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Permit CITY OF TIGARD PLUMBING PERMIT 1 g COMMUNITY DEVELOPMENT Permit #: PLM2013 00234 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 07/10/2013 Parcel: 25111 DD06500 Jurisdiction: Tigard Site address: 15800 SW STRATFORD LP Project: Wiebe Subdivision: STRATFORD Lot: 62 Project Description: Bathroom remodel, replace shower, water closet, sink & jacuzzi tub. Contractor: EMPIRE PLUMBING LLC Owner: WIEBE, SUE ELLEN REVOCABLE LIVIN 19572 SW TREEHOUSE LN 15800 SW STRATFORD LOOP BEAVERTON, OR 97007 TIGARD, OR 97224 PHONE: 971 - 506 -6354 PHONE: FAX: FEES Quantity Description Date Amount 1 ea Lavatories 07/10/2013 $25.02 Specifics: 2 ea Tub /Shower /Shower Pan 07/10/2013 $25.02 1 ea Water Closet 07/10/2013 $25.02 Type of Use: SF 1 12% State Surcharge - 07/10/2013 $9.01 Class of Work: ALT Plumbing Type of Const: Occupancy Grp: Stories: Total $84.07 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 que o OU16.py calling 503.232.1987 or 1.800.332.2344. C Issue By: \\ Permittee Signature: 1 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. ceived 7 / /D f� C. , ')Q Permit No.: �llyaQys_eOQ City of Tigard Date/By: ! .J '�y"'/ 11111 I a 13125 SW Hall Blvd., Tigard, OR 9 Plan Review Phone: 503.718.2439 Fax: 503.5'4 'l:�' ■ EIVED Date/By: Other Permit No.: Inspection Line: 503.639.4175 Date Ready/By: Juris: ® See Page 2 for 1 I RD Internet: www.tigard- or.gov t '. n. Notified/Method: Supplemental Information • TYPE OF WORK VV r , FEE* SCHEDULE �E Wnn��Tmid1GARD For special information use checklist. • ❑ New construction Description Qty. Ea. Total 14 Addition/alteration /replacement HMG DNIJIUN New 1- 2- family dwellings (includes 100 ft. for each utility connection) CATEGORY OF CONSTRUCTION SFR (I) bath 312.70 SFR (2) bath 437.78 E4 I- and 2- family dwelling ❑ Commercial /industrial 500.32 SFR (3) bath ❑ 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: m Catch basin or area drain 18.76 Job site address: C� J!T' /C 0.� " 18.76 J 0O .5 IN // Catch basin , l ine, or trench drain City /State /ZIP: - G` b ) © g / .f .2 2 7 Footing drain (no. linear ft.: ) Page 2 Suite/bldg. /apt. no.: 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 fl.: ) Page 2 Subdivision: I Lot no.: Fixture or item: Backflow preventer 31.27 Tax map /parcel no.: 12.51 Backwater valve DESCRIPTION OF WORK Clothes washer 25.02 /" 7 1 )wir)-14,-67(Cr (' I /, = ) Dishwasher 25.02 C ♦ - , f Drinking fountain 25.02 V Ejectors /sump 25.02 ❑ PROPERTY OWNER I 0 TENANT Expansion tank 12.51 Fixture /sewer cap 25.02 Name: Floor drain/floor sinlc/hub Address: Garbage disposal 25.02 City /State /ZIP: Hose bib 25.02 Phone: ( ) Fax: ( ) Ice maker 12.51 Interceptor/grease tra 25.02 la APPLICANT ❑ CONTACT PERSON tra Medical gas (value: $ ) Page 2 Business name: ��{�'�ii2 � L U/�l, ji A/G G C Primer 12.51 Contact name: V4G Er( L 4A/c L Roof drain (commercial) 12.51 Address: ,19 5 2 $ pa - r2G �ROCf6t - 1A/ Sink/basin/lavatory 4 25.02 23 y q 2 Solar units (potable water) 62.54 City/State/ZIP: _VP�'1 l 419. / „1 T� 0- 7 Phone: (5•7/) 5 63s-- Fax:: ( ) Tub /shower /shower pan el 12.51 5O." Urinal 25.02 E- mail: 20690 �� Water closet 25.02 ag " CONTRA O Water heater 37.52 Business name: ESP/ r 2z 0/1. A/ 6 GGC Water piping/DWV 56.29 Address: / ,9 6' 7 2 2 5 , 'c / 7E E r/ 0 US6 GA/ Other: 25.02 City/State/ZIP: �,,A _ 75.04' tY t / a / J Subtotal 73.� Minimum permit fee: $72.50 Phone: (57,/) 5 6 6 3 s 7 Fax: ( ) Plan review (25% of permit fee) CCB Lic.: 4 9 7- 2 1. cebo I y Plumbing Lic. no.: Fa: 1,2149 7 State surcharge (12% of permit fee) :TO/ Authorized signature: em- 7//// TOTAL PERMIT FEE D(./ .07 `' This permit application expires if a permit is not obtained within 180 days Print name: V G �� ��C U Date: /�p /�0/3 after it has been accepted as complete. *Fee methodology set by Tri - County Building Industry Service Board. 