Permit CITY OF TIGARD PLUMBING PERMIT
` ' COMMUNITY DEVELOPMENT Permit #: PLM2009 -00289
,TjGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Date Issued: 10/13/2009
Parcel: 2S103BD01800
Jurisdiction: Tigard
Site address: 11905 SW CARMEN ST
Subdivision: Lot: 0
Project: Wiencek
Project Description: Shower pan replacement.
Owner: FEES
WIENCEK, DAVID Quantity Description Date Amount
11905 SW CARMEN ST
TIGARD, OR 97223 1 ea Tub /Shower /Shower Pan 10/13/2009 $12.51
1 12% State Surcharge - 10/13/2009 $8.70
PHONE: 503 - 989 -7387 Plumbing
60 ea Minimum Fee Adjustment - 10/13/2009 $59.99
Contractor: Plumbing
MERRIMAN PLUMBING
P.O. BOX 246
BRUSH PRAIRIE, WA 98606
PHONE: 360- 518 -1362
FAX: 360- 891 -4265
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 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
or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By: l'.t/l.` J Permittee Signature: n A
x.0 p p •
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.
Oct 13 09 05:50p MERRIMAN PLUMBING, LLC (360) 891 -4265 p.1
Pjumbingj ertnit Application
kr• 1 '7 D
Building Fixtures IH:t)1A I l 1 !c i. 1 ,1 41•\I '
City of Tigard T t 3 7.009 Rerriveri ! Perm No., I th .A - • OO. i 4
13125 SW Hall Blvd.. Tigard- OR 97123
Plan Review
N.> Phone: 5113.639.41;1 Fax: 5(73.598-: GF TIGARD D.../By; Other Per,Ot Ro•
i r ,: I Inspection line: 503.639.4175
> D N
1 L DING DI VISION. Ante yray el See Pasczfar
;C�: �te1 retema; wens -0r a Notified/Method, 1, tementel Information
�!�� ��F', t�q.��Tr r r. .ter- �• T'�. �•vr � .. ���y��. b r� !�•�• �_
� ilife1. r igli9'� : '''''.. ^7 r Alif l0.i at.:ri!� ma:�Y1`J4iw i C � n' .�i,r M sore y M W r . -
❑ New construction 1:1 Demolition
For Taint iaJnna�ean rtserhetiAfixt
Decal 'bon [ Qty. 1 Pa. [ Total
13 Addition /alteration/replacement 0 Other. New 1.2 -fnut ly dwell . (snctudes 100 ft. for cach uuli connection)
Kw" r' v� ' 1 tip `7 nivl t
' MtaYmT '- : •I .`t 75 ^3 :: . w };-i b++�+,r• v,..:..6 v • r o ��� i i' SPR w balk 312.70
1 - and 2- family dwelling ❑ Commciclallthdttl • A SFR (2) bath 437.71
1:1 Accessory building Q Mull- family ' ` SFR (3) bath .1.11 500.32
Each additional bath/kitchen 25.02
CI Master builder
��yy r�ti ❑ Other: N. ' r I , ,.,wd,, (_ sq. ft.) Eng
'idw; xk!'4fi? S'` ~ `, 1 s :: 5t1�. H,4 .1F : ` .
