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Permit INCITY OF TIGARD �: PLUMBING PERMIT r COMMUNITY DEVELOPMENT �� Permit#: PLM2015-00201 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 06/29/2015 T f C�t"�P L 9 Parcel: 2S111AD16100 Jurisdiction: Tigard Site address: 15034 SW 91ST AVE Project: Caminschi Subdivision: MALLARD LAKES Lot: 27 Project Description: Remodel of bathroom&closet,(1)lav,(1)tub&(1)shower.(Permit not required to replace existing toilet in same location). 8/12/15,reprinted to change contractor and add(1)additional lay. 11/16/16 REPRINTED to add additional(1)lay,(1)shower&(1)water closet. Contractor: KRAFTSMAN PLUMBING LLC Owner: CAMINSCHI,ANDREI &KIMBERLY S 2606 A ST 15034 SW 91ST AVE FOREST GROVE, OR 97116 TIGARD, OR 97224 PHONE: 503-793-4338 PHONE: 425-753-6669 FAX: FEES Quantity Description Date Amount 2 ea Lavatories 06/29/2015 $50.04 Specifics: 2 ea Tub/Shower/Shower Pan 08/12/2015 $25.02 1 12%State Surcharge- 08/12/2015 $9.01 Type of Use: SF Plumbing Class of Work: ALT 45 Misc Administration Fee 08/12/2015 $45.00 Type of Const: 1 ea Lavatories 11/16/2016 $25.02 Occupancy Grp: 1 ea Tub/Shower/Shower Pan 11/16/2016 $12.51 Stories: 1 ea Water Closet 11/16/2016 $25.02 45 Misc Administration Fee 11/16/2016 $45.00 0 12%State Surcharge- 11/16/2016 $7.50 Plumbing Total $244.12 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 questions to OUNC by calling 503.232.1987 or 1.800.332.2344. Issu By: .6„,,, Permittee Signature: �� ` .ilr!� .�.�. , lel 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. Tle Plumbing Permit App � ni APS t Building Fixtures NOV1 ").01h Received / City of TigardPermit No.: L rt�Dl ^d0 1111 i 13125 SW Hall Blvd.,Tigard,OR 97223 PlanDaRevBy: �� f� /lQ 7 �l ■ Phone: 503.718.2439 F' yy�5 +9 ",t :y !r Date/By: Review Other Permit No.: �� -i!`Q�•� � r_x � !i Date/By: T I G A IZ D Inspection Line: 503.639.41,/.1 {i 1:,.., .3 t;t c. Date Ready/By: Auris: &I See Page 2 for Internet: www.tigard-o414 LP'., 1_ t.s 1' I+'1 Notified/Method: Supplemental Information f;. TYPE OF WORK FEE* SCHEDULE ❑New construction 0 Demolition For special information use checklist Description I Qty. Ea. Total ❑Addition/alteration/replacement 0 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 0 Commercial/industrial SFR(2)bath 437.78 SFR(3)bath 500.32 ❑Accessory building 0 Multi-family Each additional bath/kitchen 25.02 ❑Master builder 0 Other: Fire sprinkler(_sq.ft.) Page 2 JOB SITE INFORMATION AND LOCATION Site utilities: Job site address: (s p 3 4 bk.) 91 74-08- Catch basin or area drain 18.76 Drywell,leach line,or trench drain 18.76 City/State/ZIP: Footing drain(no.linear ft.:_) Page 2 Suite/bldg./apt.no.: I 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 _, Backwater valve 12.51 _' DESCR 'IQN OF .' n _ Clothes washer 25.02 i 1)11)-o -----K(s-rl(J�o 130-1111 I PLM 9‘)15- Gb 1; Dishwasher 25.02 Drinking fountain 25.02 Ejectors/sump 25.02 .. 0 PROPERT tf R - ❑ i+IANT Expansion tank 12.51 Name: Fixture/sewer cap 25.02 Floor drain/floor sink/hub 25.02 Address: Garbage disposal 25.02 City/State/ZIP: Hose bib 25.02 Phone:( ) Fax:( ) Ice maker 12.51 ; Interceptor/grease 25.02 [� APPLI, , ti�. .. CQ-.COI�,7'� T PERS(?N, trap 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 , �/^(J�•����� Water heater 37.52 Business name: Water piping/DWV 56.29 Address: Other: 25.02 City/State/ZIP: Subtotal Phone:( ) Fax:( ) Minimum permit fee: $72.50 CCB Lic.: Plumbing Lic.no.: Plan review (25%of permit fee) State surcharge(12%of permit fee) Authorized signature:�( TOTAL PERMIT FEE ` t/�j.ms" Print