Permit � CITY OF TIGARD PLUMBING PERMIT
= COMMUNITY DEVELOPMENT Permit#: PLM2015 00053
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 02/23/2015
Parcel: 2S 102AC01704
Jurisdiction: Tigard
Site address: 12720 SW PACIFIC HWY
Project: Maid for Hire Subdivision: BURNHAM TRACT Lot: 1
Project Description: Add(1)new clothes washer and replace(1)laundry tray.
Contractor: POWER PLUMBING CO Owner: LARAWAY,JOSEPH CHARLES TR
PO BOX 19418 3370 RACHEL WAY
PORTLAND,OR 97280 HOOD RIVER, OR 97031
PHONE: 503-244-1900 PHONE:
FAX: 503-244-8825
FEES
Quantity Description Date Amount
1 ea Clothes Washer 02/23/2015 $25.02
Specifics: 1 ea Laundry Tray 02/23/2015 $25.02
1 12%State Surcharge- 02/23/2015 $8.70
Type of Use: COM Plumbing
Class of Work: ALT 22 ea Minimum Fee Adjustment- 02/23/2015 $22.46
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 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 stions to 0 I by calling 503.232.1987 or 1.800.332.2344.
Ise d By: Permittee Sigtiature: ( N
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.
FEB-23-2015 08:32 From: To:5035981980 Page:1/2
Plumbing Permit Application ECEIVEP
Building Fixtures FEB 2 3 2015
Reaccivcd
City of Tigard p�L Dare/By: -� a3 /S ,� Permit No.: rtp.e 6--ere 53
13125 SW Hall Blvd.,Tigatp,lil "L j'/GA Plan Review
IN II. Phone: 503.718'2439 Fax: 501_599 9filf1V j __ Date/By. Other Permit No.: k,a-.15:--C le.
inspection Line: 503.6394175LU jj G EMV1S,O*t Date Read /B I uu ® !ire I o
I t l i A K U Internee: ww w.li and-or.•ov 7 1' Ready/By: at I inn
!: 6 Notifieoi/Method SnpplemerHal information
TYPE'tiF WORK itr< .'..3,'
_ , , FEE''' SCHEDULE ' . •
U Ncw construction ❑Demolition For special information use checklist.
Description I Qty. I Ea. f Total
Addition/alteration/replacement ❑Other: New 1-2-family dwelling (includes 100 ft.for each utility connection)
:i ' CATEGORY`OF CONSTRUCTION t l '• ' ! SFR(1)bath 312.70
❑1•and 2-family dwelling .{a Commercial/industrial SFR(2)bath 437.78
❑Accessory building ❑Multi-family SFR(3)bath 500.32
Each additional bath/kitchen 25.02
❑Master builder Iii Other: Fire sprinkler( sq.ft.) Page 2
-a'. :it . l:',i '':OR SITE'IINFORMATION;AND^LOCATION i, '. :i 11 l'','.:,,`,.' ' Site utilities:
Job site address: i a1 2o 5W Pa c.-fc_. H W`A Catch basin or area drain 1 H.76-
Drywcll,leach line,or trench drain 18.76
City/State/ZIP: O O . cf l ZZ 3
Ul Footing drain(no.linear ft-: ) Page 2
Suit.e/bldg./apt-no.: (Project narne:`"1 e6 0. fry, HA,(l Manutaentred home utilities 50.03
Cross street/directions to job site: Manholes 18.76
Rain drain connector 18.76
Sanit uy 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.: 015/C 9- Ctrl 7a/ Backllow prev enter 31.27
cot;4'''''': ix .i I: r.r : ". Backwater valve 12.51
t DESCIPTI01el(OFr:WORK +' ;:'1:,. + -
�l / _ Clothes washer 1 25.02 25-Cl
ff 1 a(. p79 ( G( cGt/ALi - Dishwasher 25.02
,Ii�� it)(fJ (.'/f � /A/ Drinking fountain 25.02
Ejectors/sunrp 25.02
d.. , .. . '.Q PROPF.R'I'Y,OWI4BR t ,[ ❑ EDir)�1T,.' ' ` Expansion tank 12.51
Name: Fixture/sewer cap 25.02
Floor drain/floor sink/huh 25.02
Address:
Garbage disposal 25.02
City/State/LIP: Hose bib 25.02
Phone:( ) Fax:( ) Ice maker 12.51
'.. . t.!'t.''�.•t) ,ICAN,T ., . .. '.. - Q CQitI7."ACt'.,"!„t`w ?1 Interceptor/grease trap 25.02
Business name: fie L� pi awl.b,K (0
Medical gas(value:S ) Page 2
--(� Primer 12.51
Contact name: JQ i i l._
Roof drain(commercial) 12.51
Address: Po 66x / Sink/basin/lavatory 1 25.02 Z5.0'�
City/State/ZIP: Pa 0/et4,,tO 6 i( 9 Solar units(potable water) 62.54
Phone:(g13) 2yy_/9Q Fax::(93).yt,/_�-g� 11)h/shower/shower pan 12.51
/] �1 { /� ���t Urinal 25.02
E-mail: Slo r v u2�D.6Z�/I� yYlrl�, 10.CtlY
1 �., Water closet 25-02
Water heater 37.52
Business name fh(i(.,(QA_ pt,./44,Z.1)/ 4.I
• Water P t PS WV 56.29
Address: LP(-V/ Silt) ill(,// z/14jli._„6 6/(/Q(., Other: 25.02
City/State/ZIP: 4 A- ax 9 7Z Z 3 Subtotal 9),Q Li
Moue:( �3) )1/1/- /9d-2 Fax (y-� ) 2.1,1q_ Minimum permit fee: 572-50 1.2.
