Permit (20) CITY OF TIGARD PLUMBING PERMIT
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I. COMMUNITY DEVELOPMENT Permit#: PLM2016-00285
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 06/01/2016
T t c,ltf.L� g Parcel: 1S133CD16700
Jurisdiction: Tigard
Site address: 13845 SW ASHBURY LN
Project: Hudson Subdivision: PEBBLECREEK NO.3 Lot: 57
Project Description: Replace tub/shower
Contractor: DAVID LOGGINS LLC Owner: HUDSON FAMILY TRUST
489 S 17TH ST 13845 SW ASHBURY LN
ST HELENS, OR 97051 TIGARD, OR 97223
PHONE: 503-313-6351 PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Tub/Shower/Shower Pan 06/01/2016 $12.51
Specifics: 1 12%State Surcharge- 06/01/2016 $8.70
Plumbing
Type of Use: SF 60 ea Minimum Fee Adjustment- 06/01/2016 $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 Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may..•• -.8 a c•• of the rules
or direct qu- • OUNC by calling 503.232.1987 or 1.800.332.2344.
Issu:d By: Permittee Signature:
At_
Call 503.639.4175 by 7:00 a.m.for the next available ins•-ction date.
This permit card shall be kept in a conspicuous place on the job site until comple '•n of the project.
Approved plans are required on the job site at the time of each inspection.
Plumbing Permit Application
Building Fixtures
Cl of Tigard RE E V 'R/ Received / - /�, �1 (,�✓
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RECEIVED M �i� Date'By: f� 1 ,.j l�J�l PennitNo.: p,,,,,... id„,..0r��0 J
13125 SW Hall Blvd.,Tigard,OR 972h3I^' Plan Review tri
Phone: 503.718.2439 Fax: 503.598`'196 1 �016' Other Permit No.:
Date/By:
Inspection Line: 503.639.4175 Date Read /B orris: ® See Page 2 for
11ciAI&I) CITY Ready/By: B
Internet: www.tigard-or.gov OF r'G Notified/Method: Supplemental Information
TYPE ofitADING DIVISION FEE* SCHEDULE
El New construction 0 Demolition For special information use checklist.
Description Qty. Ea. I Total
),Addition/alteration/replacement El Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(I)bath 312.70
I-and 2-family dwelling El Commercial/industrial SFR(2)bath 437.78
SFR(3)bath 500.32
0 Accessory building El Multi-family
Each additional bath/kitchen 25.02
El Master builder El Other:
Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: /3 g 41.5- .51-1.1471416«/�y LA! Catch basin or area drain 18.76
City/State/ZIP: Drywell,leach line,or trench drain 18.76
4 d O Q.<._E-- 9 77'CI Footing drain(no.linear ft.:_) Page 2
Suite/bldg./apt.no.: 1 Project name: lf4l LD e,O NJ 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: 1 Lot no.: Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 25.02
Atm 7T.`6/--S -k Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
la PROPERTY OWNER I/ ❑ TENANT Expansion tank 12.51
Name: 41/HC.�./N 4-.SUE / Cua.i4A-) Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address:
! 3 e`{S S t.✓ Art1-sSuKy Lr
Garbage disposal 25.02
City/State/ZIP: ' fl' e) / 7 2_23 Hose bib 25.02
Phone:( ) Fax:( ) Ice maker 12.51
ppAPPLICANT 0 CONTACT PERSON Interceptor/grease trap 25.02
Business name: New-6 G INr C L,L,C
Medical gas(value:S ) Page 2
1.4,66/ Prime 12.51
Contact name:
l9ti/ Roof drain(commercial) 12.51
Address: l78 Q S 7 70 St
Sink/basin/lavatory 25.02
City/State/Z1P: Sr- 4. 6.,-( o ?7 r Solar units(potable water) 62.54
Phone:( 0 3) --�3 4-7 Fax: :( ) Tub/shower/shower pan / 12.51 (2_,.
E-mail: f ,�� 4 e...„sa qt /e 6-wt.
Urinal ( 25.02
I CONTRACTOR Water closet 25.02
Water heater 37.52
Business name: #21 f �� c Water piping/DWV 56.29
Address: `�� Other: 25.02
City/State/ZIP: Subtotal
Phone:( ) Fax:( ) Minimum permit fee: $72.50 ' jJ
CCB Lic.: f g5-6Z9 / Plumbing Lic.no.://?4,6 d Plan review (25%of permit fee) $-7v
i State surcharge(12%of permit fee) �-
Authorized signature: TOTAL PERMIT FEE �t',
'4 This permit application expires if a permit is not obtained within 1 0 Says
Print name: /A.4/ l�t� ( Date:
Q after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
I:Building Permits PLMU-PermitApp.doc 1001 09 440-46167(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-l''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
each additional$100.00 or fraction thereof,to
Other Inspections or Fees Qty. Fee(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 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 51.20 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
❑ 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
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'• 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: -Lay/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:ABuilding\Permits\PLMF_PermitApp.doc 08/04/2011 2