t�.�" t1 )vc 4 �.� >> lig7-av Aft:
Job si te address: 11,905 SW Carmen $t. r�j 1. �
�A ' • /itch basin or arts drain 18.76 '
City/State/ZIP: Tigard, OR 97333 `` Drywv11. leach line, or trench drain 18.76
VI. }� Footing dean (no. linear 0.: _) Paga 2
Suite/bldg./apt. no.: I Project name: Manufactured home utilities . 50.03
Cr otas street/directions to job site: Off SW 121st. One hIock south itl Walnut Manholes 18.76
Rain drain connector 18.76
Sanitary sewer (no. linear ft. _ 1 Page 2
Storm sewer (no. linear ft.: Page 2
Water service (re. linear ft.: 1 Page 2
Subdivision: Lot no.:
Fixture or item:
Tax map/parael Ito.: Rackflow ersventer 31.27
r r{ t4 ? ? dv y , r .,, . 5. !`'' yi p t Backwatrxralvc 1251
'i>Y . b .. . �! ; 7 r � :. r r, i + . -44 t.1 f'r �rx'47;+�t ,1 "'k. l l:�, r.' ': o
+tn tit i 1$t arr ltrsl , n a Mal GS washer 25.02
B.11ansi m remodel - replace fiberp,1aan shower shell. Shower pan Installation Dishwasher 25.02
Drinking fountain 25.02
E+ectora/sump 25.02
� n:.1v .. , 4i' . e 7 . . r;
+ • �b.���vmr��nV�IR5c'1�tZik3 dlai�raiitdN13s1 }�. ..r.�.an+� . f'' T !�H.+A. Expansion tank 12_51
Name: David Wiencek Fixture/sewer car 25.02
Address; 11905 SW Carmen Si
Floor draintfloor sink/huh 25.02
Cxirbage disposal 25.02 l
City/State/ZIP: Tigard,, OR 9722.3 • Hose bib 25.02
Moue: (5113)989 -73.87 Fax: ( ) 'Ice maker 1231
r . •r' nk� snin. c� :.i��i
�� �ti' .. • 2.5 .02
� • 4 '' 1 •Bfl'(�,tGi'' a�W n�it.lti �)s..>ldhs�Pn ` ) � ,.� ;• � Intercepter/grease trap
Business name: Medical gas (valve: S ) Page 2
Contact name:
Primer 12.51
Roof drain (commercial) 12,51
Address:
Sink/basin/lavatory 25 02
City/State/ZIP:
Solar units (potable water) 62,54
Mime: ( ) .Fax:: ( ) 1tib /stiower/showcrpa 12.51 12.51
E -mail: Urinal 25 " 02
i; �' kN, ,�. Water closet 25 • ht ,-,fdt� . . . 't h vY :.`i " ^, . ., ' {:. rer3' ; 1 . gvti v; . �• 4 ., ;c �t 1
. � i ; :. . w�fs�ek' � ?. . . s water hemp- 37.52
8urtress name aQ l l
d1,Al Wnta pi ping/DYN 56.2S
Address: 9-13. e ttIC T-01) Other.
�xYt rd 25,02
City/State/ZIP' tL
• .7 • " , • i r Subtotal 125)
Phone: • (3CO b, /1 .). - : �i (d 0) ' Minimum permit fee 572.50 72.50
CCS Lie.: 1 53 :s 4 Plumbing tic. nn": ��j Plan review (25% of permit foe)
Stec surcharge (12% of permit fez) 8.70
y _ Authorised signature • �, W /
���-.�-�,' , ,�� . �. �... : TOTAL PFsRM 1T FME 81.20
4 . . • AA" ' _ I • Date 0 This 'wrath applieatim, captrei N r permll Y not eht,.ined with 31110 days
after it her Nom necepted es eampleI.
'Fee methodology stn by T- i"County Building Industry Service Board_
trnwild ingWmnionmmt..p ,1iAm.Aine Inn? IA19 4 e0H6167 1 roevcomfwesi
•
Plumbing Permit Application
��CE���
Building Fixtures milimitiosummi.
City of Tigard ()CI 1 2009 uat
�</ Permit No.:p) ?m 6o a89
IIII a 13125 SW Hall Blvd., Tigard, OR 97223 `
a Phone: 503.639.4171 Fax: 503.598.1 Plan Review Other Permit No.:
Inspection Line: 503.639.4175 OF T IGARD DateB
T I G A k D
BUILDING DIVISION Date Ready /By: u i See Page 2 for
g g BUIL N % Supplemental Information
Internet: www.tigard-or.gov
TYPE OF WORK. FEE" '.SCHEDULE
❑ New construction ❑ Demolition For special information use checklist.
