Permit III u CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT INS % Permit#: PLM2014-00013
Date Issued: 01/15/2014
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 parcel: 2S103BB04800
Jurisdiction: Tigard
Site address: 12345 SW KATHERINE ST
Project: 12345 k st Subdivision: BROOKWAY Lot: 48
Project Description: remodel. 1/16/14,reprinted to add to scope of work,replace(3)hose bibs, (4)sinks,(2)shower valves&(3)water
closets. ' — —
Contractor: ARMOUR PLUMBING INC Owner. RYZNER, FRANCIS V TRUSTEE
PO BOX 692 12345 SW KATHERINE
BORING, OR 97009 TIGARD,OR 97223
PHONE 503-464-6216 PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Clothes Washer 01/15/2014 $25.02
Specifics: 3 ea Hose Bib 01/1612014 $75.06
1 ea Sink 01/15/2014 $25.02
Type of Use: SF 3 ea Lavatories 01/16/2014 $75.06
Class of Work: ALT 3 ea Tub/Shower/Shower Pan 01/16/2014 $37.53
Type of Const: 3 ea Water Closet 01/16/2014 $75.06
Occupancy Grp: 1 12%State Surcharge- 01/16/2014 $37.53
Stories: Plumbing
Total $350.28
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 questi UNC by calling 503.232.1987 or 1.800.332.2344.
Issued - `_' ` I / Permittee Signs re: l// ot-f( /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.
I
Plumbing Permit Application
Site Utilities V11 FOR OFFICE USE ONLY
�f
City of Tigard Received E f I'enntt No.: J. iii
'r 13125 SW Hall Blvd.,Tigard,OK,9 �Q D �� r� `�II
g �,� Plan Review
a Phone: 503.718.2439 Fax: 503.59 .I , Other Permit No.:
Inspection Line: 503.639.4175 �F'`' 0 DateRy
T I G A R[� Internet: www.tigard-or.gov D�j\GP�� Ready/By: furls 0 See Page 2 for
�((4 Notified/Method: Supplemental Information
TYPE OF WORI1��,��\ 1.1.m 0 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 OF CONSTRUCTION SFR(1)bath 312.70
❑ 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: /A � ,.'4N C. f Catch basin or area drain 18.76
3 S Drywell,leach line,or trench drain 18.76
City/State/ZIP:
Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: I Project name: le,/ZJe r--- 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.: ) I Page 2
Subdivision: f Lot no.: Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
/J DESCRIPTION OF WORK Backwater valve 12.51
4t f0lt, Q. ? L /� , /- - Clothes washer 25.02
1 ? • mac 6. 4-17 -f -r, vkc t A sivalei(a3.IJ/t Dishwasher 25.02
t
c'Wd 3 lwlct r-r- Clase,tr iv GXI li... , Drinking fountain 25.02
4eAte-A I t - Q/ V1 2e iiK'0 J 13 Ejectors/sump 25.02
PROPERTY OWNER ❑ TENANT Expansion tank 12.51
Name: Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address:
Garbage disposal 25.02 w,�!/
City/State/ZIP: Hose bib 3 25.02 '?worm
Phone:( ) Fax:( ) Ice maker 12.51
❑ APPLICANT ❑ CONTACT PERSON Interceptor/grease trap 25.02
Medical gas(value:$ ) Page 2
Business name: ��S ie „Ra �d1• C rVC (t7A,
Primer 12.51
Contact name: S[iet
Roof drain(commercial) 12.51
Address: f S-`37 ,s F /ar )Z Si--- Sink/basin/lavatory il 25.02 /ice,0$'
City/State/Z1P: MI/ V r q7 7 2 Solar units(potable water) 62.54 `
Phone:(q7I ) 275- /7,, Fax::( ) Tub/shower/shower pan a 12.51 ��- 02
pp 1//� � Urinal 25.02
E-mail: S[ci �( .s5 t1asseikom rug lima) . GDS^
Water closet 3 I 25.02 -75;CONTRACTOR -75;
Water heater 37.52
Business name: Q f/7„,nytr ! t hey Water piping/DWV 56.29
Address: V•u I Other: 25.02
City/State/ZIP: V{e _4{) I 1 Subtotal Z7
S
_
Minimum permit fee: $72.50( ) C/
CCB Lic.: /7y 0 3 Plumbing Lic.no.: Plan review (25%of permit fee)
State surcharge(12%of permit fee)
Authorized signature: ' ''. _ TOTAL PERMIT FEE Q
t� �' / L Tbu permit application aspires if a permit is not obtained within-180 days
I Print name: .Xa Date: I_r'.,
y5 after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
1:V Building 1permita\PLMU-PermitApp.doc 10/01/09 440.4616T(10/02/COM/WEB)
r
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site Utilities - Qty. Fee(a) Tel Square Footage: Permit Fee:
Footing drain-I"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 10 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 Oki- Fete 0't Tofu each additional$100.00 or fraction thereof,to
A 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 SI.54 for
which no fee is specifically indicated 90.004u 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*.
