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Permit CITY OF TIGARD PLUMBING PERMIT 1111 - COMMUNITY DEVELOPMENT Permit#: PLM2015 00122 T IGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 04/23/2015 Parcel: 1 S136CB03700 Jurisdiction: Tigard Site address: 11085 SW 83RD AVE Project: Simser/Arnsberg Subdivision: STEVE&HUGHIE'S PLACE Lot: 9 Project Description: Relocate(1)lay and(1)shower for bathroom remodel. Contractor: OWNER Owner: SIMSER, SARAH N SIMSER/ARNSBERG ARNSBERG, ERIC 11085 SW 83RD AVE 11085 SW 83RD AVE TIGARD, OR 97223 TIGARD, OR 97223 PHONE: 503-913-7630 PHONE: 503-913-7630 FAX: FEES Quantity Description Date Amount 1 ea Lavatories 04/23/2015 $25.02 Specifics: 1 ea Tub/Shower/Shower Pan 04/23/2015 $12.51 1 12%State Surcharge- 04/23/2015 $8.70 Type of Use: SF Plumbing Class of Work: ALT 35 ea Minimum Fee Adjustment- 04/23/2015 $34.97 Type of Const: Plumbing 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 ques tions to OUNC by calling 503.232.1987 or 1.800.332.2344. Issued Byi/ `.c Permittee Signature: 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. 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. 7, -for ..__________4)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. Ara17 &&MeV Print Name of Permit Applicant alt 1 4 4 S / ignature of Per it Applicant Date Permit#: 02-H 9,015 -eco---)-- Address: � � ,�.•� :cget.AcD 02 72, .n.,;• Issued y: ate: y�/ �u . This Copy for Permit Offices Plumbing Permit Application Building Fixtures RECEIVED FOR OFFICE USE ONLY Received �/ Irri City of Tigard Q C t Permit No.: g Date/By: T (J' f7 / �O�� l p.I� ■ 13125 SW Hall Blvd.,Tigard,OR 9722 , R 2 3 2015 Plan Review Phone: 503.718.2439 Fax: 503.598. 0 Date/By: Other Permit No.: Inspection Line: 503.639.4175 n Date Ready/By: Juris ® See Page 2 for TIGARD Internet vc'cvv tigard-or��nv lTY OF TIGARD y Y 8 .z Notified/Method: Supplemental Information I I'I,. OF WORKS i. r I• FEE* SCHEDULE - ❑New construction ❑Demolition P I Fors special information use checklist. Description I Qty. I Ea. 1 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 ® 1-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:11085 SW 83rd Ave Catch basin or area drain 18.76 City/State/ZIP:Tigard,OR 97223 Drywell,leach line,or trench drain 18.76 Footing drain(no.linear ft.:_) Page 2 Suite/bldg./apt.no.: Project name:Master Bath Manufactured home utilities 50.03 Cross street/directions to job site:Hall to Pfaffle to 83rd 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: Lot no.: Fixture or item: Tax map/parcel no.: Backflow preventer 31.27 DESCRIPTION OF WORK Backwater valve 12.51 Clothes washer 25.02 Move water lines and drain pipes in master bath. Install shower valve. Dishwasher 25.02 Drinking fountain 25.02 Ejectors/sump 25.02 ® PROPERTY OWNER I ❑ TENANT Expansion tank 12.51 Name:Eric Arnsberg Fixture/sewer cap 25.02 Floor drain/floor sink/hub 25.02 Address: 11085 SW 83rd Ave Garbage disposal 25.02 City/State/ZIP:Tigard,OR 97223 Hose bib 25.02 Phone:(503)913-7630 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:Eric Arnsberg Roof drain(commercial) 12.51 Address: 11085 SW 83r1 Ave Sink/basin/lavatory 1 25.02 City/State/ZIP:Tigard,OR 97223 Solar units(potable water) 62.54 Phone:(503)913-7630 Fax::( ) Tub/shower/shower pan I 12.51 E-mail:ernsberg@gmail.com Urinal 25.02 CONTRACTOR Water closet 25.02 Water heater 37.52 Business nam-. 1.J.Reynolds .. l/°D ��F Water piping/DWV 56.29 Address:13788 SW • . . I rive Other: 25.02 City/State/ZIP:Ti l. d,OR ' '- Subtotal Minimum permit fee: $72.50 ,0,5-01 Plan 79-8408 Fax:( ) 7 Plan review (25%of permit fee) CCB Li .: 5g , 4-he, Plumbing Lic.no.: State surcharge(12%of permit fee) ?. 7C Authorized signature:)ciau mARA TOTAL PERMIT FEE X i,0/p Print name: <S ,/7 c 1r Date:11/2.3//6- This permit application expires if a permit is not obtained within 180 days / ( after it has been accepted as complete. *Fee methodology set by Tri-County Building Industry Service Board. I:\Buildingwermits\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-19 100' 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 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 Quantity by Fixture Type Plan Review for Plumbing Installations Fixture Type for Replace/ Plan review is required for any of the following.Performed: Capped Added Relocate Please check all that apply. y g Baptistry/Font 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 El New exterior plumbing site utilities for any complex structure Cuspidor/Water Aspirator as defined in OAR918-780-0040. Dishwasher Commercial ID 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. -3" Isometric or Riser Diagram Car Wash Drain ❑ Isometric or riser diagram is required for new buildings-Domestic-non-food s g q g Disposal -Domestic-food related that meet the qualifications above. -Commercial-food related -Industrial-food related Ice Mach./Refrig.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 Filter *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 Water Closet-Toilet fees assessed for the sewer increase must be paid before the Urinal plumbing permit can be issued. Other Fixtures: C:\Users\arnsberge\Down loads\PLMF_PermitApp.doc 2 L 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 11085 SW 83RD AVE, TIGARD, OR, 97223 Residential - Plumbing 399 Plumbing ﬁnal PASS - No C of O PLM2015-00122 Don Sylvester Violation Summary: Inspector Contractor