Stories:
Total $126 10
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 -0 090. You may obtain a copy of the rules
or direct questions to OODUNC by calling 503.232.1987 or 1 800.332.2344.
Issued By: / Permittee Signature:
� 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 Applicatio
Building Fixtures RECE\!ED
City of Tigard �' g JUN - 3 2013 Date/By: Received 473 /3 Permit Na ^ OO/
:� q 13125 SW Hall Blvd., Tigard,OR 97223
Phone: 503.718.2439 Fax: 503.598.1 � T Y OFTIGAR D Date/By: Plan By: Other Permit No.:
Inspection Line: 503.639 4175 D ate Read B runs ®See Pa e 2 for
I I G,� Il t� B UILDING DIVISIOr y y �� g
Internet: www.tigard 1 Notifie Supplementallnformation
TYPE OF WORK FEE* SCHEDULE
❑ New construction ❑ Demolition For special information use checklist
Description I Qty. I Ea I Total
I"Addition/alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (1) bath 312 70
L!d l- 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:
� 1o5 5 . w I o u' , / i d Catch basin or area drain 18.76
Job site address: 1
Drywell, leach line, or trench drain 18.76
City/State /ZIP: "r; Sa Y( 0 ( Footing drain (no. linear ft.: _) Page 2
Suite/bldg. /apt. no.: I Project name: Ho& 6 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
A I Clothes washer 25.02
R 1 r el, n ew hay .5 I nn( and Re I P1 S Ki 1Ckrr1 Dishwasher i 25.02
Fist S (OIV (a Aug e dL NOS u,I i •Frxzef) Drinking fountain 25.02
Ejectors /sump 25.02
❑ PROPERTY OWNER I ❑ TENANT Expansion tank 12.51
Name: Fixture /sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address:
Garbage disposal l 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 'Z 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
', / �++ l II__ Water heater 37.52
Business name: f� YU l jYY1U11 f I U-nib 1'1.3 L I c, Water piping/DWV 56.29
Address: 60 . f Other. 25.02
City/State /ZIP: roYeS) 67oQe. Oa 9'4 // 6 Subtotal
Phone: (6o3 ) 19 - f� 3 '; Fax: ( ) Minimum permit fee: $72.50
� Plan review (25% of permit fee)
CCB Lic.: / . O / Plumbin g Lic. nob/ 5' 2 _ •
State surcharge (12% of permit fee)
Authorized signature. �� TOTAL PERMIT FEE 426, /0
Print name:1.1 } I Zeici8 6 eL Dater 103 )3 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\PermiMPI-MU- 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 - 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
P 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
Baptistry/Font ❑ Any new commercial building with water service 2" and
greater, except systems designed and stamped by licensed
Bath: -Tub /Shower
- JacuzziAWhirlpool engineer.
Car Wash: Each Stall ❑ New exterior plumbing site utilities for any complex structure
Drive tall 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
❑ 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: - Lav/Bar 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:
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