Permit s CITY OF TIGARD PLUMBING PERMIT
114 . COMMUNITY DEVELOPMENT Permit#: PLM2016 00319
TEG R D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 06/22/2016
Parcel: 1S133AD11900
Jurisdiction: Tigard
Site address: 12694 SW SPRINGWOOD DR
Project: Beeble Subdivision: AMART SUMMER LAKE NO.3 Lot: 148
Project Description: Bathroom remodel: add(1)lay,(1)shower&replace(1)Jacuzzi tub,
Contractor: EMORY PLUMBING Owner: BEEBLE, JOHN R&ELAINE J
533 45TH PL SE 12694 SW SPRINGWOOD DR
SALEM, OR 97317 TIGARD, OR 97223
P
PHONE: 503-475-7001
HONE: 971-340-6068
FAX:
FEES
Quantity Description Date Amount
1 ea Lavatories 06/22/2016 $25.02
Specifics: 2 ea Tub/Shower/Shower Pan 06/22/2016 $25.02
1 12%State Surcharge- 06/22/2016 $8.70
Type of Use: SF Plumbing
Class of Work: ALT 22 ea Minimum Fee Adjustment- 06/22/2016 $22.46
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 Notifi ••. 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 0 C by ailing 503.232.1987 or 1.800.332.2344.
lssu d By: k. / `� Permittee Signature: Rf _
f
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
City of Tigard Received Ct /� 0, �L Permit No.: /N!�r��Q6 ✓1
q Date/By: lIa
13125 SW Hall Blvd.,Tigard,OR 3 2 2 2016 Plan Review
I Phone: 503.718.2439 Fax: 503.598.1960 Other Permit No.:
Date/By:
T I C.A R U Inspection Line: 503.639.417C(r�/OF $ ADate Ready/By: Juris: ® See Page 2 for
r god l Notified/Method: Supplemental Information
Internet: www.ttgard-o
❑New construction 0 Demolition For special information use checklist
Description Qty. Ea. Total
1 Addition/alteration/replacement ❑Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
R
' 'rc1rb ,,l,,�s� �fr'��b ,� � t t 0n� t� s,,d �,. '�'� SFR(1)bath 3]2.70
1-and 2-family dwelling
0 Commercial/industrial SFR(2)bath 437.78
SFR(3)bath 500.32
0 Accessory building 0 Multi-family
Each additional bath kitchen 25.02
0 Master builder ❑Other: Fire sprinkler( sq.ft.) Page 2
} 1 fad r t °I ps i,.1_"macft l t) `t qtr * x m�!i �u Site utilities:
Catch basin or area drain 18.76
Job site address: (,. .(12(1,-) 43 r5 p v'i n Cl l ir1( � f`
City/State/ZIP: 1 rc�i O� (-1 q +7 3Drywell,leach line,or trench drain 18.76
° Footing drain(no.linear ft.:_) Page 2
Suite/bldg./apt.no.: `� Project name: {y v
1 1>,i'C� ,y1 IC
�e-do Manufactured home utilities 50.03
Cross street/directions to job site: i(\ 30,-.0) t j-1-4 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: up Vi v l uJ od Lot no.: Fixture or item:
Backflow preventer 31.27
Tax map/parcel no.:
l v" Backwater valve 12.51
�sy. �.... „.1CA 4. EL�.,. Clothes washer 25.02
ka
KC S(� v•a(� Lii 4 -v� �� e Dishwasher 25.02
�' ( �1 �/lCO (L G `�V1(3 1� Drinking fountain 25.02
4� C � Zai _ha
Ejectors/sump 25.02
"' x ` : ' "�'Int Il ", Expansion tank 12.51
Fixture/sewer cap 25.02
Name:• s t) y_ tCi t vle13 -�� Floor drain/floor sink/hub 25.02
Address: , fiC4d V Garbage disposal 25.02
City/State/ZIP: i tr�� C �'�, ,� Hose bib 25.02
�
•t-1,--,O,.\ Fax:( ) Ice maker
Phone:(S ) 12.51
r ,- s ,, b�* 7. a a t '' '1::
x m1 y 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 ( 25.02 p6 •o'
City/State/ZIP: Solar units(potable water) 62.54
Phone:( ) Fax::( ) Tub/shower/shower pan 12.51 �S�dy
E-mail: Urinal 25.02
€ M t 1''' < `t4r ,fid M Water closet 25.02
y,_
FA
t s 1 . .. �.
