Permit IN CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit #: PLM2011 -00217
T1CrAAD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 07/12/2011
Parcel: 2S 111 BA01500
Jurisdiction: Tigard
Site address: 9755 SW INEZ ST
Project: Frederick Subdivision: Lot:
Project Description: New indirect water heater and 8' of pipe.
Contractor: POINT PLUMBING Owner: FREDERICK, SCOTT G & KATHLEEN R
4200 SW 175TH AVE 9755 SW INEZ
ALOHA, OR 97007 TIGARD, OR 97223
PHONE: 503 - 265 -1708 PHONE:
FAX: 503 - 268 -1567
FEES
Quantity Description Date Amount
1 ea Water Heater 07/12/2011 $37.52
Specifics: 25 Misc Other Fee 07/12/2011 $25.02
1 12% State Surcharge - 07/12/2011 $8.70
Type of Use: SF Plumbing
Class of Work: ALT 10 ea Minimum Fee Adjustment - 07/12/2011 $9.96
Plumbing
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 -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: `��� //// 11-4-- Permittee Signature: Ow /97 /e4
��' lll��� ���/// 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.
Jul 08 11 09:08a Josh 503 -268 -1567 p.1 __
RECEIVED
Plumbing Permit Application
Building Fixtures JUL 0 8 2011 I ot: ui 1 1( 1 1 ., t1\.1
City of Tigard I �7F TIGA-RD R0a' ' /a /i � r N�:
13125 SW Hall Blvd.. T' : • FF �a1a0// -t702/7
'' I ' Phone: 503.718.2439 F. , t DIVISION P DatdBy. w Otis Pumit No.:
. `. _` ,; i , Inspection Line: 503.639.4175
Date Internet: www.tigard or.gov Sf See Page I roe
Supptemen taf orraatim
TYPE OF WORK FEE. SCHEDULE
❑ New construction ❑ Demolition
For special brjennadoa use dFetatllsL
ra ' Description I Qty. 1 Ea. I Total
Addition/alteration/replacement ❑ Other. New 1 - 2-family dwelllny (includes 100 R for each utility connection)
CATEGORY OF CONSTRUCTION SFR (1) bath 312.70
[l 1- and 2-family dwelling 0 Commercial/ industrial SFR (2) bath 437.78
0 Accessory building 0 Multi- family SFR (3) bath 500.32
D Master builder 0 Other: Each additional bath/kitchen 25.02
Fire sprinkler (__ sq. ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: .17 55 5 • in/ • . /7 e 2. -
Catch brim or area dram 1 8.76
Q � Drywall, leach line, or trench drain 18.76
City/StattlZlP
�o r' f - 0 i2 . - 1 -7 . } `t. Footing drain (no. linear ft.:, ) Page 2
Suite/bldgiapt no,: (Project [tame: Manufactured home utilities 50.03
Cross street/directions to job site: 472‘,... D v 1. r t /DP 4-- / 00 7h Manholes
18.76
Rain drain connector 18.76
Sanitary sewer (no. linear ft.: 1 Page 2 .
