Permit (42) CITY OF TIGARD PLUMBING PERMIT
! COMMUNITY DEVELOPMENT Permit#: PLM2016 00442
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 08/15/2016
Parcel: 1S133AD10300
Jurisdiction: Tigard
Site address: 10659 SW 127TH CT
Project: JACOBS Subdivision: AMART SUMMER LAKE NO.3 Lot: 159
Project Description: Installing(1)tub,(1)sink,and(1)water closet.
Contractor: EXCELLENCE PLUMBING LLC Owner: JACOBS, GREGORY TODD&
7913 SW NIMBUS AVE JULIE ELIZABETH
BEAVERTON, OR 97008 10659 SW 127TH CT
TIGARD, OR 97223
PHONE: 503-643-3459 PHONE:
FAX: 503-643-2815
FEES
Quantity Description Date Amount
1 ea Lavatories 08/15/2016 $25.02
Specifics: 1 ea Tub/Shower/Shower Pan 08/15/2016 $12.51
1 ea Water Closet 08/15/2016 $25.02
Type of Use: SF 1 12%State Surcharge- 08/15/2016 $8.70
Class of Work: ALT Plumbing
Type of Const: 10 ea Minimum Fee Adjustment- 08/15/2016 $9.95
Occupancy Grp: Plumbing
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 By:tr , _ Permittee Signature: le
G-£
70.
Call 503.639.4175 by 7:00 a.m.for the next available ins ection date.
P
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
City of Tigard BECENED Received
Date/By: o I�i[ Permit No.: y
514
13125 SW Hall Blvd.,Tigard,OR 97223 q _ �(f�/�aC11 CQ �«J 1
_ l� `ZO,� Plan Review �t
Phone: 503.718.2439 Fax: 503.598.19601W G 1 Date/By: Other Permit No.:
Inspection Line: 503.639.4175 p'+�
T l L i n R D cry �� A L. Date Ready/By: Juris: ® See Page 2 for
Internet: www.tigard-or.gov �� Notified/Method:
w� h` Supplemental Information
TYPE'OF w0 0�'" '
ilopI �G FEE* SCHEDULE
0 New construction 0 Demolition For special information use checklist
Description Qty. Ea. Total
Addition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION r SFR(1)bath 312.70
) (1-and 2-family dwelling 0 Commercial/industrial SFR(2)bath 437.78
❑Accessory building 0 Multi-family SFR(3)bath 500.32
❑Master builderEach additional bath/kitchen 25.02
0 Other: Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: p 6C1 51A/ 1 27 7-01 C-1:- Catch basin or area drain 18.76
/ Drywell,leach line,or trench drain 18.76
City/State/ZIP: 1 1
Footing drain(no.linear ft.:_) Page 2
Suite/bldg./apt.no.: I Project name: 3 MC-17 5 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: I Lot no.: Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
DESCRU1TION OF WORD.$; 4:
Backwater valve 12.51
Cr )�5 mil lA / �SUl K i �l \� j� Clothes washer 25.02
J Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
❑ pitiontiri OOV'IVER 0 E '''"' Expansion tank
12.51
n ,,
Name: Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address:
Garbage disposal 25.02
City/State/ZIP: Hose bib 25.02
Phone:( ) Fax:( ) Ice maker 12.51
] APPLICANT 0,CON'TACT PERSON` Interceptor/grease trap 25.02
Business name: Medical gas(value:$ ) Page 2
Contact name:
Primer 12.51
Roof drain(commercial) 12.51 '
Address:
Sink/basin/lavatory 25.02 25,02
City/State/ZIP: Solar units(potable water) 62.54
Phone:( ) Fax: :( ) Tub/shower/shower pan 12.51 )2151
E-mail: Urinal 25.02
ONWater closet ) 25.02 251 02
)/ Water heater 37.52
Business name: �XC2ll Ce IDI ukr)1 i LWaterpiping/DWV 56.29
7
Address: ' I l3 S W J�,
/V 1►M�]�S �
� Other: 25.02
City/State/ZIP: Zfe 0,V (-) Subtotal 4 1,5!j
Phone:(5D3) IQ 43- Li- l Fax:(503l(
) YT3.^22'15 Minimum permit fee: $72.50 -72,60
CCB Lic.: r75-7(9 g Plumbing Lic.no.: p a 3 9-y-- Plan review (25%of permit fee)
lY State surcharge(12%of permit fee) -7 L"1
r
Authorized signature: , I/
_ TOTAL PERMIT FEE 0, r
Print name: She)I y ��Phi / Date: B'ms's^//6 This permit application expires if a permit is not obtained within 180 days
/ after it has been accepted as complete.
*Fee methodology set by TriCounty Building Industry Service Board.
1:\Building\Permits\PLMU-PermitApp.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 Utilities Qty. Fee t ) otal Square Footage: ;° Permit Fee:
Footing drain-151 100' 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
Valuation: = Permit Fee:
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
To each additional$100.00 or fraction thereof,to
Other inspections or Fees •` )- 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*. San Review for Plumbing 1nstallati ins,
Quantity by Fixture Type " Plan review is required for any of the following.
FietureType 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 0 New exterior plumbing site utilities for any complex structure
Car Wash: -Each Stall as defined in OAR918-780-0040.
-Drive Thru
Cuspidor/Water Aspirator 0 Medical gas and vacuum systems for health care facilities.
Cuspidor/Water
irator 0 Any multipurpose fire sprinkler system.
-Commercialom ❑ Any complex structure as defined in OAR918-780-0040.
-D
Drinking Fountain
Submit 2 sets of plans with any of the above.
Eye Wash
Floor Drain/sink: -2"
3" Isometric or Riser Diagram
4"
0 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/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:
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