Permit CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit#: PLM2013 00370
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 10/21/2013
Parcel: 2S103CB10400
Jurisdiction: Tigard
Site address: 12192 SW QUAIL CREEK LN
Project: Gadbery Subdivision: QUAIL HOLLOW-EAST Lot: 62
Project Description: Master bath remodel,switch locations of tub and shower
Contractor: NELSON&NELSON INC Owner: GADBERY, MICHAEL K&CATHY A
14051 SE 119TH DR 12192 SW QUAIL CREEK LN
CLACKAMAS, OR 97015 TIGARD,OR 97223
PHONE* 503-201-5038 PHONE:
FAX
FEES
Quantity Description Date Amount
2 ea Tub/Shower/Shower Pan 10/21/2013 $25.02
Specifics: 1 12%State Surcharge- 10/21/2013 $8.70
Plumbing
Type of Use SF 47 ea Minimum Fee Adjustment- 10/21/2013 $47.48
Class of Work: ALT
Plumbing
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 Not - - 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 dir= questions to •• C b calling 503.232.1987 or 1 800.332.2344
Is- ed By: _ / 40e. ' Permittee Signature: JAL/
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 ApplicatiECEIVED
Building Fixtures roi OIFlCl use ONL
OCT 21 2013
City of Tigard Received / Permit No l ��
�7 DatcBy. (.° o / / 3 ° / O'-1' `tom
v 13125 SW Hall Blvd.,Tigard OR Via OF TIGARD Plan Review
' o` Phone' 503.718.2439 Fax 503 5 1 Other Permit No.
Inspection Line: 503 639 4175 BUILDING DIVISION DateBy.
TI G A R lJ p Date Ready/By Juns RI See Page 2 for
Internet: www tigard-or gov Notified/Method I_Supplemental Information
TYPE OF WORK FEE* SCHEDULE
❑New construction ❑Demolition For special information use check list.
Description I Qty. I Ea. I Total
Addition/alteration/replacement ❑Other: New l-2-family dwellings(includes 100 ft for each utility connection)
CATEGORY OF CONSTRUCTION SFR(1)bath 312.70
141-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: 19,A A 1 S 0 Qui �9 v wi z Catch basin or area drain 18.76
Drywell,leach line,or trench drain 18.76
City/State/ZIP: 1 ,' e� q'
I , Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: Project name: a1, 6E 2y 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: 1 Lot no.: Fixture or item:
Tax map/parcel no.: Backflow preventer 31 27
DESCRIPTION OF WORK Backwater valve 12.51
,_ _ _{� Clothe
shwa washer 25.02
" � Dishwasher 25.02
GO.C.P-Ak rv,q i9� ctv ' �) Drinking fountain 25.02
i.
Ejectors/sump 25 02
' ❑ PROPERTY OWNER I ❑ TENANT Expansion tank 12 51
Name: en ft-ibt a-ki el t t_1.f,bi- L N �4,mo I Fixture/sewer cap 25.02
/ �T t�►y
Floor drain/floor sink/hub 25.02
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: + 1 1 ./I _Q_ _ Medical gas(value:$ ) Page 2• 1 S`""�`�"i Primer 12 51
Contact name: A�, • SPAM
Roof drain(commercial) 12.51
Address: tyoe SO 11 ,t-s 'C ,_,1 , Sink/basin/lavatory 25.02
City/State/ZIP: (1 f _ 9'1 O f S Solar units(potable water) 62.54
Phone:( 5ci9 z 0 1 -S-O 3 qj Fax: :( ) Tub/shower/shower pan 2. 12.51
Urinal 25.02
E-mail: ;'19._1%_"i'Plu villa 1'b.kO 1t LI . LO v1-1 Water closet 25.02
CONTRACTOR
Water heater 37.52
Business name: (1 j'a, ,, 3tn t_, Water piping/DW V 56.29
Address: 11-1o51 50
fl ett.y OA , Other: 25.02
City/State/ZIP: _.... el'1u It c- Subtotal
Phone:(Z-69 Ac)( -5-0 j g Fax:( ) Minimum permit fee• $72 50 '2A•9D
/ Plan review (25%of permit fee) -�-
CCB Lic.: aoO i(Q 40 ,l5 Plumbing Lic.no.: p6 1r 359
ii? State surcharge(12%of permit fee) -It_)
Authorized signature: ?rt/f y TOTAL PERMIT FEE g/ .9.6_
Print name: y) ;/� (Su Date:( -Li- i3 This permit application expires if a permit is not obtained within 180 days
1 i �L�1 i `7 after it has been accepted as complete.
*Fee methodology set by Tri-County Building industry Service Board
1\Building'Permits\PLMU-Per mttApp doe 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
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 Inspections or Fees Qty. Fee(ea) Total each additional$100.00 or fraction thereof,to
l� 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
Quanti 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
❑ Any new commercial building with water service 2"and
Baptistry/Font • greater,except systems designed and stamped by licensed
Bath: -Tub/Shower _
engineer.
Jacuzzi/Whirlpool
CI tall New exterior plumbing site utilities for any complex structure
Car Wash: -Each Stall tall as defined in OAR918-780-0040.
ID Cuspidor/Water Aspirator Medical gas and vacuum systems for health care facilities.
Dishwasher: -Commercial ❑ Any multipurpose fire sprinkler system.
Domestic -" CI 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: -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:
1:\Building\Permits\PLMF_PermitApp.doc 08/04/2011 2
City of Tigard
13125 SW Hal Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
12192 SW QUAIL CREEK LN, TIGARD, OR, 2013 -11 -26 00:00:00
97223
Record Type: Record ID:
Residential - Plumbing PLM2013 - 00370
Inspection Type: Result:
399 Plumbing final PASS - No C of 0
Comments:
Violation Summary:
Inspector Contractor