Permit CITY OF TIGARD PLUMBING PERMIT
Permit#: PLM2016-00065
11 COMMUNITY DEVELOPMENT
T WARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 02/08/2016
Parcel: 2S109DB03700
Jurisdiction: Tigard
Site address: 12996 SW HAZELCREST WAY
Project: BALASUBRAMANIAN Subdivision: SUMMIT RIDGE Lot: 75
Project Description: Installation of(1)new shower pan
Contractor: KING PLUMBING&SERVICES LLC Owner: BALASUBRAMANIAN, SHANKAR& HEMA
1815 S 22ND PLACE 12996 SW HAZELCREST WAY
RIDGEFIELD,WA 98642 TIGARD, OR 97224
PHONE: 360-213-6178 PHONE.
FAX:
FEES
Quantity Description Date Amount
1 ea Tub/Shower/Shower Pan 02/08/2016 $12.51
Specifics: 1 12%State Surcharge- 02/08/2016 $8.70
Plumbing
Type of Use: SF 80 ea Minimum Fee Adjustment- 02/08/2016 $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 Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a spy of the rules
or. ct questions to aUNC b Illiin1
Ming 503.232.1987 or 1.800.332.2344.
I--ued By: J-- / 1 ' Permittee Signature: $
�/ Call 503.639.41'7[5 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 RECEIVED
Cityof Tigard Received �/ ,,/
g FEB 2016 0 6 Date/By: 0 I� Permit No.: Li-0614o ��Wl�
71 01 13125 SW Hall Blvd.,Tigard,OR 97223 � Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 Other Permit No.:i•-•/ 7 / 'o
Date/By:
I I c .1 R I�
ofe
Notified/Method:
Inspection Line: 503.639.4175 CITY O, ?G, . Date/BDate Ready/By: Juris: ® See Page 2 for
Internet: www.tigard-or.gov * 11 43e $t e ,t Supplemental Information
ri L:a
0 New construction ❑Demolition For special information use checklist
Description Qty. I Ea. Total
Addition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)r " SFR 1 bath
3 � s i c`� t �� r O 312.70
-and 2-familydwelling . SFR(2)bath 437.78
0 Commercial/industrial
SFR(3)bath 500.32
❑Accessory building 0 Multi-family
Each additional bath/kitchen 25.02
0 Master builder ❑Other Fire sprinkler( sq.ft.) Page 2
'J+1 `*i 1441 1.ATP- A 32{?CATIOt4 Site utilities:
Z9 it ip S�1 6.•%-e- /jam r Catch basin or e drain 18.76
Job site address: rQ/•�,,
Drywall,leach line,or trench drain 18.76
City/State/ZIP: 77#" Footing drain(no.linear ft.:_) Page 2
Suite/bldg./apt.no.: I Project name: Manufactured home utilities 50.03
Manholes 18.76
Cross street/directions to job site:
Rain drain connector 18.76
Sanitary sewer(no.linear ft.:_) Page 2
Storm sewer(no.linear ft.:_) Page 2
Water service(no.linear ft.:_) Page 2
Subdivision: 1 Lot no.: Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
DCIU ;OS O1F`xWORK ., Backwater valve 12.51
" ' 6" 60 Clothes washer 25.02
� I^/ S Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
' Z ""7" , '2' Expansion tank 12.51
.,, .sum#,,. .,.. ;, d .ti .:
S `� n h Fixture/sewer cap 25.02
Name: +v7�4
�'ap� Floor drain/floor sink/hub 25.02
Address: Iv'/-il` S iJ I ner'?tflels r ice]
Garbage disposal 25.02
City/State/ZIP: -77 t4 Hose bib 25.02
Phone:( ) Fax:( ) Ice maker 12.51
° Vag�... : _ . ,u,• 25.02- w 1441;v0"' 7 ,7 ° : Interceptor/grease trap
( l w i , " ;,: Wv. ."'M..a .
-
Business name: S0 K�C�. �G�� �.L6. Medical gas(value:$ ) Page 2
Primer 12.51
Contact name: et*L 3 0 w 1...
Roof drain(commercial) 12.51
Address: (Qll:l 14 0 S'yJ 4S lt...4r) Sink/basin/lavatory 25.02
City/State/ZIP: e4 3e- 80- -9^'2, Solar units(potable water) 62.54
Phone:(� O
Fax: :( ) Tub/shower/shower pan 12.51
E-mail: Urinal 25.02
x< , °x, °r _ �r ,. .. ; ,,,w.,.,„;,.. Water closet 25.02
:!4 . . �.� sF ,iG (tit .ff .,,.dk �9.�"'4
� � Water heater 37.52
Business name: e. � �7
Iw+ c„VtI. $,J4, ••r•cco,dit„�' J��e Water piping/DWV 56.29
Address: /r t L ! tors-e-- Other: 25.02
City/State/ZIP: /7" D0e""m grz.4.) (AA 914,ya Subtotal 7�
(36/0) �3-(0i 7c6 I •Fax:( ) Pb���� �7 Minimum permit fee: $72.50 7a.5U
Phone: 77
8 Plan review (25%of permit fee)
CCB Lic.: 2.42 gm.( ZZ // �l t 7 Plumbing Lic.no.: 101 Q
State surcharge(12%of permit fee) g.70
Authorized signature: (--1TOTAL PERMIT FEE
Print name: 0417 erV te-p Date:47/(G 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.
440-4616T(10i02
I:Building,Permits‘PLMU-PermitApp.doc 1001,09 COM WEB)
•
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Su i s ression S stems:
; 1
'
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 r t A .s-;
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
1 each additional$100.00 or fraction thereof,to
�� �
ti !. a,�b, t� --41:1171W�. � „..: l.,r ,.�.._.�;,..-�.k. .� 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/In $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 Jt
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
Baptistry/Font greater,except systems designed and stamped by licensed
Bath: -Tub/Shower
engineer.
-Jacuzzi/Whirlpool
Car Wash: -Each Stall ❑ New exterior plumbing site utilities for any complex structure
as defined in OAR918-780-0040.
-Drive Thru
Cuspidor/Water Aspirator ElMedical gas and vacuum systems for health care facilities.
Dishwasher: Commercial 111 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"
116414.S1'. n a t s a�, " sem aii4tiltera
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 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
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
12996 SW HAZELCREST WAY, TIGARD, OR,
97224
Residential - Plumbing
399 Plumbing final
PASS - No C of O
PLM2016-00065
Chip Barnett
Violation Summary:
Inspector Contractor