Permit CITY OF TIGARD PLUMBING PERMIT
'l COMMUNITY DEVELOPMENT Permit #: PLM2009-00124
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 05/20/2009
Parcel: 1S135DC08600
Jurisdiction: Tigard
Site address: ( 11.520,SW 92ND AVE
Subdivision: MLP97 -0010 DOWNING Lot: 2
Project: Specialized Housing
Project Description: Replace tub and w /c.
Owner: FEES
SPECIALIZED HOUSING, INC Quantity Description Date Amount
4140 SW 109TH AVE
BEAVERTON, OR 97005 1 ea Tub /Shower /Shower Pan 05/20/2009 $16.60
1 ea Water Closet 05/20/2009 $16.60
PHONE: 1 12% State Surcharge - 05/20/2009 $8.70
Plumbing
Contractor: 39 ea Minimum Fee Adjustment 05/20/2009 $39.30
BEAVERTON PLUMBING INC - Plumbing
13980 SW TV HWY
BEAVERTON, OR 97005
PHONE: 503 - 643 -7619
FAX: 503 - 643 -7620
Type of Use:
Class of Work: 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 Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain a copy of the rules
Issued By: 4 Permittee Signature:
0/V 6P/ e'- 1 97 7®//
Call 503.639.4175 by 7:00 a.m. for an inspection that business day.
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.
05/12/2009 12:08pm #174 Page 02/03
...uni
rermn Application
... ,.. • .... ,. -
Building Fixtures riii-,.1 FIVFC i ' . FO oir. L1SL 61N•1;Y:
' : • ...- City of Tigard R r... , 9 _ ..cps
Pcnnit NO.: puri2ap.aot
'• .,...% ' R 13125 SW Hall Blvd., Tigard, OR 97223 M YA 1 2 Z 009 a"/ • t
I • , . .
IN 1 Phone: 503.639.4171 Fax; 503.598.1960
Plan Review
Datc./Dy: Other Permit No.:
TWARD
Inspection line: 503.639,4175
•
CITY OF TIGARD Date Rearly/By: 1 El See l'ngr 1 for
Internet: www.tigard-rgov
.•. .....,. les pi rth Notifithimood: Tic I supplemental loinrrnntion
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['New construction 0 Demolition For special information use checklist
• Description I Qty, 1 1 / Total
EJ Addition/alterationireplacument 0 Other:
New 1 - 2-family dwellings (includes 100 R. for each utility connection)
:, ; :. ...... 1..... :.'. '.:. :•:'..-.:::::'...:',' q4 0 : - j , : : :'l P''::;,' SFR (1) bath 249.20
..._
0 I- and 2-family dwelling - El Commercial/industrial - strial SFR (2) bath 350.00
SFR 399.00
U Accessory building p Multi-family (3) bath
Each additional bath/kitchen 45,00
D Master builder 0 Other: _!______
:: , , ... .., „,. ,.., Fire sprinkler ( sq. ft.) Page 2
':-,...:..,.V'*it:)ikFtiitAlketii*i*NtittiCAllioN,-::;ii:i,,?::::...'..!.:::,...,' Site utilities
Job site address: 11520 SW 92" AVE __
Catch basin or area drain 16.60
City/State/ZIP: TIGARD, OREGON 97223 Drywell, leach line, or trench drain 16,60
Fooling drain (no. linear ff.: _) Pac 2
Suite/bldg./apt. no.: Project name:
_
Manufactured home utilities 110.00
Cross Street/directions to job site:
-
Manholes 16.60
_______________ _ Rain drain connector 16,60
Sanitary sewer (no, linear It,: _..,_) Page 2
Storm sown: (nu. linear ft.: ) Pag _
Water service (nu. linvat it! ) Page 2
Subdivision:
Lot no.:
-
Fixture or item
Tax map/parcel no.:
16.60
., ,.. .:;;:..,::. 7 ." , ! i . !'‘'1ii : 4 0i 11 00$0 : : . *Ot 1 *:'! ; P : ;A:i1:' . i.'; A:.',:': :.:*. 13ackflow preventer Page 2
REMOVE CRACKED TI.113 Al) REPLACE Will I NEW ONE Backwater valve 16.60
REMOVE BROKEN TOILET AND REPI .A CE WITH NEW ONE _ Clothes washer 16,60
_
_
•
Dishwasher 16.60
16.60
16.60
Name; SPECIALIZED DOUSING
Expansion tank 16.60
Address:
Fixture/sewer cap 16,60
City/State/Zip:
Floor drain/floor sink/hub 16.60
- _
Phone: (503)469,9248 XT 10 Fax: (503)469.9826 Garbage disposal 16,60
16.6,0
trk.Apii .7777b,&il- Hose bib
16.60
Business name: BEAVERTON PLUMBING, INC
Interceptor/grease trap 16.60
Contact name: NEAL FOUTS
Medical gas (value: $ ) Page 2
Address: 13980 SW TuA LATIN VALLEY HWY Primnr 16,60
City/State/7,1P: BEAVERTON, OREGON 97005 Ruuf drain (commercial) 7 ,6.60
I
PhOlic. (503) 643.7619 Fax; : (503) 643.7620 Sink/basin/lavatory 6.60
-
V Tub/shower/shower pan 1 16.60 16.60
F.-ma 11: sue@beaventonplum,,king.co,
, lirinal 16,60
• :'-::::: V:: . . ..: : . : * 1 **i 4 7*:1 : ,',•: ,.f'''''::.. ':'"," Water closet I 16,60 16.60
• i
Business name; BEAVERTON PLUIVIBING, INC Water heater 16.60
_ .
