Permit CITY OF TIGARD PLUMBING PERMIT
t:. COMMUNITY DEVELOPMENT Permit#: PLM2015 00139
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 05/06/2015
Parcel: 1 S 135AA00905
Jurisdiction: Tigard
Site address: 10200 SW 90TH AVE
Project: Dent Subdivision: METZGER,TOWN OF Lot: 9
Project Description: Repair altered waste line from kitchen sink.
Contractor: BRUNER PLUMBING Owner: DENT, MICHAEL
PO BOX 23985 10200 SW 90TH AVE
TIGARD, OR 97281 TIGARD,OR 97223
PHONE: 503-484-5105 PHONE: 503-382-9124
FAX: 503-624-2173
FEES
Quantity Description Date Amount
1 ea Water Piping/DWV 05/06/2015 $56.29
Specifics: 1 12%State Surcharge- 05/06/2015 $8.70
Plumbing
Type of Use: SF 16 ea Minimum Fee Adjustment- 05/06/2015 $16.21
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
Utilit •a i icatio .- ter. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
direct questions to O C b . g 503.232.1987 or 1.800.332.2344.
Issued By: ks, e/ , 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.
Plumbing Permit Applica I1 Ct 1%J I
Building Fixtures FOR OFFICE USE ONLY
City of Tigard , Received 1,
III 2 15 DatcBy: 7 G I7 Penult No.: i tj1 c /..!...'t0 1 9
• 13125 SW Hall Blvd.,Tigard,OR 97223
>Z Plan Review 8 r n i5-- ,,02.,/
Phone: 503.718.2439 Fax: 503.598.1960 Other Permit No.: (�(�Ai z.LGV
Inspection Line: 503.639.4175 {{� 11UAKU Date/By:
TI G A R D 1 S7 Date Ready/By: Juris: 0 See Page 2 for
Internet: www.tigard-or.gov F pINGDiviSIO Notified/Method: Supplemental Information
TYPE 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
❑ l-and 2-family dwelling ❑Commercial/industrial SFR(2)bath 437.78
Q ❑Accessory building Multi-family
SFR(3)bath 500.32
❑Multi-famil
Each additional bath/kitchen 25.02
❑Master builder ❑Other:
Fire s ( sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: I 60a) 5. 4 h4 �A Catch basin or area drain 18.76
r City/State/ZIP: Tt c �,,, ) �V G1 s, t��23 D Fire sprinkler erm drain line,or trench drain
Page 2
?f+�`�' Footing drain(no.linear ft.: ) I I Page 2
Suite/bldg./apt.no.: Project name: 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.: ) Page 2
Subdivision: I Lot no.: Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 25.02
p,47,.._ 7-cm A LT t,c t 0 fi1J,2• T4 L-r AI F N n1 .2 Dishwasher 25.02
Nc..,,tS�_ Drinking fountain 25.02
,J Ejectors/sump 25.02
❑ PROPERTY OWNER I ❑ TENANT Expansion tank 12.51
`\ Name: ,` yam n �e 02 Fixture/sewer cap 25.02
_
Floor drain floor sink/hub 25.02
Address: l U Z Q� 9 u-e_ Garbage disposal 25.02
y City/State/ZIP: '"T, 3V...- M22-3 Hose bib 25.02
Phone:(5?)3) 3a _9 1 a,4, Fax:( ) Ice maker 12.51
❑ APPLICANT 11 ❑ CONTACT PERSON Interceptor/grease trap 25.02
Medical gas(value:$ ) Page 2 I 1
Business name:
J Primer r 12.51
Contact name:
Roof drain(commercial) 12.51
Address: Sink/basin/lavatory 25.02
City/State/ZIP: Solar units(potable water) 62.54
Gi
Phone:( ) Fax::( ) Tub/shower/shower pan 12.51
E-mail: Urinal 25.02
4
CONTRACTOR Water closet 25.02
Water heater 37.52
Business name: 'nj,v\13A- (_ _,,.., Water piping/DWV x 1 56.29
Address: Po (�X a 5qgr,/V Other: 25.02
City/State/ZIP:-77,, p. 6a X72.$1 Subtotal
Phone:(�5yj3) (' (/ ',/O5� Fax:( ) Minimum permit fee: $72.50 -7�,j(
Plan review (25%of permit fee)
CCB Lic.: �I 8 5� Plumbing Lic.no.: State surcharge(12%of permit fee) cr -22
Authorized signature:[ Iltik.- I(1 TOTAL PERMIT FEE Do
Print name: ' ./G V .,e.(A Date: !�" ,, /S This permit application expires if a permit is not obtained within 18b days
\�+ after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
1:\Building\Permits\PLMU-PermitApp.doc 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
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-Ist 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 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
El Any new commercial building with water service 2"and
Baptistry/Font greater,except systems designed and stamped by licensed
Bath: -Tub/Shower
engineer.