name: / Date: 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:\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-1 s'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; (ea) f 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 Re* wv for Pluntbb nstallalhii, Quantity 1y Fixture Type Plan review is required for any of the following. Fixture Type for Please check all that apply. Work Performed: Capped Added Relocate ', Baptistry/Font 0 Any new commercial building with water service 2"and greater,except systems designed and stamped by licensed Bath: -Tub/Shower -Jacuzzi/Whirlpool engineer. Car Wash: Each Stall 0 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 0 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 0 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 Water Extractor fees assessed for the sewer increase must be paid before the Water Closet-Toilet plumbing permit can be issued. Urinal Other Fixtures: I:\Building\Permits\PLMF PermitApp.doc 08/04/2011 2 CITY OF TIGARD PLUMBING PERMIT 11111 1 ' COMMUNITY DEVELOPMENT rfA3P Permit#: PLM2015-00201 TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 # Date Issued: 06/29/2015 Parcel: 2S111AD16100 Jurisdiction: Tigard Site address: 15034 SW 91ST AVE Project: Caminschi Subdivision: MALLARD LAKES Lot: 27 Project Description: Remodel of bathroom&closet,(1)lay,(1)tub&(1)shower. (Permit not required to replace existing toilet in same location). 8/12/15,reprinted to change contractor and add(1)additional lay. Contractor: KRAFTSMAN PLUMBING LLC Owner: CAMINSCHI,ANDREI & KIMBERLY S 2606 A ST 15034 SW 91ST AVE FOREST GROVE, OR 97116 TIGARD, OR 97224 PHONE: 503-793-4338 PHONE: 425-753-6669 FAX: FEES Quantity Description Date Amount 2 ea Lavatories 06/29/2015 $50.04 Specifics: 2 ea Tub/Shower/Shower Pan 08/12/2015 $25.02 1 12%State Surcharge- 08/12/2015 $9.01 Type of Use: SF Plumbing Class of Work: ALT 45 Misc Administration Fee 08/12/2015 $45.00 Type of Const: Occupancy Grp: Stories: Total $129.07 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 Notific• 't -nter. 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 : estions to 0 C by c ling 503.232.1987 or 1.800.332.2344. Issu d By: Permittee Signature: / GY(LLZ 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 App Helton Buildin g FixturesCEIVEP FOR OFFICE USE ONLY Recencd City of Tigard and Permit Nu..` 13125 SW Hall Blvd.,Tigard,OR A:1 12 2015 Daty. �!yl!) � � a j,/�2 015- 002.0 • Phone: 503.718.2439 Fax: 503.59:. ' 1 Date/By:Review Other Permit No.: Date/By: Inspection Line: 503.639.4175 v/T, / () Date Read B h,ris: ® See Pa e 2(or TIGARU Internet: www.ti ardor. ov Cll I OFTIGARD y y g g g Notified/Method: Supplemental Information ❑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) SFR(1)bath 312.70 1-and 2-family dwelling ❑Comercial/industrial SFR(2)bath 437.78 m SFR(3)bath 500.32 ❑Accessory building ❑Multi-family Each additional bath/kitchen 25.02 ❑Master builder ❑Other: Fire sprinkler(_sq.ft.) Page 2 n Site utilities: lob site address: rso3 k Su 9154 4ve Catch basin or area drain 18.76 Drywell,leach line,or trench drain 18.76 City/State/ZIP: 4 �i V 1Z 4 2 Zy 3 � 0 9 Footing drain(no.linear ft.: ) Page 2 Suite/bldg./apt.no.: I 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 It.: ) Page 2 Subdivision: l Lot no.: Fixture or item: Tax map/parcel no.: Backflow preventer 31.27 C DESCRIPTION OF WORK Backwater valve 12.51 ��L 1 r Clothes washer 25.02 I'L06 e 1 mo 6l eV A 4frwoom , I >lo b, Z show Dishwasher 25.02 `Z Jl L ir 45` Drinking fountain 25.02 Ejectors/sump 25.02 