Address: 13980 SW TUALATIN VALLEY HWY Other:
City/State/ZIP! RF.AVERTON, OREGON 97005
Minimum permi Subtotal
t fee; $72.50
72.50
Phone: (503) 643.7619 Fax: (503) 643.7620 Residential backflow minimum permit fee: $36,25
CCB Lie.: 12889 Plumbing Lie. taa,: 34-4PB Flan review (25% of permit fee)
State surcharge (12% of permit fee) 8.70
Authorizcd sipaturc: _., caQr
..._,_
TOTAL PERMIT FEE 81.20
- 1 -
Fint name: SUSAN DEAN Date: 5112/2009 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,
lAlanildinTcrmitAPLIs4F-retrnitApp do; 15/27/05 440-4616T( i 0/01.k701WW1i13)
#174 Page 03103
05/12/2009 12 :09pm
Piflmbin Per Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Sur ressionl Systems
Site:1tilit'e ' ; 0t} F.e (ea) Tmroi .
A s r flare'Foot`u ` 1 resit Fee:'
Footing drain 1 "' 100' 55.00 0 to 2,000 -
$115,00
hooting drain - each additional 100' 41;,40 2.001 to 3,600 $160.00
Sewer - 1st 100' 55,00 3 .601 to 7,200 $220.00
7,201 and greater $309.00
— Sewer - each additional 100' 46.40
Water Service - 1st 100' 55.00
Water Service - each additional 100' 46.40 Medical Gas Systems:
Storm 3i: Rain Drain - 1st 100 55.00 V luation Pe nit_ ee;
Storm &Ram Urain -each additional 1 UO' $1,00 to $5,000.00 Minimum tee $72.50
46.40 $5,001.00 to $10,000.00 172.50 for the first $5,000.00 and $1.52 for each
Fixture or Item Qty. 1 ec'(ea) : Tota l,
addition& $100.00 or fraction thereof, to and
Commercial Back Flow Prevention Device `^ - including $10,000.00.
4640 $10,001.00 to $25,000.00 $ 148,50 for the first $10,000.00 and $1.54 for
Residential I3ackllow Prevention Device _ each additional $100.00 or fraction thereof, to
(minimum permit fee $36,25) 27.55 _ and including $25,000.00.
Rain Drain, single family dwelling 65.25 $25,001.00 to $50,000.00 $379.50 for the first $25,000,00 and $1,45 for
Inspection of existing plumbing or each additional $100.00 or fraction thereof, to
specially requested inspections - per hour 72.90 and including $50,000,00.
Subtotal: $50,001.00 and up $742.00 for the first $50,000.00 and $1.20 for
each additional $100.00 or fraction thereof.
■ a .
Commercial Fixture Work: lsl 01 ie►y for immibin 'Yi3stall t ion c
Arc you capping, adding or replacing fixtures? If "yes ", Plan review is required for any of the following.
please indicate work performed by fixture. Failure to Please check all that apply.
accurately report fixtures could result in increased sewer fees*. El Any new commercial huilding with wirier service 2" and
nand ' b bailie Work 1?CrPormed ".; greater, except systems designed laud stamped by licensed
.Fixture'Typc •
:.. aentaei ". engineer.
.. Prevaouia' Ca 1 ' d Addt F... iia CI New exterior plumbing site utilities for any complex structure
aapustry /Font as defined in OAR918 -780- 0040.
Bath - Tub /Shower I ❑ Medical gas and vacuum systems for health care facilities.
- Jacuzzi/Whirlpool ❑ Any multipurpose fire sprinkler system,
Car Wash -Each Stall
❑ Any complex structure as defined in OAR918- 780 -0040.
-Drive Thru
Cuspidor /Water Aspirator
Dishwasher - Commercial Submit 2 sets of plans with any of the above.
- Domestic
Drinking Fountain
' ISomm'metrie, or Riser 'D iagram
Eye Wash - ❑ Isometric or riser diagram is required for new buildings
Floor Drain /sink - 2" that meet the qualifications above.
3
-4 „
Car Wash Drain
Garbage - Domestic Comments re
Disposal - cnn,ana rcial — regarding fixture work:
- Industrial REMOVE AND REPLACE CRACKED TUB
Ice Mach.iRelrig. Drains REMOVE AND REPLACE BROKEN TOTLE'I'
Oil Separator (Gus Station)
Rec. Vehicle Dump Station
Shower - Garry
-Stall
-
Sink - Rer/LOvutory
- Bradley — *Note; If the fixture work under this permit results in an
- Commercial J increase of sewer EDIfs, a sewer permit will be issued and
Service fees assessed for the sewer increase must be paid before the
swimming Pool i•'ihcr
washer - Clothes plumbing permit can be issued.
Water Extractor
Water Closet - Toilet I
Urinal
Other Fixtures:
is18UiIdlag \Permits\'LM- PcrmitApp due 12/27/06