Permit (64) CITY OF TIGARD PLUMBING PERMIT
1111
COMMUNITY DEVELOPMENT Permit#: PLM2016-00377
T EG AR D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 07/13/2016
Parcel: 2S101AD03000
Jurisdiction: Tigard
Site address: 6969 SW HAMPTON ST
Project: Peterson Kolberg&Associates Subdivision: WEST PORTLAND HEIGHTS Lot: 19-26&
Project Description: Replace(5)lays&(5)water closets
Contractor: PIPE IT PLUMBING LLC Owner: KF LLC
2229 NE BURNSIDE ST#81 7407 SW HUNT CLUB DR
GRESHAM, OR 97030 PORTLAND, OR 97223
PHONE: 503-544-0477 PHONE:
FAX: 503-912-0045
FEES
Quantity Description Date Amount
5 ea Lavatories 07/13/2016 $125.10
Specifics: 5 ea Water Closet 07/13/2016 $125.10
1 12%State Surcharge- 07/13/2016 $30.02
Type of Use: COM Plumbing
Class of Work: ALT
Type of Const:
Occupancy Grp:
Stories:
Total $280.22
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 a obtain a copy of the rules
or dire estions to NC b ailing 503.232.1987 or 1.800.332.2344.
Iss ed By: / A, Permittee Signature:
t:410Allie
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 completi•n of the project.
Approved plans are required on the job site at the time of each inspection.
Plumbing Permit Application
Building Fixtures
UPICity of TigardPermitN
■ u 13125 SW Hall Blvd.,Tigard,OR 97223/114 1 9 " Date/By:.IIIIII)I)IMI=IFIIMINRece,,ed
� �j l t �p r (rj(�3 77
Phone: 503.718.2439 Fax: 503 CC9 71960 2016 D Review
Other Permit No.
I I U A R II Inspection Line: 503.639.4170,11, `� y ��/!o���
� � /, Date Ready/By:
Internet: www.tigard-or.gov •t,r)r° t °a G4 Notified/Method: 1PRB H See Page 2 forSupplemental Information
0 New construction 0 Demolition For special information use checklist
Description I Qty. I Ea. I Total
ddition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION . SFR(1)bath 312.70
❑ 1-and 2-family dwelling Erdommercial/industrial SFR(2)bath 437.78
IDAccessory building 0 Multi-familySFR(3)bath 500.32
❑Master builderEach additional bath/kitchen 25.02
0 Other: Fire sprinkler( sq.ft.) Page 2
OB SITE INFORMATION-AND LOCATION Site utilities:
Job site address: v•
-i*/ ,, 4rJ r Catch basin or area drain 18.76
City/State/ZIP: /.- \ Drywell,leach line,or trench drain 18.76
il --(:'�-.1 ,)
Footing drain{no.linear ft.: ) Page 2
Suite/bldg./apt.no.: ( Project name: ) 4 ;'.
Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
tr
1 `'t ,� 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
Backwater valve
I ESCR OF WORD; 12.51
/f3. I/4 , t.L�� - t`,t 4-4-LA-e..,- Clothes washer 25.02
Dishwasher 25.02
("vf Drinking fountain 25.02
Ejectors/sump 25.02
arPROP,ERTY OCVNItIR I El. ` Expansion tank 12.51
Name: .../5,_/4". ,." ,`id), ,' Fixture/sewer cap 25.02
Address: in G(' G� t t ( �_� L - Floor drain/floor sink/hub 25.02
City/State/ZIP:
Garbage disposal 25.02
Hose bib 25.02
Phone:( ) Fax:( ) Ice maker 12.51
Appu ❑. ONTACT ItER,soN Interceptor/grease trap 25.02
Business name: 1.Li (( z,L. t ry <-, t.?.-. `( ( ( ( Medical gas(value:$ ) Page 2
Contact name: Primer 12.51
Address: 1 L 1 <- L( � (�l L+ :'%^ ( l' t F- ,e Roof drain(commercial) 12.51
., ; S v-1-- Sink/basin/lavatory ' 25.02 /42�/Z�
City/State/ZIP: i 7 to•PL- ..,-'L ' i -11.„ (t 6,.._ 3 J L( Solar units(potable water) 62.54
Phone:(\ ) ),„)._.../."„ - 1 "62 Fax::( ) Tub/shower/shower pan 12.51
----< S G `-e' (�z-s.,.e:t t` Urinal
E-mail: 6 z. dC t•, l C t ( �A_ C v 25.02
Water closet
- �� 25.02 /9-57/0
"
Water heater
Business name: 1�i ?s-" C
t 4.-4-1 ,. c.,_ 37.52
I CC , Water piping/DW V 56.29
Address: �_W ‘1 Ni c. F*L..z , i s,'
1.,.E
.c-( Other: 25.02
City/State/ZIP: \-G'e4,,,...,_.,, , e(a Subtotal .A5?).PO
Phone:( 1 5) c t,i L.f v. c`. It-1 -) Fax:( ) Minimum permit fee: $72.50
CCB Lic.: I `)t 1 � j ( _ $umbing Lic.no.: Plan review (25%of permit fee)
/ State surcharge of 50.01:-
Authorized
signature: .,,- .c < ,,.-- (12% permit fee)
`� TOTAL PERMIT FEE aO20•342-
Print name: '� -,t--e? t 1(6-
Date: - s /J,. /4, 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.
I:\Building\PennitsTEMU-PennitApp.doc 10/01/09 440-4616T(10/02/COM/WEB)
Plumbing Permit Application - City of Tigard
Page 2-Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site V0il410s ' , - 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
Sewer-1st 100'
62.543,601 to 7,200 $233.20
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 "'
$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
Other Inspettions or Fees QtY' F"Oa .,'Til each additional$100.00 or fraction thereof,to
Inspection of existing plumbing or for and including$10,000.00.
$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 90.00/1u and including$50,000.00.
Additional plan review for revisions 90.00/hr $50,001.00 and up $742.00 for the fust$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*.
‘,...tr by Fixture Type Plan e� Y far Plumbing:�tallation*
Fixture Type for Re ace/
Work Performed: Capped Added Relocate Plan review is required for any of the following.
Baptistry/Font Please check all that apply.
Bath Tub/Shower ❑ Any new commercial building with water service 2"and
JacuzziJWhirlpool greater,except systems designed and stamped by licensed
Car Wash -Each Stall engineer.
Drive Thru 0 New exterior plumbing site utilities for any complex structure
Cuspidor/Water Aspirator as defined in OAR918-780-0040.
Dishwasher -Commercial 0 Medical gas and vacuum systems for health care facilities.
-Domestic 0 Any multipurpose fire sprinkler system.
Drinking Fountain 0 Any complex structure as defined in OAR918-780-0040.
Eye Wash
Floor Drain/sink -2" Submit 2 sets of plans with any of the above.
Car Wash Drain .` Isometric or Rs` lam ,
Garbage Domestic-non-food LJ Isometric or riser diagram is required for new buildings
Disposal -Domestic-food related that meet the qualifications above.
-Commercial-food related
-Industrial-food related
Ice Mach./Refrig.Drains
Oil Separator(Gas Station) Comments regarding fixture work:
Rec.Vehicle Dump Station
Shower -Gang
-Stall
Sink/Lav -Non-food related i-
-Bradley
-Commercial-food related
-Service
Swimming Pool Filter
Washer-Clothes *Note: If the fixture work under this permit results in an
Water Extractor increase of sewer EDUs,a sewer permit will be issued and
Water Closet-Toilet 6'. fees assessed for the sewer increase must be paid before the
Urinal plumbing permit can be issued.
Other Fixtures:
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