Permit CITY OF TIGARD PLUMBING PERMIT
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a COMMUNITY DEVELOPMENT Permit#: PLM2014-00270
T f GARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 08/13/2014
Parcel: 1S 133AD15800
Jurisdiction: Tigard
Site address: 11241 SW SUMMER LAKE DR
Project: Vhay Subdivision: SUMMER LAKE Lot: 39
Project Description: Tub to shower conversion,new vlave and drain locations.
Contractor: BATH FITTER(BATHTUB SOLUTIONS INC) Owner: VHAY,JOHN S&ANN E
11747 NE SUMNER 11241 SW SUMMER LAKE DR
PORTLAND, OR 97220 TIGARD, OR 97223
P
PHONE: 503-643-3201
PHONE: 503-595-8827
FAX: 503-595-6051
FEES
Quantity Description Date Amount
1 ea Tub/Shower/Shower Pan 08/13/2014 $12.51
Specifics: 1 12%State Surcharge- 08/13/2014 $8.70
Plumbing
Type of Use: SF 60 ea Minimum Fee Adjustment- 08/13/2014 $59.99
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 obtain a copy of the rules
or direc :'estions to 'UNC by calling 503.232.1987 or 1.800.332.2344.
Is ed By: // Permittee Signature: !�
:II 503.639.4175 by 7:00 a me 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.
08/13/2014 11:00 5035956051 BATHFITTER PAGE 01/01
Plumbing Permit A.pplic� t>i l•'EIVEP
Building Fixtures ,/FOR OI1�F�I,C'E USE ONLY
Received t 3 /41.`/ l��h Permit No.: I(.hi �d a-7 ap
111 q City of Tigard 1 3 2014 Plan 13125 SW Hall Blvd.,Tigard,OR Plan Review
2: '• Phone: 503.718.2439 Fax: 503.598.1960 Date/By: Other Permit No.:
Inspection Line: 503.639.417S�'ITY OF T IGARD Date Ready/3y: : luris: Id See Page 2 for
T I G 1 R.D Internet: www tigard-Or gov Notified/Me Supplemental Information
4r r M1 •,tt'(m '^pwr". �a¢ t3 r RP 4r 5",t ,*�c ':�i�,'",--yY ..w;,o�fi'rt,.J';"' '! i" } ..
I4,e4;`;'Y;-a,'aii'.''Vii .y,`jr4A \ d ,: �wy.t ., a t 4'.;sife.,. .....a { iii 'o:. _ .e• - .
`^,'' ..s,Nx l." I For s eclat in ormatlon use checklist
❑New construction ❑Demolition
- esc
I •t Ea. Total
n•lion
ED Addition/alteration/replacement r.]Other New 1-2-family dwellings(includes 100 ft.for each utility connection)
u Ma T t f7 " vt3 `Y rr:i ' :: ' FR(1)bath 312.70
(•x 1 :r. ♦ r FR(2)bath 437.78
® 1-and 2-family dwelling ❑Commercial/industrial
'FR(3)bath 500.32
• ❑Accessory building El Multi-family h additional bath/kitchen 25.02
El Master builder ❑Other: •ire sprinkler( sq.ft.) Page 2
" 34 , s w Site utilities:
-...c..:::...,_:.> ,1,1.7 .a,r var: it : ;,3.:4. ,1r� R' .E....- 1--...t.t--,,, �.q, ' Er: A;:
arch basin or area drain 18.76
Job site address:11241 SW Summer Lake Drive _ I. ell,leach line,or trench drain 18.76
City/State/ZIP:Tigard,OR 97223 'noting drain(no.linear ft.: ) ' Page 2
Suite/bldg./apt.no.: Project name:7244-Vhay anufactured home utilities 50.03
Cross street/directions to job site: . anholes 18.76
Pain 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: Lot no.: Fixture or item:
.1 TaxBackflow preventer 31'27
v* , s
map/parcel no.: s!I* 'rn-.4; nT '"zr - 1 9i-wsp (49(49,..r Backwater valve 12.51 1
„`tt" F r.r K: ate a '10 Q , "'''4• '} i ,:, Ciothes washer 25.02
tub to shower coversion-new valve&drain relocation _ Dishwasher 25'02
prinking fountain 25.02
jectors/sump 25.02
'ra-i,i+ci,. P k.Sa' 0v: 5 . 3t i ,4: 'i.,,�ar r �s+ Bxpansion tank ��•,
■ 12.51
.A..'":-*- ,''•4 r - y • s,o.,.-,r;, �.. ^•« :.,,,''Y':,,c-.. �: Fixture/sewer cap 25.02
Name:Ann&John Vhay loor drain/floor sink/hub 25.02
Address:11241 SW Summer Lake Drive bage disposal 25.02
City/State/ZIP:Tigard,OR 97223 ose bib 25.02
Phone:(503)643-3201�y 1 Fax:( ) .ce maker 12.51
c„-j-4 f r APX X t(--, r T f..' a - ', Qw.., , .-- ),- ti!w''•K:' Interceptor/grease trap ��
(65. ° aura" 1 edical gas(value:S ) Page 2
Business name: ■
mcr
Contact name: Ii.oof drain(commercial) IIM
Address. Sink/basin/lavatory 25.02
City/State/ZIP: 'Solar units(potable water) 62.54
Phone:( ) Fax::( ) Tub/shower/shower pan 1 12.51
Urinal 25.02
E-mail:
Water closet
25.02
ri,p ; v. j • 3*5 E f • 2. ,,.