-Jacuzzi/Whirlpool
Car Each Stall 1:1 New exterior plumbing site utilities for any complex structure
as defined in OAR918-780-0040.
-Drive Thru
Cuspidor/Water Aspirator El Medical gas and vacuum systems for health care facilities.
Dishwasher. Commercial CI Any multipurpose fire sprinkler system.
Domestic El 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
El 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: -LavBar 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
Water Closet Toilet plumbing permit can be issued.
Urinal
Other Fixtures:
I:\Building\Permits\PLMF_PermitApp.doc 08/04/2011 2
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
10200 SW 90TH AVE, TIGARD, OR, 97223
Record Type: Record ID:
Residential - Plumbing PLM2015-00139
Inspection Type: Inspector:
399 Plumbing final George Heimos
Result:
FA I L
Comments:
Called Mike Dent 503-382-9124 requested plumber that did work come in to Building
Dept. and get name changed to Pottle Plumbing 503-319-2517 from name shown on
permit, Bruner Plumbing who did not do plumbing.
Violation Summary:
Inspector Contractor
City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT
■ 4
1111111 Request for Permit Action
i i G A R n 13125 SW Hall Blvd. •Tigard,Oregon 97223 • 503-718-2439 • www.ti and-o . v , ..
ti :rj,IVEI
TO: CITY OF TIGARD
Building Division JUN 0 2 2015
13125 SW Hall Blvd.,Tigard,OR 97223
Phone: 503-718-2439 Fax: 503-598-1960 TigardBuildingPertnits @:_. .1::)".e I i(GARD ,
■UILD DIVISION
FROM: ❑ Owner ❑ Applicant ❑ Contractor IS City Staff
Check(1)one
REFUND OR Name:
INVOICE TO: (Business or Individual) / t(
Mailing Address: D o
City/State/Zip: ,�16 S ,6
Phone No.: ( e°1J °�D � '
1 11 v
PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (i): r ` t� Vl •Q('
GLOB /9G2 ' 7 &g �V `_ 1 t� \
PERMIT APPLICATION. 1 V W 1 `
❑ REFUND PERMIT FEES (attach copy of original receipt and provide explanation below). i V.
❑ ►k • FOR FEES DUE (attach case fee schedule and provide explanation below).
M • A' PLACE CONTRACTOR ON PERMIT(do not cancel permit).
Permit#: p L M W rJ- \3q
Site Address or Parcel#: O'100 SV\I \O}h AN Q,
Project Name: De` +
Subdivision Name: Lot#:
EXPLANATION: pe c m + noi- r + f — no o re-cart u
r
, s / i'5 £/ 9alr.✓ TX- Aftfz. Pi_te..t1 L IA!( — ,a(A A/' )
771E WO/
Signature: YAK // '4d? Date: 6 1 2 1 5
Print Name: -11m ..3r1f back)
Refund Policy
1. The city's Community Development Director,Building Official or City Engineer may authorize the refund of:
• Any fee which was erroneously paid or collected.
• Not more than 80%of the application or plan review fee when an application is withdrawn or canceled before review effort
has been expended.
• Not more than 80%of the application or permit fee for issued permits prior to any inspection requests.
2. All refunds will be returned to the original payer in the form of a check via US postal service.
3. Please allow 3-4 weeks for processing refund requests.
FOR OFFICE USE ONLY
Route to S s Admin: Date B Route to Records: Dat- , 17/�Qtr,!%��
Refund Processed: Date B Invoice Processed: Date B
Permit Ganeeieelr . 1.■ate(o AQ MIAIIIMINE Parcel Ta:Added: Date B
I:\Building\Forms\RegPemvtAction_I.23 4.doc