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Permit (16) CITY OF TIGARD PLUMBING PERMIT I . 1 COMMUNITY DEVELOPMENT Permit#: PLM201600116 TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 03/07/2016 Parcel: 25111 CA09700 Jurisdiction: Tigard Site address: 9878 SW KABLE ST Project: Jolley Subdivision: TAMI PARK Lot: 4 Project Description: Relocate shower drain Contractor: OWNER Owner: JOLLEY, RICK B& RICK JOLLEY HOUGHTON, CYNTHIA LU 9878 SW KABLE ST 9878 SW KABLE ST TIGARD, OR 97224 TIGARD, OR 97224 PHONE: 503-349-5050 PHONE. FAX: I FEES Quantity Description Date Amount 1 ea Tub/Shower/Shower Pan 03/07/2016 $12.51 Specifics: 1 12%State Surcharge- 03/07/2016 $8.70 Plumbing Type of Use: SF 80 ea Minimum Fee Adjustment- 03/07/2016 $59.99 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 Utility . • -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• ect questions to O► C b ailing 503.232.1987 or 1.800.332.2344. Ilssued By: L , _<fer_ i/ttA--,61 ,- Permittee Signature: 5..... .0..... /, 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 -j� FOR OFFICE USE ONLY Cityand Received Q / of Tigard � �t1 Date/By: �� Permit No.: (rl��-(Q Il� 13125 SW Hall Blvd.,Tigard,Olde�,LIV23 7 2016 Plan Review Phone: 503.718.2439 Fax: 503.598.1960Da[e/By: Other Permit No.: u T I G A R D Inspection Line: 503.639.417 1'1 Y O1 r I GARD Date Ready/By: orris: I ® See Page 2 for Internet: www.tigard-or.gov 11 Notified/Method: Supplemental Information TYPE UIDtle1)1V1IFEE* SCHEDULE ❑New construction ❑ Demolition For special information use checklist. Description I Qty. I Ea. I Total 3 Addition/alteration/replacement ❑Other: New 1-2-family dwellings(includes 100 ft.for each utility connection) CATEGORY OF CONSTRUCTION SFR(1)bath 312.70 Et I-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 0 Master builder ❑Other: Fire sprinkler( sq.ft.) Page 2 JOB SITE INFORMATION AND LOCATION Site utilities: ', 1 Catch basin or area drain 18.76 Job site address: �W t'k 5 7 Drywell,leach line,or trench drain 18.76 City/State/ZIP: ^I ro 4 7 0 OL q7 2 Z, 11 Footing drain(no.linear ft.:_) Page 2 Suite/bldg./apt.no.: Project name: Manufactured home utilities 50.03 Cross street/directions to job site: S GO q 8 r A 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 M 0 V C. $moo it)CA, 0 fL4-1 At F QQ SrICX(2 Dishwasher 25.02 T 1 L E) Drinking fountain 25.02 Ejectors/sump 25.02 [T PROPERTY OWNER I 0 TENANT Expansion tank 12.51 Name: Fixture/sewer cap 25.02 g1 -Ic d l) L�f/ q Floor drain/floor sink/hub 25.02 Address: ! '7 8 ,S LA) K A.gL£ S I Garbage disposal 25.02 City/State/ZIP: 'I 6,.4," OA 9 7 22 9 Hose bib 25.02 Phone:(ct ) 3 c.+ ci_ co co Fax:( ) Ice maker 12.51 0 APPLICANT 0 CONTACT PERSON Interceptor/grease trap 25.02 Medical gas(value:$ ) Page 2 Business name: G 0LA 1 e.-D f2 LL C Primer 12.51 Contact name: ggae . ©L 5 SU�i Roof drain(commercial) 12.51 Address: ! Sy i 0 S LID S PA- j1OG2) C-fc=ie0 Sink/basin/lavatory 25.02 City/State/ZIP: a 4,4 V r/2.rOil 0/Z ' )o 0 2 Solar units(potable water) 62.54 Phone:( ti3)S%,) _ ( 9 9 V Fax::( ) Tub/shower/shower pan / 12.51 E-mail: Urinal 25.02 CONTRACTOR Water closet 25.02 Water heater 37.52 Business name: �t e it. n DG L Y Water piping/DWV 56.29 Address: Other: 25.02 City/State/ZIP: Subtotal Phone: ( ) Fax:( ) Minimum permit fee: $72.50 7A-6E--) Plan review (25%of permit fee) -CCB Lie.: Plumbing Lie,no.: State surcharge(12%of permit fee) g•70 Authorized signAre:S- �!G TOTAL PERMIT FEE gi•.340 p'' Date: 2 This permit application expires if a permit is not obtained within 180 days Print name: I� G [/G$SO/v/ J��/�6after it has been accepted as complete. (( *Fee methodology set by Tri-County Building Industry Service Board. I:Building Permits PLMU-PermitApp.doc 10'0109 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"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 7tr Valuation: Permit Fee: Storm&Rain Drain-1st 100' 62.54 SI.00 to 55.000.00 Minimum Ice S72.50 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 each additional$100.00 or fraction thereof,to p Qty. (ea) Total 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 nonnal 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 90.00Mr $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*. 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 0 Any new commercial building with water service 2"and Baptist') I Ont 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 0 Medical gas and vacuum systems for health care facilities. Dishwasher: Commercial 0 Any multipurpose fire sprinkler system. Domestic 0 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 tll • ir ' D 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 Ext sactor plumbing permit can be issued. Water Clooset-Toilet p g p Urinal Other Fixtures: I:\Building\Permits\PLMF_PermitApp.doc 08/04/2011 2