. _ -,_ a c,k �, .. .m ,.y �.. :� �,a Water heater 37.52
Business name: 343& t YY't 11 Water piping DWV 56.29
Address: G1� %51'41 Pr ►� F'J Other: 25.02
/
City/State/ZZIP: 0 Ft q'7 37 Subtotal
Phone:( R'71 340-66 . Fax:( /) Minimum permit fee: $72.50 7a.S�
CCB Lic.: 0 3 g St'pol l q Plumbing Lic.no.: Pe)faa Plan review (25%of permit fee)
�- P � /� / State surcharge(12%of permit fee) gr,7
Authorized signature: r 1- 7/�L 7 TOTAL PERMIT FEE g/.
Print name: , 6iA FZ, 6ec j- (c,
J Date: (F g L 9Ql(c^ This permit application
it expireshasbeen if aaccepted permit isas notcomplete.obtained within 180 days
*Fee methodology set by Tri-County Building Industry Service Board.
440-4616T(10/02/COM/WEB)
I:1Building Permits1PLMU-PermitApp.doc 10/01/09
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Su 'ression S stems:
�- ti � .sk' B p y„. �y'E . Y :�.:g� �, �^f� a .gar 4u ':.� 5 � ,;.r
...;;;-.417/..-4!,a1:4--,;2_ ,, ' ;,,,.f.° ;,i �s yfi.. Oa m,ia,o., - 4 n4 ;r 1.Jnr , . ,::!. ., .''
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 IV- 1
.4,,°xnekr d,1,,Y, �' �,e I. ,i,, '. sh .sem.' Brr.'
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
t C Y 1' ' each additional$100.00 or fraction thereof,to
4411,, e' -: °''... h a -' 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 char_e-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$100.00 or fraction thereof.
Subtotal:
Commercial Fixture Work:
Are you capping,adding or replacing fixtures? If"yes",
please indicate work performed by fixture. Failure to
accurately report fixtures could result in increased sewer fees*.
:: A)iiiiiiit �Filial'.ii'Type Plan review is required for any of the following.
fixture Replace! pp y
t Please check all that a 1
*Ott*49,704. CAI)ped Added yz',::Relocilt
�d �, ❑ Any new commercial building with water service 2"and
Baptistry/Font greater,except systems designed and stamped by licensed
Bath: -Tub/Shower
-Jacuzzi/Whirlpool engineer.
Car Wash: Each Stall
0 New exterior plumbing site utilities for any complex structure
as defined in OAR918-780-0040.
-Drive Thru
Cuspidor/Water Aspirator 0 Medical gas and vacuum systems for health care facilities.
Dishwasher: Commercial
0 Any multipurpose fire sprinkler system.
Domestic 0 Any complex structure as defined in OAR918-780-0040,
Drinking Fountain
Eye Wash Submit 2 sets of plans with any of the above.
Floor Drain/sink: -2"
-3" iy- '�a:�;'{ n w # E 4 1�';x�' l�.s.k, ,E ..~E$a.w� ...,21441
-4 ❑ Isometric or riser diagram is required for new buildings
-Car Wash Drain
that meet the qualifications above.
Garbage -Domestic non-food
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/Sery/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:
1: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
12694 SW SPRINGWOOD DR, TIGARD, OR,
97223
Residential - Plumbing
399 Plumbing final
PASS - No C of O
PLM2016-00319
Don Sylvester
Violation Summary:
Inspector Contractor