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Permit
CITY OF TIGARD PLUMBING PERMIT ' Permit#: PLM2016-00504 m COMMUNITY DEVELOPMENT 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 10/03/2016 I�''' Iz.Ij g Parcel: 2S104AD00300 Jurisdiction: Tigard Site address: 12775 SW MARIE CT Project: ANDERSON Subdivision: BELLWOOD Lot: 12 Project Description: Plumbing for 900 sq.ft.addition of family room,bedroom,bathroom and laundry:30 ft.of sanitary sewer,60 ft.of rain drains,(1)clothes washer,(1)hose bib,(2)sinks,(1)shower,and(1)water closet. Contractor: OWNER Owner: ANDERSON,JAIMI S&SPENCER D SPENCER ANDERSON 12775 SW MARIE CT 12775 SW MARIE CT TIGARD, OR 97223 TIGARD, OR 97223 PHONE: 971-322-6041 PHONE: FAX: FEES Quantity Description Date Amount 30 If Sanitary Sewer 10/03/2016 $62.54 Specifics: 1 ea Clothes Washer 10/03/2016 $25.02 1 ea Hose Bib 10/03/2016 $25.02 Type of Use: SF 2 ea Sink 10/03/2016 $50.04 Class of Work: ALT 1 ea Tub/Shower/Shower Pan 10/03/2016 $12.51 Type of Const: 1 ea Water Closet 10/03/2016 $25.02 Occupancy Grp: 60 If Storm Sewer 10/03/2016 $62.54 Stories: 1 12%State Surcharge- 10/03/2016 $31.52 Plumbing Total $294.21 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. y //) ----,Issued By: Permittee Signature: �= 410 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 City of Tigard « Received /`, ^b 2 &it: u t le 3 tr Permit No.." pYJ/6 v"JC�i 1111 ��' i Date/By: w �/.J 1 13125 SW Hall Blvd.,Tigard,OR �i Plan Review li Phone: 503.718.2439 Fax: 503. 1 0 Date/By: Other Permit No.:0('-j-aiiC (r,3 y fj Inspection Line: 503.639.4175 qq Date Ready/By: ® See Pa e 2 for IG' `7 TIGARD 5 (iQl� g Internet: www.tigard-or.gov c Notified/Method: Supplemental Information :> TYPE OF WORK TIG kktt' FEE* SCHEDULE""j ❑New construction 4o14DIN i S T A 1"a For speciud information use check!!sb Description Qty. Ea. Total Addition/alteration/replacement [ New 1-2-family dwellings(includes 100 ft.for each utility connection) CATEGORY OF CONSTRUCTION SFR(1)bath v ' 312.70 gl I-and 2-family dwelling 0 Commercial/industrial SFR(2)bath 437.78 SFR(3)bath 500.32 ❑Accessory building 0 Multi-family Each additional bath/kitchen 25.02 ❑Master builder 0 Other: Fire sprinkler( sq.ft.) Page 2 JOB SITE INFORMATION AND LOCATION Site utilities: 1 x-77 � [ Catch basin or area drain 18.76 Job site address: 5 City/State/ZIP: r,{_pt T ©� q-7)_)__.5 DrYwell,leach line,or trench drain 18.76 "fFooting drain(no.linear ft.:_) Page 2 Suite/bldg./apt.no.: Project name:AJ ,(X ) P-)a-loll. Manufactured home utilities 50.03 Cross street/directions to job site: Manholes 18.76 Rain drain connector b Y 7 le 12:6-('1-i An�D L.-YAL-1�Jr p'/l CAL-- x-"C4 --ry-r-- - Sanitary sewer(no.linear ft.:3 0) 1 Page 2 Ga-21 0.3 " 12-4(i OFF 12_1--at Storm sewer(no.linear ft.: ) J Page 2 61-g^-r' Water service(no.linear ft.:_) Page 2 Subdivision: I Lot no.: Fixture or item: Tax map/parcel no.: Backflow preventer 31.27 * ''.:4":„,1%.' DES " ON OF1.m nic "; ,,,,..W.,,,,,,„ Backwater valve 12.51 .A�,. t1., ,, ,�'< ,. ,. Clothes washer 1 25.025,0a At7D 1 " f t ,°L 1' A) )p.J( n1A51-4 Dishwasher 25.02 A/ )'Th LAU,i op( (z,b,/vi, Drinking fountain 25.02 Ejectors/sump 25.02 PROPERTS OWNER I 0 Expansion tank 12.51 Name: GJPg�( An�IDeiu ,�J Fixture/sewer cap 25.02 , Floor drain/floor sink/hub 25.02 Address: ,-.77'7 S cJiN c / �-! Garbage disposal 25.02 City/State/ZIP: !iJ 1Z-� °e, 'fl 20.1.--2) Hose bib I 25.02 V. Phone: O( 17 17 2_2___ bt)Gil Fax ( ) Ice maker 12.51 A 1f1:::031ViACT PERSON Interceptor/grease trap 25.02 Medical gas(value:$ ) Page 2 Business name: �A Primer 12.51 Contact name: Ppm C4 L A/..11--)r..5://x-- /-...1 Roof drain(commercial) 12.51 Address: Sink/basin/lavatory A 25.02 ,$ZI„i,ti City/State/ZIP: Solar units(potable water) 62.54 Phone:( ) Fax::( ) Tub/shower/shower pan ( 12.51 / 5 E-mail: Urinal 25.02 Water closet I A` 25.02 )51.1)_, CONTRACTOR Water heater 37.52 Business name: v v.010 Water piping/DWV 56.29 Address: Other: 25.02 City/State/ZIP: Subtotal 2 ' Y Phone:( ) Fax:( ) Minimum permit fee: $72.50 - Plan review (25%of permit fee) CCB Lic.: I/ Plum ing Lic.no.: State surcharge(12%ofpermit fee) r -^� .." g c�ttt� S. Authorized signature: ' TOTAL PERMIT FELE `� � r f This permit application expires if a permit is not obtained within 180 days Print name: �j�" � - � �; Date: 3 -� after it has been accepted as complete. *Fee methodology set by Tri-County Building Industry Service Board. I:\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(ea) Total Square Footage: Permit Fee: Footing dram-15'100' 50.03 0 to 2,000 $121.90 Footing dram-each additional 100' 37.52 2,001 to 3,600 $169.69 3,601 to 7,200 $233.20 Sewer-1st 100' l 62.54 O 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 6, $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 Inspections ns ections or Fees Qty. Fee(ea) Tot each additional$100.00 or fraction thereof,to p 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*. PIS Review for Plu bbig Instals + 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_ 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. 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: -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:\Building\Permits\PLMF_PermitApp.doc 08/04/2011 2