Permit CITY OF TIGARD PLUMBING PERMIT
111
a COMMUNITY DEVELOPMENT Permit#: PLM2013 00362
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 10/16/2013
Parcel: 2S109DA13900
Jurisdiction: Tigard
Site address: 12685 SW MOUNT VISTA CT
Project: Armstrong Subdivision: ARLINGTON HEIGHTS NO.3 Lot: 58
Project Description: Adding bathroom in basement,(1)ejector pump,(2)lays,(1)shower and(1)water closet.
Contractor: COLUMBIA PLUMBING Owner: ARMSTRONG, BRIAN P
6626 SE HARNEY STREET 12685 SW MOUNT VISTA COURT
PORTLAND,OR 97206 TIGARD, OR 97224
PHONE: 503-704-0077 PHONE:
FAX: 503-775-8490
FEES
Quantity Description Date Amount
1 ea Ejectors/Sump 10/16/2013 $25.02
Specifics: 2 ea Lavatories 10/16/2013 $50.04
1 ea Tub/Shower/Shower Pan 10/16/2013 $12.51
Type of Use: SF 1 ea Water Closet 10/16/2013 $25.02
Class of Work: ALT 1 12%State Surcharge- 10/16/2013 $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 es :•opted by the Oregon
Utility Notifi .- --.ter. Those rules are set forth in OAR 952-001-0010 through • • -001-!••0. •, I ay obtai a copy of the rules
or direc •uestions to OU" by ' g 503.232.1987 or 1.800.332.2344.
Issu-• 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 Application
Building Fixtures C r F ND FOR OFFICE USE ONLY
City of Tigard �.,-- Received , / Permit No.: L
Q 13125 SW Hall Blvd.,Tigard,OR 9722Arr 1 13 Plan Review /� /?j . (,U?-W �C�J�
III Phone: 503.718.2439 Fax: 503.598. 601 g 20 Plan Review
Date/By: Other Permit No.:
T I G A R D Inspection Line: 503.639.4175 ��±ft�® Date Ready/By: Saris: ® See Page 2 for
Internet: www.tigard-or.gov r�+1��//oF G.k, Notified/Method: Supplemental Information
rim l .,naA1A1
TYPE 'OF WOH n�D'NG1))t,Ulc7t�td FEE* SCHEDULE
,®
❑New construction ❑Demolition For special information use checklist.
Description I Qty. I Ea. I Total
FAddition/alteration/replacement ❑Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(1)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:
'/ MI" `)61 . C 3S Catch basin or area drain 18.76
Job site address: � � �� v
Drywell,leach line,or trench drain 18.76
City/State/ZIP: ---X ��' Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: I Project name: Manufactured home utilities 50.03
- - Cross street/directions-to-job site: Manholes . -- --- 18.76
1101\ 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 (�/� q� -� J� ,(J Clothes washer 25.02
Ww /30-/'-120,;)'1 t" 'irij -e•�"rrtdr o"U'4'1+ Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump II 25.02 A 5-.0),_ .
PROPERTY OWNER I ❑ TENANT Expansion tank 12.51
Name:
�\11, \ (� �` Fixture/sewer cap 25.02
1V 'h- J -
S ,- 1 A�� �� -fN n Floor drain/floor sink/hub 25.02
Address: \"\ >\ �
Garbage disposal 25.02
City/State/ZIP: -71 \ Hose bib 25.02
Phone: ' R\S- -1 77 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 me ial) / 12.51
Address: Sink/b n/lavato X 25.02 So. 01-i
City/State/ZIP: Solar units potable water) f' 62.54
-Phone:( ) Fax::( ) Tub/shower/shower pan r 12.51 1 .51
E-mail:
Urinal 25.02
CONTRACTOR Water closet 1 25.02 a..5-0a.
Water heater 37.52
•
Business name: Co it,/39614. 011.416'.17 rf;« t•'7 Water piping/DWV
56.29
Address: 6 4'9 ' 5F 1,44,,,,y 5 Other: 25.02
7 G C Subtotal /2 5i
City/State/ZIP: GY7 a!L _ 5 ! 1
Phone:(cry' ) 704 ( 7 7 Fax:(5-e2 ) 77 5 .y 9 G Minimum permit fee: $72.50
CCB Lic.: t'6 / 7 i 9 / Plumbing Lic.no.: r-- 0 k Plan review (25%of permit fee)
State surcharge(12%of permit fee) 3..5
Authorized signature,/'= - TOTAL PERMIT FEE 2(0,to
��^ Date:or ill I 1 This permit application expires if a permit is not obtained within 180 days
Print name: ��(%/ �'�tY?�p�'�5°'� after it has been accepted as complete.
"Fee methodology set by Tri-County Building Industry Service Board.
I:\Building\Permits'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-1'100' 50.03 0 to 2,000 $121.90
Footing drain-each additional 100' 37.52 2,001 to 3,600 $169.69
Sewer 3,601 to 7,200 $233.20
ewer-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
Storm&Rain Drain-1st 100' 62.54 Valuation: Permit Fee:
$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
(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, n, n
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
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 underthis 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
WaterCloset-Toilet plumbing permit can be issued.
Urinal -
Other Fixtures:
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