Permit CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit #: PLM2011 -00276
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 09/01/2011
Parcel: 2S111BA00807
• Jurisdiction: Tigard
Site address: 14270 SW 100TH AVE
Project: Smith Subdivision: FOUR SEASONS, THE Lot: 10, PLU:
Project Description: Add new soaking tub to master bath.
Contractor: LOTUS PLUMBING COMPANY Owner: TREICHLER, LAURA K
8100 SW ELMWOOD ST WILSON, JOHN C
PORTLAND, OR 97223 WOOD, SALLY L ET AL
14270 SW 100TH AVE
PORTLAND, OR 97224
PHONE: 503 - 522 -2728 PHONE.
FAX: 503 - 892 -2639
FEES
Quantity Description Date Amount
1 ea Tub /Shower /Shower Pan 09/01/2011 $12.51
Specifics: 1 12% State Surcharge - 09/01/2011 $8.70
Plumbing
Type of Use SF 60 ea Minimum Fee Adjustment - 09/01/2011 $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 more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notificatia 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 dir questions to b NC by c- g 503.232.1987 or 1.800.332.2344.
Iss ed By: % Permittee Signature:
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 . ,.
i
Building Fixtures -,..,!... ,,....,,, , • .
FOR OFFICE USE ONLY
c r t if , ' ''', . ,
City of Tigard
Permit No.: jr . ed , ,/ ... A74,
I 13125 SW Hall Blvd., Tigard, OR 97223 0.*'''' .\. ,-0'\\ p D t a an ie/B Re y vi : ew
: .' 2 •
• Phone: 503.639.4171 Fax: 503.598.1960 ...? , ,cli?ate/Ety: Other Permit No.:
Inspection Line: 503.639.4175
TI,GARb ,,.. --; \C„ ‘15ato hlris: Fil See Page 2 for
Internet: www.tigard-or.gov ,. ..r.,1 CW t,.. IV tlifted/Method: - r --- _, Supplemental Information
TYPE OF WORK - ' -` - FEF! S6POIJCC;
.. - - tVe '1 ) %. •
0 New construction 0 Demolit ,..1,,...,
For special information use checklist
n
Description I Qty. I Ea. I Total
O lkddition/alteration/replacement 0 Other: New 1 - 2-family dwellings (includes 100 ft. for each utility connection)
.-. ,,,-:,:-;:,.'--, A;j' •?-'-.;-.,.?---:':;"' CATEGORY OF 'CONSTRUCTIOlsi.:;.° --: ' - - - T -. ";' : SFR (1) bath 249.20
and 2-family dwelling 0 Commercial/industrial SFR (2) bath 350.00
SFR (3) bath 399.00
0 Accessory building 0 Multi-family
Each additional bath/kitchen 45.00
0 Master builder 0 Other:
Fire sprinkler ( sq. ft.) Page 2
: :. - . :„..„ ,..4.,- JOR 517 LOCATION ' • - Site utilities '
Job site address: / t../ 5(3 / 0 0 -.--- _1 - Catch basin or area drain 16.60
City/State/ZIP:Tri v7 ( cV 4 722_3 Drywell, leach line, or trench drain 16.60
Footing drain (no. linear ft.: ) Page 2
Suite/bldg./apt. no.: Project name: ---- t ehiLed____
Manufactured home utilities 110.00
Cross street/directions to job site:
Manholes 16.60
P c Do -,- 'Lc( ( t <2 , Rain drain connector 16.60
Sanitary sewer (no. linear ft.: ) Page 2
Storm sewer (no. linear ft.: ) Page 2
Subdivision: Lot no.:
Water service (no. linear ft.: ) Page 2
1
Fixture or item
Tax map/parcel no.: a; / / 1 44-696) key-7
Absorption valve 16.60
1 , ,1 t= ' -,, '`:'• 4 ''''' btkiliiii ON OT '. - - ;,--- , , -,,- :-,•:-.,--
•,. . -._ .- ,,,,:,,z,, .. ..,, .r...; .,.... ......s.,.,-..,, - ,. - ...: ,.,.- --2., _ „-,,• • , s ,, ,-.:. Backflow preventer Page 2 ,..
