Permit CITY OF TIGARD PLUMBING PERMIT
• COMMUNITY DEVELOPMENT Permit #: PLM2009 -00217
-T. f GARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 08/11/2009
Parcel: 2S 103CC07400
Jurisdiction: Tigard
Site address: 13580 SW 124TH AVE
Subdivision: WHISTLER'S WALK Lot: 21
Project: O'Brien
Project Description: Add full bathroom and bar sink to basement.
Owner: FEES
O'BRIEN, MICHAEL D Quantity Description Date Amount
13580 SW 124TH AVE
TIGARD, OR 97223 2 ea Lavatories 08/11/2009 $33.20
PHONE: 1 ea Tub /Shower /Shower Pan 08/11/2009 $16.60
1 ea Water Closet 08/11/2009 $16.60
1 12% State Surcharge - 08/11/2009 $8.70
Contractor: Plumbing
KEVIN SHARPE PLUMBING 6 ea Minimum Fee Adjustment - 08/11/2009 $6.10
PO BOX 80907 Plumbing
PORTLAND, OR 97280
PHONE: 503 - 697 -6949
FAX: 503 - 697 -6949
Type of Use: SF
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 more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notif - • - ter. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain a copy of the rules
or dir- • questions to 0 • by . g 50 .246.6699 or 1.800.332.2344.
Issu • d By: � / Permittee Signature: y c
I
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.
Plumbing Permit Application'
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uilding Fixtures ` ' ..4' j I
City of Tigard �I I ail 2009 Received ii M 6 Permit No. 0009 -& oi l 7
II • 13125 SW Hall Blvd., Tigard, My /223
Date/By. V �i '
Plan Review
Phone: 503.639 4171 Fax: 5 GARD Date/By. Other Permit No
'' v
Inspection Line: 503.639.41 1 1
Ti G A R D a n QION Date Date Ready/By , tern A ® See Page 2 for
Internet: www.tigard- or.gorl '`I n ,� u,,.-1 Notified/Method 7 Supplemental Information
TYPE OF WORK FEE* SCHEDULE '''
❑ New construction ❑ Demolition For special information use checklist
Description Qty. I Ea. I Total
SAddition/alteration/replacement ❑ Other: New I - 2 - family dwellings (includes 100 ft for each utility connection)
CATEGORY OF -CONSTRUCTION SFR (1) bath 249.20
1- and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 350.00
❑ Accessory building ❑ Multi - family SFR (3) bath 399.00
❑ Master builder Each additional bath/kitchen 45.00
❑ Other: Fire sprinkler (_ sq. ft.) Page 2
r " JOI Si: Y1 0:4111 TTON M4D CATION
... � S ut
Job site address: 1 3'5 $ 0 S W \ 2 t-' +4 A v cy Catch basin or area drain 16.60
City /State /ZIP: 't ( y1/4.Ca Ore o o.' t i 7 2 3, Drywell, leach line, or trench drain 16.60
Suite/bldg./apt. no.: Project name: Footing drain (no. linear ft.: ) Page 2
Cross street /directions to job site:
Manufactured home utilities 110.00
Manholes 16.60
5LJ 12,E s'- r G o e_ Rain drain connector 16.60
Sanitary sewer (no. linear ft.: ) Page 2
Storm sewer (no. linear ft.: ) Page 2
Subdivision: I Lot no.: Water service (no. linear ft.: ) Page 2
Tax map /parcel no.:
Fixture or item
_ & Absorption valve 16.60
-
a l t d d �� Backflow preventer Page 2
add c t,� \\ \00..A'ArC o c y cx r ck 1c)ck.r 5 1 I \ 1L Backwater valve 16.60
\ n Vnc�G e NINIeh't Clothes washer 16
Dishwasher 16.60
PROpETkTY o*I■rE`ii I °p Tif4Aivr `
Drinking fountain 16.60
Ejectors /sump 16.60
Name: “\'t Or) CCk_e_ \ 0 ,` ■ e Expansion tank 16.60
Address: \ 35 g 0 5 \ 2t ' l I v e el tff Fixture /sewer cap 16.60
City /State /ZIP: "1 ciar a I Or e C j o r 91 2.13 Floor drain /floor sink/hub 16.60
Phone: (S03) '1 Si - 3$ O (� y .241, Fax: (50 'l '66 ° 3 g $S Garbage disposal 16.60
"; ` �;`tv�4 ■ �� .a o T a t 1 � ` t3I ' R Hose bib 16.60
Ice maker 16.60
Business name: S Ina ( e P \ I,VY,b1 n)
P Interceptor /grease trap 16.60
Contact name: \/e. x ih ts r - Reti cc 0.._ 9,16..c e e Medical gas (value: $ ) Page 2