7
Plan review (25%of permit fee)
CCB Lie.:
54 37 1 State surcharge(12%of permit fee) 3.- I V
Authorized signature: ' U c-- TOTAL PERMIT FEE '3 ,16
This permit apps cation cxpiro it a permit is not obtained ssithin 180 days
Print name: �� 1\ Q S Datc: l 3 I/Sr after it ha-5 beta accepted as complete.
�`` ` I
"Fee methodology Set by Tri•Coumy ttuilding Industry Service board.
I:S BUIlA1naTermltsV'LMti-PCrrnliApp. 1ON14,39 440-4616T(IM)JCOM/WEH)
FEB-23-2015 08:32 From: To:5035981980 Page:2/2
Plumbing Permit Application- City of Tigard
Page 2-Supplemental Information
Fee Schedule: _ Residential Fire Suppression Systems:
Site;Utilities a F (.ee) . , � cFo Per iit 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 5233.20
Sewer-1st 100' 62.54 7,201 and greater $327.54
Sewer-each additional 100' 37.52
Water Service-ba 100' 62.54 Medical Gas Systems:
Water Service-each additional 1(X1' 37.52 �Q'•'•;. ' !Pelrmlt F8e• , ,
Storm&Rain Drain-1st 100' 62.54 $1.00 to$5,000.00 Minimum fee$7250
Storm&Rain Wain-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 Ins tins:ar.Fees: Fee(ea) .',Total,
each additional 5100,00 or fraction thereof,to
1� and including$10.000.00.
inspection of existing plumbing or for $10,(M)1.00 to$25,000.00 $148.50 for the first$10,000.00 and$154 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,(01.(0 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
Rcinspeetion Fees 90.(0/hr _ and including$50000.00.
Additional plan review for revisions 90.00/hr 550,001.00 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*.
Oaxntity by Fixture Type ";Plan.Review'for'•'Plumbing Installations
•
Fixturr.Typc fiir Replatd' Plan review is required for any of the following.Peironned: + Cawiod:: Added ' Relocate Y g-
Please check all that apply.
Baptistry/Font - ❑ Any new commercial building with water service 2"and
Barb -Tub/Shower
.Jacuz ziWhi rlpexl greater,except systems designed and stamped�b licensed
Car Wash -Each Stall engineer'
-Drive 1ltru ❑ 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.
live Wash
Floor Drain/sink -2" Suhmit 2 sets of plans with any of the above.
4" . I`somuetric or Riser Diagram
Car Wash Drain ❑ isometric or riser diagram is required for new buildings
Garbage -Domestic-non-food G
Disposal -Dtmtestic—furl related that meet the qualifications above.
—
-Commercial-food related
-Industrial-food related _
Ice MachiRcfrig.Drains
Oil Separator(Gas Station) Co ments regarding fixture work:
Rec.Vchick Dump Station I C-4411
Shower -Gang '"'%%%%��'
'Stan
Sink/Iav -Non-food related •/ — f' /. &. 4 A ' /L '-
-Bradley rtil pv1 T
-Commercial-food related
-Service
Swimming Pool Filter
Washer-Clothes ! Note: If the fixture work under this permit results in an
Water Extractor increase of sewer EDUs,a sewer permit will be issued and
Water Closet-Toilet fees assessed for the sewer increase must be paid before the
Urinal plumbing permit can be issued.
Other Fixtures:
hltpJ/www.tigard-or.gov/documentcenter/Building/PLMF_PermitApp.dtg
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
12720 SW PACIFIC HWY, TIGARD, OR, 97223
Commercial - Plumbing
399 Plumbing final
PASS - No C of O
PLM2015-00053
George Heimos
EcoLab equipment installed, pass
Violation Summary:
Inspector Contractor