4 Z4-5 4 / t s--, - . kj". ) <:/) GI i t V-4 Jo Backwater valve . 16.60
j ra 64 7 - Clothes washer 16.60
Dishwasher 16.60
''.' ,•--- .17:1 P ROPE RTY ' ' ' ''''" ' " , car - 1-.4 ' '', ' ' .4 ' 1 --, . -- - , ` .= . -,•, ,. - Drinking fountain 16.60
:',.- ' .,;!-•- .g - - - Li 0 1-
vv, OWNE ',. - di --'2i !W ".-. '12.' TENANT :1, ',--". 4-, • .*':
Ejectors/sump 16.60
Name: - t e.-fri-f 2 4..4ci dry- Expansion tank 16.60
Address: Fixture/sewer cap 16.60
City/State/ZIP: Floor drain/floor sink/hub 16.60
Phone: ( ) Fax: ( ) Garbage disposal . 16.60
P' I'EllakIFf,""W.2:.Ii-A -2 '';' 7 7 ' Er" Hose bib 16.60
. „
-''''' 1 " Ice maker 16.60
Business name:
Interceptor/grease trap 16.60
Contact name: Medical gas (value: $ ) Page 2
Address: Primer 16.60
City/State/ZIP: Roof drain (commercial) 16.60
Sink/basin/lavatory 16.60
Phone: ( ) I Fax: : ( )
Tub/shower/shower pan . / 16.60
E-mail:
Urinal 16.60
. • :. i;..! i=.,:•%. c y ,-.: -„_;. -z:... , .CON171AC39147 5 -1' ''' ,: ,.:: - - -- :::: ,, *17, - ,:k e :V;; Water closet 16.60
Business name: L e 1, 5 7 h/,---t. ati , Water heater 16.60
Address:TO cf 6 4, . , Other:
Subtotal j
City/State/ZIP:7704,1/4"d o_w ot 722 Minimum permit fee: $72.50
Phone: (5 6,2 a , A 7 A sli Fax: (cap ci-4 2_ A 39 Residential backflow minimum permit fee: $36.25
CCB Lic.: /8'qi, Plumbing Lic. no.: ?,'3 6/_S"-- Plan review (25% of permit fee)
State surcharge (8% of permit fee)
Authorized signature: / , <1 0...e..„4-(....------ TOTAL PERMIT FEE
Print name:, . A/6 44. t .. ! . ‘ „..., Date: 5 o v6 .z / 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.
1:1Building\PermitskPLMF-PermitApp.doc 12/27/06 440-4616T(10/02/COM/WEB)
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site_.Utilities " ' . -: . " .. . Q�.. , . Fee lea) Total Square Footage: " . ' 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•-
Va °• „<�, _,.<
uation: - r -, 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
,i .„ additional $100.00 or fraction thereof, to and
Fiztui-e_ Iten'w � �:. _ ",�"
:. Qty. Fee (ea) Total 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
Inspection of existing plumbing or each additional $100.00 or fraction thereof, to
and including $50,000.00.
specially requested inspections - per hour 72.50
Subtotal: $50 and up $742.00 for the first $50,000.00 and $1.20 for
each additional $100.00 or fraction thereof.
Fixture Work: r Plan Review, for Plumbing Installations .
Are you capping, adding or replacing futures? 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*. ❑ Any new commercial building with water service 2" and
`'� ° ` ' °' ` °4" 1„ Quantity by afore Work Performed.
greater, except systems designed and stamped by licensed
= Fixture Type; °tr, -t t ,. - ,,., . _ -,,i i : t' -i, ;,° ° -; Replace : engineer.
% . ° ", : "' :;0- z� `Prev,00s' capp ' "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 a . .
Drinking Fountain . ; . Isometne, or. Riser. Diagram -- • -
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 avatory
- Brad ey *Note: If the fixture work under this permit results in an
- Commerci. increase of sewer EDUs, a sewer permit will be issued and
- ervice 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:
i:\ Building \Permits4PLM- PermitApp.doc 12/27/06