Address: P epx 239g1 Primer 16.60
City /State /ZIP: 'r q a r C { 1 O(Z <R 1 Z g I Roof drain (commercial) 16.60
Phone: (503) 590- _J DSp Fax: (5Q3) S 9 --]QS6 Sink /basin lavatory 16.60
()
Tub /shower /shower pan J 16.60
E -mail: -
--
Urinal 16.60
Ct?JTRACTOR " ` Water closet 16.60
Business name: S h Ct.(p e e‘ 1 l allot vi) Water heater 16.60
Address: f p 601 2 39 VI Other:
- t• - 1 a id I 02 612--8 � Subtotal
City /State /ZIP:
r- Minimum permit fee: $72.50 �, b�
b
Phone: ( b3) S DJ__ - dso F ax: ( S0 -7QJ a Residential backflow minimum permit fee. $36.25
CCB Lic.: I `Z g q $ Plumbing Lic. no.: 2 t - 593 7 , Plan review (25% of permit fee) ..-
State surcharge (12% of permit fee) g. ?�
Authorized signature: c� a A
i �-tJ �- TOTAL PERMIT FEE g,
Print name: 1. E V IN 51-114 (L Pe- Date: g I p 21)01 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.
1.\ Building \Permits\PLMF- PermitApp. doc 12/27/06 440- 4616T(10 /02 /C0M/WEB)
Plumbing Permit Application - City of Tigard
•
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site :Utilities QtY. F ee (ea) ri ft $ acre oo
Footage' ....q�>t ,._. g u Permit Fee:
Footing drain - 1 100' 55.00 0 to 2,000 $115.00
Footing drain - each additional 100' 46.40 2,001 to 3,600 $160.00
3,601 to 7,200 $220.00
Sewer - 1st 100' 55.00 7,201 and greater $309.00
Sewer - each additional 100' 46.40
Water Service - 1st 100' 55.00 Medical Gas Systems:
Water Service - each additional 100' 46.40 Valuation: Permit Fee:
Storm & Rain Drain - 1st 100' 55.00 $1.00 to $5,000 00 Minimum fee $72.50
Storm & Rain Drain - each additional 100' 46.40 $5,001.00 to $10,000.00 $72.50 for the first $5,000.00 and $1.52 for each
Fixture or Item
ON' Fee (ea) Total additional $100.00 or fraction thereof, to and
including $10,000.00.
Commercial Back Flow Prevention Device 46.40 $10,001.00 to $25,000.00 $148.50 for the first $10,000.00 and $1.54 for
Residential Backflow 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
each additional $100.00 or fraction thereof, to
Inspection of existing plumbing or and including $50,000.00.
specially requested inspections - per hour 72.50 $50,001.00 and up $742.00 for the first $50,000.00 and $1.20 for
Subtotal: each additional $100.00 or fraction thereof.
Commercial Fixture Work: Plan Review for Plumbing Installations
Are 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 *. 111 Any new commercial building with water service 2" and
Quantity_by (Fixture) Work Performed greater, except systems designed and stamped by licensed
Fixture Type: Replace engineer.
.: Previous Capped Added Existing ❑ New exterior plumbing site utilities for any complex structure
Baptistry/Font as defined in OAR918- 780 -0040.
Bath - Tub /Shower ❑ 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 Submit 2 sets of plans with any of the above.
Dishwasher - Commercial
- Domestic
Drinking Fountain I some t r i c ‘ ,1 7 ,
Eye Wash ❑ Isometric or riser diagram is required for new buildings
Floor Drain /sink - 2" that meet the qualifications above.
-3"
Car Wash Drain
Garbage - Domestic Comments regarding fixture work:
Disposal - Commercial
- Industrial
Ice Mach./Refrig. Drains
Oil Separator (Gas Station)
Rec. Vehicle Dump Station
Shower -Gang
-Stall
Sink - Bar/Lavatory
- Bradley *Note: If the fixture work under this permit results in an
- Commercial increase of sewer EDUs, a sewer permit will be issued and
- Service fees assessed for the sewer increase must be paid before the
Swimming Pool Filter plumbing permit can be issued.
Washer - Clothes
Water Extractor
Water Closet - Toilet
Urinal
Other Fixtures:
is\ Building \Permits\PLM- PermitApp.don 12/27/06