1:\ Building \Permits\PLMU- PermitApp.d°c 10/01/09 440- 4616T(10 /02/COM/WEB) • Plumbing Permit Application - City of Tigard Page 2 - Supplemental Information Fee Schedule: Residential Fire Su 1 . ression S stems: Qty. Total IIIIIIIIIIIII Footin drain - 1�' 100' S • uare Foota e: $1 Footing drain - each additional 100' Fee: 50.03 0 to 2,000 ® 2,001 to 3,600 _ $121.90 Sewer - 1st 100' 3,601 to 7,200 $169.69 Sewer - each additional 100' 62.54 $233.20 _ ®_ 7,201 and _realer Water Service - 1st 100' _ 62.54 Water Service - each additional 100' _ Medical Gas S stems: ® Valuation: & Rain Drain - 1st 100' aluatlOn: Permit Fee: Storm & Rain Drain -each additional 100' 62.54 _ ®_ $1.00 to $5,000.00 Minimum fee $72.50 OtherIns I actions or Fees Qty. Total $5,001.00 to $10,000.00 $72.50 for the first $5,000.00 and $1.52 for Inspection of existing plumbing or for each additional $100.00 or fraction thereof, to which no fee is specifically indicated and includin_ $10,000.00. minimum char_e — 1/2 hour 90.00/hr ■ $10,001.00 to $25,000.00 $148.50 for the first $10,000.00 and $1.54 for Inspections outside of normal business each additional $100.00 or fraction thereof, to Inspections minimum a of n — 2 hours each additional $100.00 or fraction thereof 90.00/hr and . or the $25,00 $25,000.00 and $1.45 for 50. Reinspection Fees _ $25,001.00 to $50,000.00 $379.50 for the first $2 90.00/hr f, to Add r $50,001.00 and up plan review for revisions 90.00/h and includin: $50 000.00. minimum ch e — 1/2 hour p $742.00 for the first $50,000.00 and $1.20 for Subtotal: __ _ each additional $100.00 or fraction thereof. Commercial Fixture Work: Are you capp add or replacing fixtures? If "yes ", please indicate work performed by fixture. Failure to accurately re port fixtures could result in increased sewer fees * . I uanti b Fixture Plan Review for Plumbin' Installations Fixture Type for ® Plan review is required for any of the following. Work Performed: Replace/ Please check all that a pp I y. Ba . tis Pont Relocate Bath: -- ❑ Any new commercial building with water service 2" and Tub /Shower - -- greater, except systems designed and stamped by licensed - Jacuzzi/Whirl.00l Car Wash: -Each Stall - -- engineer. Drive tall = -- ❑ New exterior plumbing site utilities for any complex structure Cus idorNVater As irator - -- as defined in OAR918- 780 -0040. Dishwasher - Commercial - -- ❑ Medical gas and vacuum systems for health care facilities. Domestic - -- ❑ Any multipurpose fire sprinkler system. Drinkin: Fountain — =_ ❑ Any complex structure as defined in OAR918- 780 -0040. Floor DraiNsink: - -- Submit 2 sets of plans with any of the above. _ - = -- Isometric or Riser Dia .ram - Car Wash Drain - -- ❑ Isometric or riser diagram is required for new buildings Garbage - Domestic non - food -- Disposal: - Domestic food related that meet the ualifications above. - Commercial food related — == - Industrial food related - -- Ice Mach./Refri:. Drains -- Oil Se.arator Gas Station _ - � Comments regarding fixture work: Rec. Vehicle Dum , Station - - Shower: -Gang - -- -Stall - - = Sink: -LavBar non -food related -_ Bradley - - - Com/Serv/Util food related - -= Service — Washer n: Pool Filter -- *Note: If the fixture work under this permit results in an Wactoes - h increase of sewer EDUs, a sewer permit will be issued and Water ter Extractor Extraractor _ - - WaterCloset - Toilet fees assessed for the sewer increase must be paid before the - == plumbing permit can be issued. O ther Fixtures: -- I:\ Building \Permits\PLMF- PermitApp.doc 08/04/2011 2