MIKO PROPERTY OWNER , 0 TENANT Expansion tank 12.51 Name: Fixture/sewer cap 25.02 Floor drain/floor sink/hub 25.02 Address: Garbage disposal 25.02 City/State/ZIP: Hose bib 25.02 Phone:( ) Fax:( ) Ice maker 12.51 ❑ APPLIC• ? ❑ CONTACT PERSON Interceptor/grease trap 1 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 CONTRACTOR Water closet 25.02 Water heater 37.52 Business name: . Yki'i5ma n 12 urn b 1 j L h C- Water piping/DWV 56.29 Address: 2_6 06 A Si- Other: 25.02 City/State/ZIP: Fay/t. 6{oe OA 97/14 Subtotal Phone:(5o3) 713,- 61,33 Fax:( ) Minimum permit fee: $72.50 CCB Lic.: 1 O I, Plumbing Lic.no.: P 35.2_ Plan review (25%of permit fee) 6 State surcharge(12%of permit fee) Authorized signature: TOTAL PERMIT FEE Print name: -+� J Date: d This permit application expires if a permit is not obtained within 180 days / lei 1�/ L7Q'J 1oP 2, 0 z I 1 S after it has been accepted as complete. "Fee methodology set by Tri-County Building Industry Service Board. I:\Building\Peimits\PLMU-PermitApp.doc 10/01/09 440-4616T(10/02/COM/WEB) Plum bine 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-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 $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 S stems: Water Service-each additional 100' 37.52 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 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*. 1 f ; .1. Quantity by Fixture Type Plan review is required for any of the following. Fixture Type for Replace/ Please check all that apply. afadinifelaked: 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„ i1 , 4" • Isometric or riser diagram is required for new buildings -Car Wash Drain Garbage Domestic non-food that meet the •ualifications 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 Filtr 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 • COMMUNITY DEVELOPMENT DEPARTMENT IN - Request for Permit Action 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503-718-2439 • www.tigard-or.gov TO: CITY OF TIGARD Building Division 13125 SW Hall Blvd.,Tigard,OR 97223 Phone: 503-718-2439 Fax: 503-598-1960 TigardBuildingPermits @tigard-or.gov FROM: /6 Owner I=1 Applicant ❑ Contractor ❑ City Staff Check(✓)one / REFUND OR Name: INVOICE TO: (Business or Individual) Mailing Address: City/State/Zip: Phone No.: PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (✓): ❑ CANCEL/VOID PERMIT APPLICATION. ❑ REFUND PERMIT FEES (attach copy of original receipt and provide explanation below). ❑ INVOICE FOR FEES DUE (attach case fee schedule and provide explanation below). ❑ REMOVE/REPLACE CONTRACTOR ON PERMIT (do not cancel permit). P2A-ic9,6/ 5-- 60 Permit#: a- ) I Site Address or Parcel#: 15 D'2) (--f c3 1 51 v• Project Name: C&iM 1 N`aC�1 Subdivision Name: �,� Lot#: EXPLANATION: C )„. as,,2.._ C 6—►�✓c c-e o�1 4e.ivl. <�� 1.. ,�-,-Ar VaL ) NIA . Signature: x K('. Cck v1At.4l3c.k1 Date: l I}/I L-- Print Name: • `AA C _ _ I 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 Sys Admin: Date ; IS BMW f Route to Records: Date By Refund Processed: Date By Invoice Processed: Date By Permit Canceled: Date By Parcel Tag Added: Date By I:\Building\Forms\RegPermitAction_092314.doc „ CITY OF TIGARD PLUMBING PERMIT It it . • COMMUNITY DEVELOPMENT Permit#: PLM2015-00201 TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 06/29/2015 Parcel: 2S111AD16100 Jurisdiction: Tigard Site address: 15034 SW 91ST AVE Project: Caminschi Subdivision: MALLARD LAKES Lot: 27 Project Description: Remodel of bathroom&closet,(1)lay,(1)tub&(1)shower.