Permit (2) CITY OF TIGARD PLUMBING PERMIT
3: COMMUNITY DEVELOPMENT Permit#: PLM2020-00072
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 02l2012020
T I GA H.L� Parcel: 1 S133DC14600
Jurisdiction: Tigard
Site address: 13281 SW TAMERA LN
Project: NICKLAS Subdivision: VILLAGE AT SUMMER LAKE PARK Lot: 1
Project Description: Replacing shower pan.
Contractor: OWNER Owner: NICKLAS, JULIE L&TIMOTHY J
TIM NICKLAS 13281 SW TAMERA LN
13281 SW TAMERA TIGARD, OR 97223
TIGARD, OR
PHONE: 203-828-6685
503-523-7506
FAX:
FEES
Quantity Description Date Amount
1 ea Tub/Shower/Shower Pan 02/20/2020 $12.51
Specifics: 1 12%State Surcharge- 02/20/2020 $8.70
Plumbing
Type of Use: SF 80 ea Minimum Fee Adjustment- 02/20/2020 $59.99
Plumbing
Class of Work: ALT
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 mo the 180 days. ATTENTION: Oregon law requires yo o follow the rules adopted by the Oregon
Utility Notification Center. Those rules ar set forth 0 952-001-0010 through OAR 95 1-0090. You may obtain a copy of th -rules
or direct questions to OU by calli $03.2 987 or 1 00. .2344.
Issued By: Permittee Signature: 1 •
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 FOR OFFICE USE ONLY
Cl of Tigard Received �<7 ' _ „` 7�
• 13125 SW Hall Blvd.,Tigard,OR 97223 Date Review
' P t Q
= Phone: 503.718.2439 Fax: 503.598.1960 Plan Review Date/By: Other Permit No.:
T I G A R D Inspection Line: 503.639.4175 Date Ready/By: Juris Ei See Page 2 for
Internet: www.tigard-or.gov Notified/Method: 1 Supplemental Information
TYPE OF WORK FEE* SCHEDULE
❑New construction ❑Demolition For special information use checklist.
Description I Qty. I Ea. Total
Addition/alteration/replacement El Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(1)bath 312.70
YV 1-and 2-family dwellin SFR(2)bath 437.78
///___ g ❑Commercial/industrial
❑Accessory building El Multi-family
SFR(3)bath 500.32
Each additional bath/kitchen 25.02
❑Master builder ❑Other:
Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: 13 a ()` ` '�, ����y- �/ Catch basin or area drain 18.76
6
City/State/ZIP: !,+ Doting leach line,or trench drain age18. 2�'C Footing drain(no.linear ft.: ) Page 2Suite/bldg./apt.no.: 7,...,4
roject name: 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
DESCRIPTION OF WORK Backwater valve 12.51
N 'mi _ r Clothes washer 25.02
l ` e-i Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
PROPERTY OWNER I ❑ TENANT Expansion tank 12.51
Name: 77-7/11 IAJ! J 5 Fixture/sewer cap 25.02
Address: / 3 42I S D-j -7 'c -c. L Floor gedr oor sink hub 25.02
r Garbage disposal 25.02
City/State/ZIP: 7° C�,...rj C<�CkC J
/ Hose bib 25.02
Phone:( ,..r �7,,r6 Fax:( ) Ice maker 12.51
APPLICANT ACOLTACT PERSON Interceptor/grease trap 25.02
ar. ///�� aatis
Business name: Medical gas(value:$_) Page 2
j r- r /� �j� e..�- Roofrimer 12.51
Contact name: K J /`/ f L
/ drain(commercial) 12.51
Address: 9 6l65' SIAf OQ [" ed Sink/basin/lavatory 25.02
` / U
City/State/ZIP: j f�G.1(+G'1�,_)/d7^-P ) 77 a s I' Solar units(potable water) 62.54
Phone:( ) O x::( ) Tub/shower/shower pan l 12.51
E-mail: CCC Urinal 25.02
Water closet 25.02
CONTRACTOR
Business name: d (- Water heater 37.52
Water piping/DW V 56.29
Address: / 3 , i f , (N 79 (,t2'.(1-c' A-,"J Other: 25.02
City/State/ZIP: tf c-P1-,C) ( , -11-1 -� Subtotal
Phone:( ) Fax:( ) Minimum permit fee: $72.50
Plan review (25%of permit fee)
CCB Lic.: Plumbing Lic.no.:
State surcharge(12%of permit fee)
Authorized signature: TOTAL PERMIT FEE
�1 This permit application expires if a permit is Dot obtained within 180 days
Print riamC/j(��am r,- Date: -� after it has been accepted as complete.
J *Fee methodology set by Tri-County Building Industry Service Board.
1:1BuildingWermitssWLMU-PermitApp.doc 10/01/09 440-46I6T(19/02/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-I'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
Other Inspections or Fees Qty. Fee(ea) Total 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/hi 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
❑ 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
Car Wash: -Each Stall ❑ New exterior plumbing site utilities for any complex structure
as defined in OAR918-780-0040.
-Drive T ru
Cuspidor/Water Aspirator ❑ Medical gas and vacuum systems for health care facilities.
Dishwasher: -Commercialirator ❑ 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"
3 Isometric or Riser Diagram
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: -Lay/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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