, pps2v R taZ '_:, a,,I,V ';i`1i f r }
Water heater 37.52
Business name:Bathtub Solutions I Water piping/DWV 56.29
Address: 11747 NE Sumner St 'Other: 25.02
City/State/ZIP:Portland,OR 97220 _ Subtotal
Fax:(503) Minimum permit fee. $72.50 ,7�
Phone:(503)595-8827 (" )595051
Plan review (25%of permit fee) `------
CCB Lic.:165987 Plumbing Lic.no.:PB312 State surcharge(12%of permit fee) 1.7a
Authorized signature: TOTAL PERMIT FEE a I,'1-C
Date:08/13/14 This permit application expires if a permit is not obtained within 180 days
Print name:Terri Eugenides .. 1 I w after it has been accepted as complete
*Fee methodology set by Tri-County Building Industry Service Board.
I.,Building\Perroits\PLMU-PetalitAPi.dnc 10/01/09 440-4616T(1U 102./COM/WED)
1
08/13/2014 10:40 5035956051 BATHFITTER PAGE 02/02
Plumbing Permit Application,- City of Tigard
Page 2-Supplemental Information
Residen 'al Fire Suppression Systems:
Fee Schedule : , r� r :: .=-.r..� ��
1 �..y� 9�I 'f ;.�.. ray.. rw aM+ h•t o r Y« .:,`•i'� '1 .'r
�,�� 1,alfi litI4 s t e'4 ,: "+��i�di, fe°w2444� (r-�y:�.x,.aSfir24 " _h.:�. ,,f.,.,. :". '' ',y!$1P.1',e , ' e.•■!.:1Y , , _.
50.03 0 to 2,000 l
Footing drain 1"100' 2,00!to 3 4 $169,69
Footing drain-each additional 100' 37,52 3,601 to 7,200 $233.20 —
Sewer-1st 100' 62.54 7,201 and: `atcr $327.54
Sewer-each additional 100' 37.52
Water Service-1st 100' 62.54 Medic 11 Gas S stems:
Water Service-each additional 100' 37.52 I ���w�, '. is.n ``! ' i.14,0 Y'�. yii' :". -= ' :*.
.vY 'U.3Lh .;
Storm&Ram Dram-1st 100' 62.54 51.00 to$..000,00 Minimum fee$72,50
Storm&Rain Drain-each additional 100' 37.52 55,001.00 $10,000.00 $72.50 for the first$5,000.00 and$1.52 for
t`Rx . each additional$100.00 or fraction thereof,to
;.,� i alt o `' rilie ;y,b,;z,„•-∎r,,I 'r•...g A.,r,.4: 't si r.= and including$10,000.00.
Inspection of existing plumbing or for $10,001.00 $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
,,inimunt charge-1/2 hour) and including$25,000.00.
Inspections outside of normal business 90.00/hr $25,001.00'o 550,000 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 550,000.00.
550,001.00 mid up $742.00 for the first$50,000.00 and$1.20 for
Additional plan review for revisions 9000/hr 1 each additional$100.00 or fraction thereof
(minimum charge-112 hour)
1 .
Subtotal:
L
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* �
tt ; Quantity'b�sgiatilekr ie ">µt,.a `.':0o 1 'Ilmsillll ?" 51�'iitotTbiii
Y r r�'eTip C,_ ' -" . . ,.i; ,,,r.'.;lepl8celr. j'" re
'IE?rxrkI erfoe for. Plan reivew is required for any of the following.
',`VYtirkrerfortiitik. _ Capped Added aelocair.
Please deck all that apply.
'Baptistry/Font tistry/Font 0 Ap new commercial building with water service 2"and
Bath -Tub/Shower gre�ter,except Systems designed and stamped by licensed
-Jacuzzi whirlpool engineer.
Car Wash -Each Stall ❑ N v exterior plumbing site utilities for any complex structure
Drive or as efined in OAR9]8-780-0040.
Cuspidor/Water as�ir�tor ❑ M real gas and vacuum systems for health care facilities.
Dishwasher -Commercial
-Domestic ❑ Alt multipurpose fire sprinkler system.
Drinking Fountain ❑ Any complex structure as defined in 0AR918-780-0040.
i
Eyc Wash -
Floor Drain/sink -2" I Submit 2 sets of plans with any of the above.
-3"
- r ^ 1;011 et1IC O Awet Dlsgrami
Car wash Drain '
❑ Isometric or riser diagram is required for new buildings
Garbage -Domestio d that meet the qualifications above.
Disposal -Domestic-fc-food d related _
-Commercial-food related
-Industrial-food related
Ice Mach./Refrig.t rains
Oil Separator(Gas Station) Corm Tents regarding fixture work:
Rec.Vehicle Dum3 Station
Shower -Gang
-Stall
Sink/Lav -Non-food related
-Bradley _
-Commercial-food related - _ -
-Service
Swimming Pool Filter — *Note: If the fixture work under this permit results in an
washer-Clothes - increa a of sewer EDUs,a sewer permit will be issued and
Water Extractor
Water Closet-Toilet --
fees ed for the sewer increase must be paid before the
Urinal plum ing permit can be issued.
Other fixtures! _
http://ww w.tigard-or.gov/city_hall/departments/cd/does/PLMF-PermitApp2doc