(Permit not required to replace existing toilet in same location) Contractor: OWNER Owner: CAMINSCHI,ANDREI &KIMBERLY S ANDREI & KIM CAMINSCHI 15034 SW 91ST AVE 15034 SW 91ST AVE TIGARD, OR 97224 TIGARD, OR 97224 PHONE: 425-753-6669 PHONE: 425-753-6669 FAX: FEES Quantity Description Date Amount 1 ea Lavatories 06/29/2015 $25.02 Specifics: 2 ea Tub/Shower/Shower Pan 06/29/2015 $25.02 1 12%State Surcharge- 06/29/2015 $8.70 Type of Use: SF Plumbing Class of Work: ALT 22 ea Minimum Fee Adjustment- 06/29/2015 $22.46 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 questi UNC by calling 503.232.1987 or 1.800.332.2344. Issued By: Permittee Signature: c./` 1 Cain Lids ibt , 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 Application Building Fixtures RECEIVE FOR OFFICE USE ONLY City of Tigard Received C, Permit No.: 1 _.]/;/ 13125 SW Hall Blvd.,Tigard,OR 7 2 Date/By: ('/9 'M' (`,,.r) L� %l5-�Jti-J• I ■ g �,. 9 2 015 Plan Review Phone: 503.718.2439 Fax: 503.598:196e Other Permit No.: Date/By: I I c�;\I:1) Inspection Line: 503.639.4175 Date Ready/13y: Juris: la See Page 2 for Internet www.tigard-or.gov (,�r�V (j} I I(AKI) Notified/Method: Supplemental Information _ - ,. TYPE t i 111 i i i el ! 1 ' FEE* SCHEDULE ❑New construction ❑Demolition For special information use checklist. Description I Q . I Ea. I Total ❑Addition/alteration/replacement ❑Other: New 1-2-family dwellings(includes 100 ft.for each utility connection) - t'CATEGORY OF CON STRUCTION. 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: 150..7.../1 �.7W ~I[ T l lJ�r Catch basin or area drain 18.76 �i 6..--412_D p� �- _ �� � Drywell,leach line,or trench drain 18.76 City/State/ZIP: l °`° l Footing drain(no.linear ft.: ) Page 2 Suite/bldg./apt.no.: Project name: ' �• u `g C , 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 NW u OF �arth CloSe Dishwasher 25.02 i-fS+C IA - l0LOC- -hk.10 ) v Q j Drinking fountain 25.02 Ejectors/sump 25.02 ❑ PROPERTY OWNER 1 ❑ TENANT Expansion tank 12.51 Name: K--t_-rn CCt_}' U_T l Se /t Fixture/sewer cap 25.02 ^ I-v`� �� Floor drain/floor sink/hub 25.02 Address: i 5�3e S[� (' T� > Garbage disposal 25.02 City/State/ZIP: Tl e 1 1P 0 6 I _____q-3-7:�4 Hose bib 25.02 Phone:('a Z` - hi, - • and 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 l 25.02 &5r City/State/ZIP: Solar units(potable water) 62.54 Phone:( ) Fax::( ) Tub/shower/shower pan 12.51 arZ c E-mail: Urinal 25.02 Water closet 25.02 CONTRACTOR Water heater 37.52 Business name: t-{-f - 0 W r1 Water piping/DWV 56.29 Address: (` • ; I ") Other: 25.02 City/State/ZIP: Subtotal Phone:( ) Fax:( ) Minimum permit fee: $72.50 7a• CCB Lic.: Plumbing Lic.no.: Plan review (25%of permit fee) State surcharge(12%of permit fee) 3.7O Authorized signature: L TOTAL PERMIT FEE V, Print name: 0.,i;A (�JAA<<- Date: ( 9 C�1 i S- 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. l X Building\Pemdts\PLMU-PermitApp.doc 10/01/09 440-4616T(10/02/COM/WEB) Plum binE 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-1st 100' 62.54 Medical Gas Systems: Water Service-each additional 100' 37.52 Storm&Rain Drain-1st 100' 62.54 Valuation: Permit Fee: $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 p 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 Baptistry/Font ❑ Any new commercial building with water service 2"and greater,except systems designed and stamped by licensed Bath: -Tub/Shower engineer. -Jacuzzi/Whirlpool ❑ New exterior plumbing site utilities for any complex structure Car Wash: -Each Stall 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 ❑ 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