Permit CITY OF TIGARD PLUMBING PERMIT
2 COMMUNITY DEVELOPMENT Permit#: PLM2014-00236
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 07/21/2014
T(�""�R g Parcel: 2S103C600200
Jurisdiction: Tigard
Site address: 13065 SW 121ST AVE
Project: LEAR Subdivision: WILLAMETTE Lot: 2
Project Description: Replacing 100 ft.of water service.
Contractor: OWNER Owner: LEAR, JOE JR&JOANN
JOE LEAR JR. 13065 SW 121ST AVE
13065 SW 121ST AVE TIGARD, OR 97223
TIGARD, OR 97223
PHONE: 503-590-1714 PHONE:
FAX:
FEES
Quantity Description Date Amount
100 If Water Service 07/21/2014 $62.54
Specifics: 1 12%State Surcharge- 07/21/2014 $8.70
Plumbing
Type of Use: SF 10 ea Minimum Fee Adjustment- 07/21/2014 $9.96
Plumbing
Class of Work: ALT
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 Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtai a y of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: / ittee Signature:
Lt� Call 5 3.639.4175 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
RECFIVF—Di d FOR OFFICE USF. ONL1
Cl of Tigard Receive Permit No.:
g DateB r si/ r
13125 SW Hall Blvd.,Tigard,OR 972 v — �'
ll Phone: 503.718.2439 Fax: 503.598.1160- 2+ 2014 Plan Review Date/By: Other Permit No.:
Inspection Line: 503.639.4175 %, ,�C Date Ready/By: ® See Page 2 for
T I L.A K L) Internet: www.ti ardor. ov 1 to , y y� S
g g 1 � Notified/Method: Supplemental Information
TYPE OF WORM!V,t ' FEE* SCHEDULE
❑New,construction ❑Demolition
For s.•cial in ormation use checklist.
'A/ Description =FM Ea. Total
0
ddition/alteration/replacement ❑Other: 11 ft.for connection)
CATEGORY OF CONSTRUCTION bath 1
SFR(2)bath 437.78
LJ'l-and 2-family dwelling ❑Commercial/industrial
bath 500.32
❑Accessory building ❑Multi-family
Each additional bath/kitchen 25.02
❑Master builder ❑Other:
sprinkler
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: / J0, S G/ /71 14 u <_ or ,
Drywell,leach line,or trench drain 18.76
City/State/ZIP: / /ii,-0-✓ or 9721_3
Suite/bldg.iapt.no.: Project name: l K L 1 1
Cross street/directions to job site: Manholes
Rain drain connector 18.76
Sanitary sewer(no.linear ft.: ) Page 2
Storm sewer(no.linear ft.: ) Page 2
Subdivision: Lot no.: Fixture or item:
Tax map/parcel no.: ' '
DESCRIPTION OF WORK
Bacicwater valve 12.51
Clothes washer 111
,4eg' ,QL OIL C ec Li ✓1 k (4,/c.7'e--- L f 0 iv!.. Dishwasher 25.02 I
Drinking fountain
PROPERTY OWNER I ❑ TENANT Expansion
' Fixture/sewer cap
Name: (Jo c 1 tea r Jr
Floor drain/floor sinic/hub 25.02
Garbage disposal 25.02
Address: 1.3066" S W 12( i+ii
City/State/ZIP: ry&r,e/ O r 9 7 2 3-Z > Hose bib 25.02
Phone:(S )3) 3-9 0 --1? 1 K 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 25.02
City/State/ZIP: Solar units(potable water) 62.54
Phone:( ) Fax::( ) Tub/shower/shower pan 12.51
E-mail: Urinal 25.02
Water closet 25.02
CONTRACTOR Water heater 37.52
Business name: 0 w /`-'
Water piping/DWV 56.29
Address: Other: 25.02
City/State/ZIP: Subtotal (p A .Jsy
Phone:( ) Fax:( ) Minimum permit fee: $72.50 -70/
Plan review (25%of permit fee)
CCB Lic.: Plumbing Lic.no.: State surcharge(12%of permit fee) P'. 1 t)
Authorized signature: j0ee I t•Gt-r TOTAL PERMIT FEE g/- R
This permit application expires if a permit is not obtained within 180 days
Print name: ��y, �„�, Date: 7-lSf-��� after it has been accepted as complete.
"Fee methodology set by Tri-County Building Industry Service Board.
I:\Building\Permits\PLMU-PermitApp.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-151 100' 50.03 0 to 2,000 $121.90
2,001 to 3,600 $169.69
Footing drain-each additional 100' 37.52 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 6# 5" 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
I� 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) cach additional$100.00 or fraction thereof,to
Reinspcction Fees 9n.nn/hr and including$SO onn.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 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: -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 p
Water Closet-Toilet plumbing permit can be issued.
Urinal
Other Fixtures:
1:\Buil ding\Permits\PLMF_PermitApp.doc 08/04/2011 2
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))
This statement is required for residential building, electrical, mechanical, and plumbing permits.
Licensed architect and engineer applicants,exempt from licensing under ORS 701.010 (7), need not
submit this statement. This statement will be filed with the permit.
Please check the appropriate box:
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 all subcontractors who work on the structure must be
licensed with the Construction Contractors Board.
or
I will be performing work on property I own, a residence that I reside in, or a residence that I will
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 have read and understand the Information Notice to Homeowners About Construction Responsibilities,
and I hereby certify that the information on this homeowner statement is true and accurate.
et/cy lcs L Alf pIto t L
Print Name of Permit Applicant
—2o/ t1
gnature of P rmit Applicant Date
Permit#: "4/4'/o26111 — Cj0.2367
Address: / 3O 42 " NC. ' �� .
Issued by: Date: 7/(21/7/`)
This Copy for Permit Offices
Location:
Record Type:
Inspection Type:
Result:
Comments:
Inspection Date:
Record ID:
Inspector:
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
13065 SW 121ST AVE, TIGARD, OR, 97223
Residential - Plumbing
399 Plumbing final
PASS - No C of O
PLM2014-00236
George Heimos
Violation Summary:
Inspector Contractor