Quantity by Fixture Type , Plan Review for Plumbing Installations
Fixture Type for Replace/
Work Performed: Capped Added Relocate Plan review is required for any of the following.
Baptistry/Font Please check all that apply.
Bath -Tub/Shower ❑ Any new commercial building with water service 2"and
Jacuzzi/Whirlpool greater,except systems designed and stamped by licensed
Car Wash -Each Stall engineer.
-Drive Thru ❑ New exterior plumbing site utilities for any complex structure
Cuspidor/Water Aspirator as defined in OAR918-780-0040.
Dishwasher -Commercial ❑ Medical gas and vacuum systems for health care facilities.
-Domestic ❑ Any multipurpose fire sprinkler system.
Drinking Fountain ❑ Any complex structure as defined in OAR918-780-0040.
Eye Wash
Floor Drain/sink -2" Submit 2 sets of plans with any of the above.
Isometric or Riser Diagram
Car Wash Drain ❑ Isometric or riser diagram is required for new buildings
Garbage -Domestic-non-food $ g
Disposal -Domestic-food related that meet the qualifications above.
-Commercial-food related _
-Industrial-food related
Ice MachiRefrig.Drains
Oil Separator(Gas Station) Comments regarding fixture work:
Rec.Vehicle Dump Station
Shower -Gang
-Stall
-
Sink/Lav -Non-food related
-Bradley
-Commercial-food related
-Service
Swimming Pool Filler *Note: If the fixture work under this permit results in an
Washer-Clothes
Water Extractor increase of sewer EDUs,a sewer permit will be issued and
WaterCloset-Toilet fees assessed for the sewer increase must be paid before the
Urinal _ plumbing permit can be issued.
Other Fixtures:
1:1Building\Permits PLMU_PermmitApp.doc 2
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Site Utilities — Plumbing Permit Application
Plan Submittal Requirements
TIGARD
A plumbing permit for site utility plumbing work is required for sanitary sewer,storm sewer
and potable water systems on private property.
1. SITE PLAN and vicinity map showing the geographic location (fully dimensional,drawn
to scale) labeled with:
A. ❑ map&tax lot# ❑ project name ❑ site address ❑ suite number
El zoning El applicant name ❑ phone number
B. North arrow.
C. Scale (architectural or engineering only).
D. Street names.
E. Building pads with project location.
2. PLUMBING PLANS - Two (2) complete sets, civil only.
All details listed below shall be incorporated into the plumbing plans:
A. Storm drainage plan showing:
1) Finish elevations throughout the developed site.
2) Grade breaks determining area serving each catch basin.
3) Location of catch basins.
4) Pipe size.
5) Type of material.
6) Slope of piping.
7) Manholes and field drains.
8) Cleanouts provided for each 100 feet or fraction thereof.
9) Roof drain laterals specifying cleanouts at each upper terminal.
10) Location of existing or proposed connection to a public sewer line.
B. Utilities plan showing.
1) Sanitary sewer line location,pipe size, type of material,slope of piping, manholes
and cleanouts provided as required for storm.
2) Size and location of domestic water piping and drainage.
3) Proposed location of connection to a public water or sanitary sewer line.
1.1Building\Permits\PLMP-PermitApp.doc 12/30/05