Permit CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit#: PLM2013-00409
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 11/14/2013
Parcel: 2S103DA05900
Jurisdiction: Tigard
Site address: 10590 SW COOK LN
Project: FOSTER Subdivision: FANTASY HILL Lot: 13
Project Description: Plumbing for bathroom addition. Structural permit not required.
Contractor: SCOTT FOSTER Owner: FOSTER, SCOTT A& LORRI K
10590 SW COOK LN 10590 SW COOK LN
TIGARD, OR 97223 TIGARD,OR 97223
PHONE: 503-989-3826 PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Sink 11/14/2013 $25.02
Specifics: 1 ea Tub/Shower/Shower Pan 11/14/2013 $12.51
1 ea Water Closet 11/14/2013 $25.02
Type of Use: SF 1 12%State Surcharge- 11/14/2013 $8.70
Class of Work: ALT Plumbing
Type of Const: 10 ea Minimum Fee Adjustment- 11/14/2013 $9.95
Occupancy Grp: Plumbing
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 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: If
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 `' FOR OFFICE USE ONLY
Received
City of Tigard Permit No.:
a 13125 SW Hall Blvd.,Tigard, 213 Date/By: /, �`/��3 - ��!''►aa�3� v0 f��
g 1 Plan Review
: I: . Phone: 503.718.2439 Fax: 503.598.1*`t Other Permit No.:
Date/By:
Inspection Line: 503.639.4175 11G1k�D Date Read /B s: ® See Pa e 2 for
TIGnItD Ready/By:
g
Internet: www.tigard-or.gov CO 1V,S�Q� Notified/Method: Supplementallnfarmatioo
•TYPE OF WORI ``OG®`J FEE* SCHEDULE
❑New construction ❑Demolition 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,CIF CONSTRUCTION ' .. - .' SFR(1)bath 312.70•
K1-and 2-family dwelling El Commercial/industrial SFR(2)bath 437.78
SFR(3)bath 500.32
❑Accessory building El 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: I(2S-/ 0 S Co DK C A15 Catch basin or area drain 18.76
City/State/ZIP: --r`I G fJ l9 a_ 1 '-7 Z?3 Drywell,leach line,or trench drain 18.76
// R Footing drain(no.linear ft.: ) Page 2 •
Suite/bldg./apt.no.: I P{oject name: 3A irVl I101.r-10"I 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
Clothes 25.02 A-601"-)G. WO7Sz- Lr/v 5 O j4l� L A/65 Dishwasher 25.02
FV �i 0 1 T ViV R�, ,4'0 )mi l
Drinking fountain 25.02
Ejectors/sump 25.02
Expansion tank 12.51
PROPERTY OWNER ❑ TENANT • Ex P
Name: c01 T fsi'�2 Fixturc/scwcr cap 25.02
Floor drain/floor sink/hub 25.02
Address: i 0510 SW (.6 K. L//3iv Garbage disposal 25.02
City/State/ZIP: j'/6 420 0 2 97 17-3 Hose bib 25.02
Phone:c503) 5 gq -3,r_c 2& Fax:( ) Ice maker 12.51
❑ APPLICANT ❑ CONTACT PERSON Interceptor/grease trap 25.02
Business name: ,S4-71.c).5 4$ �p,/F Medical gas(value:$ ) Page 2
Primer 12.51
Contact name:
- Roof drain(commercial) 12.51
Address:
Sink/basin/lavatory I 25.02 �.5 0?
City/State/ZIP: Solar units(potable water) 62.54
Phone:( ) Fax: :( ) Tub/shower/shower pan ( 12.51 44_s7
E-mail: Urinal 25.02
. Water closet I 25.02 ,2.5.-.0,)_
• . • ' CONTRACTOR ' . • .
n - Water heater 37.52
`
Business name: Opel AS 0 v,6 c _ Pos.cl(3 c? Water piping/DWV 56.29
Address: Pt 21/./t Cu -y'2 PC-rvK Other: 25.02
City/State/ZIP: --r g D Subtotal
Phone:( ) Fax:( ) Minimum permit fee: $72.50 7)5-01
CCB Lic.: Plumbing Lic.no.: Plan review (25%of permit fee)
State surcharge(12%of permit fee) If.
Authorized signature: TOTAL PERMIT FEE $"(
Print name: cu -�' Date: .l (it y / This permit application expires if a permit is not obtained within 180 days
IT 1`OS �� 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(I0/02/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
❑ Any new commercial building with water service 2"and
Baptistry/Font 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 Thru
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.
Commerc ❑ 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:
I:\Buil ding\Permits\PLMF_PermitApp.doc 08/04/2011 2
A
Property Owner Statement
Regarding Construction Responsibilities
Oregon Law requires residential construction permit applicants who are not licensed with the
Construction Contractors Board to sign the following statement before a building permit can be
issued. (ORS 701.325 (2))
is statement is required for residential building, electrical, mechanical,and plumbing per mits.
ensed architect and engineer applicants,exempt from licensing under ORS 701.010(7), need not
Ibmit this statement.This statement will be filed with the permit.
'lase check the appropriate box:
I- I own, reside in, or will reside in the completed structure and my general contractor is:
Name • CCB# Expiration Date
I will inform my general contractor that a II subcontractors who work on the structure must be
licensed with the Construction Contractors Board.
0
1 I will be performing work on property I own, a residence that I reside in, or a residence that I w ill
reside in. If I hire subcontractors, I will hire only subcontractors licensed with the Construction
Contractors Board. If I change my mind and hire a general contractor, I will select a contractor
who is licensed with the CCB and will immediately give the name of the contractor to the office
issuing this Building Permit.
I hive read and understand the Information Notice to Homeowners About Construction Responsibilities,
an I hereby certify that the information on this homeowner statement is true and accurate.
S(Cr1 1--cs 7,5J2.
Print - .f Permit Applicant
ais1 , ) iIILII13
Signature o -ermi •pplicant Date
Permit#: "L1t1Z)/1—L>U'tt47/re---c---0100-ce►�,S1j
Address: 1(-:� .5A' �Cc+'C 4Wr'
7-i y4./W CZ 4 7)1 0 ?r.rs i_
Issued by: �.1. Date: //A ly
This Copy for Permit Offices
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
10590 SW COOK LN, TIGARD, OR, 97223
Residential - Plumbing
399 Plumbing final
2014-03-03 00:00:00
PLM2013-00409
PASS - No C of O
Violation Summary:
Inspector Contractor