Permit CITY OF TIGARD PLUMBING PERMIT
114 11 ' COMMUNITY DEVELOPMENT Permit#: PLM2013-00323
Date Issued: 09/16/2013
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503 718 2439 Parcel: 2S102AC00202
Jurisdiction: Tigard
Site address: 9110 SW BURNHAM ST
Project: Ferguson Enterprises Subdivision: BURNHAM TRACT Lot: 3
Project Description: Interior plumbing:Relocating(1)drinking fountain,(3)sinks,and(2)water closets.
Contractor: PILOT PLUMBING&HEATING LLC Owner: MILLER, PRUDENCE M TRUST
6897 SW GREENWICH DR BY PRUDENCE M MILLER TR
PORTLAND, OR 97225 4220 SW GREENLEAF DR
PORTLAND, OR 97221
PHONE: 503-367-9271 PHONE:
FAX
FEES
Quantity Description Date Amount
1 ea Drinking Fountain 09/16/2013 $25 02
Specifics: 6 ea Fixture/Sewer Cap 09/16/2013 $150 12
3 ea Lavatories 09/16/2013 $75.06
Type of Use: COM 2 ea Water Closet 09/16/2013 $50.04
Class of Work: ALT 1 12%State Surcharge- 09/16/2013 $36 03
Type of Const: Plumbing
Occupancy Grp:
Stories:
Total $336.27
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:
Call 503.639.4175 by 7:00 a.m.for the next available inspection d e.
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 li)Building Fixtures FOR OFFICE USE ONL1
r� Received p J
City of Tigard Q�J Date/By / /�%� Permit No Mil as 13. 3
n 13125 SW Hall Blvd,Tigard,OR 972 1 6 �. Plan Review /
Phone: 503.718 2439 Fax. 503 598.1960 c Q i t� at y Other Permit No ,g al 3_00/3(
T.I G A R D Inspection Line: 503.639 4175 Oj` �g) „c\(� to Ready/By Juns ® See Page 2 for
Internet www tigard-or gov c AA�,a Notified/Method L2,6 Supplemental Information
TYPE OF WORK C 9 0-Sv FEE* SCHEDULE
El New construction ❑Dem9 For special information use checklist:
Description I Qty I Ea. I Total
Addition/alteration/replacement ❑Other: New 1-2-family dwellings(includes 100 ft for each utility connection)
CATEGORY OF CONSTRUCTION SFR(l)bath 312 70
12 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: c'//Q f Lr) Ed../,-A.) 4 yy. Catch basin or area drain 18.76
City/State/ZIP: y d O 72 23 Drywell,leach Ime,or trench drain 18.76
S • Footing drain(no linear ft.: ) Pagc 2
Suite/bldg./apt.no.: Project name: F r (A Sc)!') t 'J-,�_� 3 Manufactured home utilities 50 03
Cross street/directions to job site: �A �"h_ 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
DESCR PTION OF WORK Backwater valve 12 51
r/ ) Clothes washer 25.02
� ✓/U I' / L°!Y>U �,/ Dishwasher 25.02
Drinking fountain 1 25.02 25,001
Ejectors/sump 25 02
❑ PROPERTY OWNER I ❑ TENANT Expansion tank 12 51
Name: Fixture/sewer cap 25.02
Floor drain/floor sink/hub ' 6 25.02 (5o,/.,
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 3 25.02 75..,t b
City/State/ZIP: Solar units(potable water) 62.54
Phone:( ) Fax: :( ) Tub/shower/shower pan 12 51
� / Urinal 25.02
E-mail: ///0�P/0fa->.6,,.., 2i✓i A e,-14,,,,j5 a�°/.)7Gi�.,co rr_
...5 J Water closet 47 Z, 25 02 ,50,06)
CONTRACTOR
�j / P/ _ Water heater 37.52
Business name: / 0 T �j,�; ✓� ,�� �N
S .J Water piping/DWV 56.29
Address: &IV J ) a r,ze,,,w,c ' Other 25.02
City/State/ZIP: / E'X/— rj t. Subtotal '3oo-).1
Phone:(5,3 ) 78 . 2 O° Fax:( ) Minimum permit fee: $72.50
CCB Lie.: /73 ZS-0 Plumbing Lic.no.:pg z$-� Plan review (25%of permit fee)
State surcharge(12%of permit fee) 3 �D, 0 3
Authorized signature z— TOTAL PERMIT FEE '3'3(p.a-7
S C , ,e z, /,. Date: /6, This permit application expires if a permit is not obtained within 180 days
Print name:
3 after it has been accepted as complete.
*Fee methodology set by Tn-County Building Industry Service Board
1\Budding\Pennits\PLMU-PermitApp doe 10/01/09 4404616T(10/0Z/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 ec
Ins tions or Fees Qty. Fee(ea) Total each additional$100.00 or fraction thereof,to
Inspections 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
(min_imum 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
-Jacuzzi/Whirlpool 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. -LavBar non-food related .3 3
-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 aid before the
Water Extractor p
WaterCloset-Toilet Z 2— plumbing permit can be issued.
Urinal
Other Fixtures:
1:\Building\Permits\PLMF_PermitApp.doc 08/04/2011 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
9110 SW BURNHAM ST, TIGARD, OR, 97223
Commercial - Plumbing
399 Plumbing final
2013-11-12 00:00:00
PLM2013-00323
PASS - No C of O
Violation Summary:
Inspector Contractor