Permit !` _` o '� ;'
.1141;;;I' CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT iriffa'r Permit#: PLM2015-00266
Date Issued: 08/11/2015
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439
Parcel: 2S101AA02300
Jurisdiction: Tigard
Site address: 12190 SW 69TH AVE
Project: Tran Subdivision: WEST PORTLAND HEIGHTS Lot: 22
Project Description: Convert laundry room into bathroom/laundry room and add bathroom upstairs. 11/30/15,reprinted to add(2)
additional sinks for HOP salon.
Contractor: OWNER Owner: TRAN, GINA
12190 SW 69TH AVE
TIGARD, OR 97223
PHONE: 503-421-8628
PHONE
FAX:
FEES
Quantity Description Date Amount
3 ea Lavatories 08/11/2015 $75.06
Specifics: 2 ea Tub/Shower/Shower Pan 08/11/2015 $25.02
2 ea Water Closet 08/11/2015 $50.04
Type of Use: SF 1 12%State Surcharge- 08/11/2015 $18.01
Class of Work: ALT Plumbing
Type of Const: 2 ea Sink 11/30/2015 • $50.04
Occupancy Grp: 0 12%State Surcharge- 11/30/2015 $6.01
Stories: Plumbing
Total $224.18
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•. • OUNC by calling 503.232.1987 or 1.800.332 2344.
Issu•d By: Permittee Signa ure:
Call 503.639.4175 by 7:00 a.m.for the next available ins•ection 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.
CITY OF TIGARD PLUMBING PERMIT
1� COMMUNITY DEVELOPMENT Permit#: PLM2015-00266
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 08/11/2015
TIGARD Parcel: 2S101AA02300
Jurisdiction: Tigard
Site address: 12190 SW 69TH AVE
Project: Tran Subdivision: WEST PORTLAND HEIGHTS Lot: 22
Project Description: Convert laundry room into bathroom/laundry room and add bathroom upstairs.
Contractor: OWNER Owner: TRAN, GINA
12190 SW 69TH AVE
TIGARD, OR 97223
PHONE
503-421-8628
E:
FAX:
FEES
Quantity Description Date Amount
3 ea Lavatories 08/11/2015 $75.06
Specifics: 2 ea Tub/Shower/Shower Pan 08/11/2015 $25.02
2 ea Water Closet 08/11/2015 $50.04
Type of Use: SF 1 12%State Surcharge- 08/11/2015 $18.01
Class of Work: ALT Plumbing
Type of Const:
Occupancy Grp:
Stories:
Total $168.13
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.
Issued By: .� 4 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 4CEd IVEI P
Building Fixtures FOR OFFICE USE ONLY
City of Tigard AUG 11 2015 Received O ,(S �/� Permit 11111 • Date/By: �� d, �yc20�-S ea 26 6
13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
U Phone: 503.718.2439 Fax: 1 Other Permit No.:
��TI GA Date/By:
Inspection Line: 503.639.4175 Date Read /B • Juris 63 See Page 2 for
T I Ci n R D Internet: www.tigard-or.gov3UILDING DIVISION Notified/Method: Supplemental Information
TYPE OF WO
❑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 11111111. SFR(1)bath 312.70
El 1-and 2-family dwelling El Commercial/industrial SFR(2)bath 437.78
Accessory building SFR(3)bath 500.32
❑ ry g ❑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: 1�1 a 6 so 1� h.., Catch basin or area drain 18.76
Drywell,leach line,or trench drain 18.76
City/State/ZIP: r it` 1 aL n ),a Footin g drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.:
Project name: I - ✓� Manufactured home utilities 50.03
Cross street/directions to job site: . nit ii� ��' Manholes 18.76
f V1 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.: et_za, Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 25.02
Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
ita PROPERTY OWNER I ❑ TENANT Expansion tank 12.51
Name: l3-Ir,,,,S Te,., L.....) 1`,‘-\..--X1 ��l\ Fixture/sewer cap 25.02
v` ! Floor drain/floor sink/hub 25.02
Address: 121 id ��'{� �-
Garbage disposal 25.02
City/State/ZIP: "1"', el 7 3 Hose bib 25.02
Phone:(G43) C./4l viLle:AA
:2 ( 14** 116C4 l C7 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 3 25.02
City/State/ZIP: Solar units(potable water) 62.54
Phone:( ) Fax::( ) Tub/shower/shower pan v- 12.51
E-mail: Urinal 25.02
im
CONTRACTOR Water closet o2 25.02
•
Water heater 37.52
Business name: vie__ Water piping/DWV 56.29
Address: Other: 25.02
City/State/ZIP: Subtotal
Phone:( ) Fax:( ) Minimum permit fee: $72.50 /se ,4,2_
CCB Lic.: Plumbing Lic.no.: Plan review (25%of permit fee)
State surcharge(12%of permit fee) `f, e/
Authorized signature: TOTAL PERMIT FEE /f,
This permit application expires if a permit is not obtained within 180 days
Print name: f ..t,_ .Air t Date: �{-/--- after it has been accepted as complete.
�/ *Fee methodology set by Tri-County Building Industry Service Board.
L\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-15t 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 Vallt>�
$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 1115 eCHOnS Or Pee 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 Plumbin 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
❑ 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 Thru as defined in OAR918-780-0040.
CI Cuspidor/Water Aspirator Medical gas and vacuum systems for health care facilities.
Dishwasher: Commercial ❑ 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„ I<.,il ,i ii:. t ) I i' ( i I):' !i..
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 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:
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