Strum sewer (no. linear ft.: __,_) Page 2
Water service (no. linear ft.: _) Page 2
Subdivision: I Lot no.:
Fixture or bean:
Tax map/pareel no.: Backflow preventer 31.27
y r) J
DESCRIPTION OF WORK valve 12 52
new i' Y' ! to vv %t: pit-- 1,-e e2-- /--ZK Dishwasher washer 25.02
Dishwashher 25.02
•
Drinking fountain 25.02
D I of pip �- Ejectors/sump 25.02
❑ PROPERTY OWNER I 0 TENANT Expansion tank 12.51
Name: •.'r - ,d t Fixuve /sewer cap 25.02
Address: Floor drain/floor sink/hub 25.02
City/State/ZIP: Garbage disposal 25.02
Hose bib 25.02
Phone: ( ) Fax: ( ) Ice maker 12.51
❑ APPLICANT ❑ CONTACT PERSON lnterceptot /8rease trap 25.02
Business name: poi n -r p L V ern b / rl Medical gas (value: S _ } Page 2
� .v S� / p Primer 12.51
Contact tame: U >�v n(�5
Roof drain (commercial) 12.51
Address: Li 2 5 i; /7,5.44" _ Sink/basin/lavatory 25.02
City/State/ZIP: `.1.‘ o‘^ta Q P., 7O 7 --- Solar units (potable water) 62.54
Phone: (503) o)-(oCe -- I . 7Q S Fax:: (5 ,3) atvS- 456 Tub/showcr /shower pan 12.51
E-mail: s , , ,,I_ P \;1 i � (� 1 9 ✓i'1 r 1` <,.C7 ,,., Urinal 25.02
CONTRACTOR Water closet 25.02
�.• Water heater t 37.52
Business nine: q) •". VY� \ �/ jvt), \.. VI 1 Water piping/DWV 56.29
Address: (- la) O 5 tru. i 75 Other. ' e-k- Q 1Q - e- f 25.02
City/State/ZIP: A 9g. 97 Subtotal
Phone: (5)3 ) O` � g . _ 17o Fax' IrSt7 ) Minimum permit fee: 572.50 7� • 5 )
- / Sto 7 ?1/ f �y Plan review permit fee)
451../<CB Lic.: / b a 6 2, Plumbing Lic no. S ( p / / (25� of n fce State surcharge(12%of permit fee) p, 70
Authorized signature: ..,,,„_,...---^
TOTAL PERMIT FEE .
n p .....7.....).4-r-7,----- f Print name: Oa, 7� 6 d t'vt t r s s c y I Date: 7 .--g-ti permit " it has mtr■ permit is not obtained within 180 days
accepted as complete.
"Fee methodology set by Trri- County Building Industry Service Board.
t:u .nr.
kuc ..itAp,da 10,01109 44046t6Tttarovntrw
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Jul 08 11 09:10a Josh 503 - 268 -1567 p.1
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 - 1' 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
and including $10,000.00.
Inspection of existing plumbing or for $10,001.00 In $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 -112 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 future. Failure to
accurately report fixtures could result in increased sewer fees * .
Quantity by Fixture Type Plan Review for Plumbing Installations
Fixture Type for Replace/
Work Performed: Capped Added Relocate Plan review is required for any of the following.
Please check all that apply.
Baptistry/Font
Bath - Tub/Shower ❑ Any new commercial building with water service 2" and
lacuui/Whirlpool greater, except systems designed and stamped by licensed
Car Wash - Each Stall engineer.
-Drive Thru El New exterior plumbing site utilities for any complex structure
Cuspidor/Water Aspirator as defined in OAR918- 780 -0040.
Dishwasher - Commercial ❑ Medical gas and vacuum systems for health care facilities.
- Domestic El Any multipurpose fire sprinkler system.
Drinking Fountain ❑ Any complex structure as defined in OAR918- 780 -0040.
Eye Wash
Floor Drain/sink - 2" Submit 2 sets of plans with any of the above.
-3"
Isometric or Riser Diagram
Car Wash Drain
Garbage - Domestic - non - food ❑ Isometric or riser diagram is required for new buildings
Disposal - Domestic - food related that meet the qualifications above.
- Commercial -food related
- Industrial -food related
Ice Mach./Refrig. Drains
Oil Separator (Gas Station) Comments regarding fixture work:
Rec. Vehicle Dump Station
Shower -Gang
-Stall
Sink/I_av - Non -food related -
- Bradley
- Commercial -food related
- Service
Swimming Pool Filter *Note: If the fixture work under this permit results in an
Washer - Clothes p
Water Extractor increase of sewer EDUs, a sewer permit will be issued and
Water Closet - Toilet fees assessed for the sewer increase must be paid before the
Urinal plumbing permit can be issued.
Other Fixtures:
http : / /www.tigani -0r.gov/ city_ hall /depattmets s /cd/docs/PLMF- PetmitApedoc