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Permit 1111 CITY OF TIGARD PLUMBING PERMIT f COMMUNITY DEVELOPMENT /p/' ! Permit#: PLM2016-00290 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 06/06/2016 T[CARD g Parcel: 1 S134ACO2648 Jurisdiction: Tigard Site address: 11060 SW COTTONWOOD LN Project: McKibbin/Donahue Subdivision: ENGLEWOOD NO.3 Lot: 214 Project Description: Replace piping for sink&hose bib. 10/6/16,REPRINTED to add garbage disposal. Contractor: OWNER Owner: BONACKER, GERALD N JEAN E MCKIBBIN/DONAHUE 11060 SW COTTONWOOD LN 11060 SW COTTONWOOOD LN TIGARD, OR 97223 TIGARD, OR 97223 PHONE: 720-244-5930 PHONE: FAX: FEES Quantity Description Date Amount 1 ea Garbage Disposal 10/06/2016 $25.02 Specifics: ea Hose Bib 06/06/2016 $25.02 1 ea Sink 06/06/2016 $25.02 Type of Use: SF 1 12%State Surcharge- 10/06/2016 $9.01 Class of Work: ALT Plumbing Type of Const: 45 Misc Administration Fee 10/06/2016 $45.00 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 Notifica.• 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 dire -•uestions to • C by c ing 503.232.1987 or 1.800.332.2344. Is ued By: Permittee Signature: vv ,l/ lam'I / 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. q CITY OF TIGARD PLUMBING PERMIT IN s COMMUNITY DEVELOPMENT Permit#: PLM2016-00290 T I G A R.0 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 06/06/2016 Parcel: 1 S 134ACO2648 Jurisdiction: Tigard Site address: 11060 SW COTTONWOOD LN Project: McKibbin/Donahue Subdivision: ENGLEWOOD NO.3 Lot: 214 Project Description: Replace piping for sink&hose bib. Contractor: OWNER Owner: BONACKER, GERALD N JEAN E MCKIBBIN/DONAHUE 11060 SW COTTONWOOD LN 11060 SW COTTONWOOOD LN TIGARD, OR 97223 TIGARD, OR 97223 PHONE: 720-244-5930 PHONE: FAX: FEES Quantity Description Date Amount 1 ea Hose Bib 06/06/2016 $25.02 Specifics: 1 ea Sink 06/06/2016 $25.02 1 12%State Surcharge- 06/06/2016 $8.70 Type of Use: SF Plumbing ea 06/06/2016 $22.46 Minimum Fee Adjustment- Class of Work: ALT 22 1 Plumbing 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 obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. Issued y: / / Permittee Signature: '( ja,/ 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 RECEIVED FOR OFFICE USE ONLY Cityof 71 fl Received / �� /� ' ( . aY ilhg Date/By: l¢ `71y'/y�t Permit No.: tet-!�4�'*069-9013125 SW Hall Blvd.,Tigard,OR 97s A 6 2016 Plan Review Phone: 503.718.2439 Fax: 503.5':. '.0Dale/By: Other Permit No.: Inspection Line: 503.639.4175 CITY Of TI Date Read /B �,;ti ® See Page 2 for TIGARD CITY Pi � � Ready/By: Internet: www.tigard-or.gov �i Notified/Method: Supplemental Information TYPE OD M'l 9dING DIVISION FEE* SCHEDULE ❑ New construction ❑Demolition For special information use checklist. Description Qty. Ea. Total tgr Addition/alteration/replacement ❑Other: New 1-2-family dwellings(includes 100 ft.for each utility connection) CATEGORY OF CONSTRUCTION SFR(l)bath 312.70 W-and 2-family dwelling [11Commercial/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: 6mN rt) Lit basin or area drain 18.76 Job site address: t(Q © _cm} .� Diywell,leach line,or trench drain 18.76 City/State/ZIP: f f ccd 77z 2 3 r Footing drain(no.linear ft.:_) Page 2 Suite/bldg./apt.no.: I Project name:j�a /-!e /4,4 Li 24 Manufactured home utilities 50.03 Cross street/directions to job site: Manholes 18.76 /44-4 CO gen �0©1 LA Rain drain connector 18.76 st 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 red•Ja G e foe,i;f-,k rj EOtQ, e t Tut i A.y P lid Mbr K� Dishwasher 25.02 A, .S i f 71/� . OJ e 6,'v ,e/,"Fn H p 40 ' Drinking fountain 25.02 elyier t<N/t/Yelp ;,1 SPG/`// �4 cc:-/ Btli Ejectors/sump 25.02 // ErPROPERFY OWNER ❑ TENANT Expansion tank 12.51 Name: 7;itt` Md t44 u Fixture/sewer cap 25.02 Floor drain/floor sink/hub 25.02 Address: _rciQ s li/,27.4c ��21A_ / d 14 Garbage disposal 25.02 City/State/ZIP: 9e.0 v QrfON 17 p r Hose bib 25.02 Phone:( ) Fax:( ) Ice maker 12.51 ❑ APPLICANT ❑ CONTACT PERSON Interceptor/grease trap 25.02 Medical gas(value:$ ) Page 2 Business name: Primer 12.51 Contact name: Roof drain(commercial) 12.51 Address: Sink/basin/lavatory 25.02 t City/State/ZIP: Solar units(potable water) 62.54 Phone:( ) Fay: :( ) Tub/shower/shower pan 12.51 E-mail: Urinal 25.02 Water closet 25.02 CONTRACTOR Water heater 37.52 Business name: G(Lt)6€(1.- Water piping/DWV 56.29 Address: Other: 25.02 City/State/ZIP: Subtotal Minimum permit fee: $72.50 7„2..7„2...3-°. Phone:( ) Fax:( ) Plan review (25%of permit fee) CCB Lie.: Plumbing Lic.no.: � State surcharge(12%of permit fee) g,7O Authorized signature:f' /j TOTAL PERMIT FEE �'i,c Print name: �� r • ,K Date: j�¢/�� This permit application expires if a permit is not obtained within 180 days P/tr�S/ after it has been accepted as complete. *Fee methodology set by Tri-County Building Industry Service Board. I::Building,Permits,PLMU-PermitApp.doc 10.0E09 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- I st 100' 62.54 Medical Gas Systems: Water Service-each additional 100' 37.52 Valuation: Permit Fee: Storm&Rain Drain-1st 100' 62.54 S1.00 to 55.000.00 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 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 Baptiste Font 12 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 ❑ 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- Isometric or Riser Diagram 4 ❑ 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:ABuilding\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 11060 SW COTTONWOOD LN, TIGARD, OR, 97223 Residential - Plumbing 399 Plumbing ﬁnal PASS - No C of O PLM2016-00290 Jeff Grove Violation Summary: Inspector Contractor