Description I Qty. - I Ea. I Total
® Addition/alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION • ' - SFR (1) bath 312.70
® I- and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 437.78
SFR (3) bath 500.32
❑ Accessory building ❑ Multi- family
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: 11905 SW Carmen St. Catch basin or area drain 18.76
City /State/ZIP: Tigard, OR 97333 Drywell, leach line, or trench drain 18.76
Footing drain (no. linear ft.: _) Page 2
Suite/bldg. /apt. no.: 1 Project name: Manufactured home utilities 50.03
Cross street/directions to job site: Off SW 121st. One block south of Walnut 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
Clothes washer 25.02
Bathroom remodel - replace fiberglass shower shell. Shower pan installation Dishwasher 25.02
Drinking fountain 25.02
• Ejectors /sump 25.02
- ® PROPERTY OWNER ` ,: ❑ Expansion tank 12.51
Name: David Wiencek Fixture/sewer cap 25.02
Floor drain /floor sink/hub 25.02
Address: 11905 SW Carmen St.
Garbage disposal 25.02
City / State/ZIP: Tigard, OR 97223 Hose bib 25.02
Phone: (503)989 -7387 Fax: ( ) Ice maker 12.51
® APPLICANT ❑ - CONTACT PERSON Interceptor /grease trap 25.02
Business name:
Medical gas (value: $ ) Page 2
Primer 12.51
Contact name:
Roof drain (commercial) 12.51
Address: Sink/basin/lavatory 25.02
City/State/ZIP: Solar units (potable water) 62.54
Phone: ( ) Fax: : ( ) Tub /shower /shower pan 1 12.51 12.51
E-mail: Urinal 25.02
CONTRACTOR - , , v Water closet 25.02
Water heater 37.52
Business name: ti), Q f1(; nOx urn 0 1 Water piping/DWV 56.29
Address: P O e Q4 t I Other: 25.02
City /State/ZIP: t�5� �( (cur, ( , 9) I0l /� ). - Subtotal 12.51
Phone: 3 b � .-- 3 8 I Fax: (0 �' (s vl 1 . 4 a Minimum permit fee: $72.50 72.50
C 'R Plan review (25% of permit fee)
CCB Lic.: ' 533 as -_,, Plumbing Lic. no.: 3-- e>
State surcharge (12% of permit fee) 8.70
* Authorized signature: _ - TOTAL PERMIT FEE 81.20
Print name: - Date: I �� 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 \PI.MU- PermitApp.doc 10/01/09 440- 46t6T(10 /02/COM/W13B)
Plumbing Permit Application - City of Tigard -
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Fee {ea)` . Total.
Site Utilities. Q 'Square Footage: Pe>rinit. 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
Storm & Rain Drain - 1st 100' 62.54 Valuation: _ Permit Fee :, w,
$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• or Fees Qty ;.. Fee (0) r Total each additional $100.00 or fraction thereof, to
Inspections. () 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/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 - 1/2 hour) each additional $100.00 or fraction thereof.
Subtotal:
Commercial Fixture Work:
Are you capping, adding or replacing fixtures? If "yes ", Plan Review for Plumbing Installations
please indicate work performed by fixture. Failure to Plan review is required for any of the following.
accurately report fixtures could result in increased sewer fees*. Please check all that apply.
Quantity by (Fixture) Work Performed ❑ Any new commercial building with water service 2" and
Fixture Type: Replace greater, except systems designed and stamped by licensed
Previous Capped Added Existing engineer.
Baptistry/Font
Bath - Tub /Shower El New exterior plumbing site utilities for any complex structure
as defined in OAR918- 780 -0040.
- Jacuzzi/Whirlpool
Car Wash Each Stall ❑ Medical gas and vacuum systems for health care facilities.
Drive tall ❑ Any multipurpose fire sprinkler system.
Cuspidor/Water Aspirator ❑ Any complex structure as defined in OAR918- 780 -0040.
Dishwasher - Commercial
Domestic Submit 2 sets of plans with any of the above.
Drinking Fountain
Eye Wash Isometric of Riser 'Diagram ° - `
Floor Drain/sink - 2" ❑ Isometric or riser diagram is required for new buildings
3 that meet the qualifications above.
-4 „
Car Wash Drain
Garbage - Domestic
Disposal -Commercial Comments ad
re din fixture work:
- Industrial regarding
Ice Mach./Refrig. Drains
Oil Separator (Gas Station)
Rec. Vehicle Dump Station
Shower -Gang •
-Stall
Sink - Bar /Lavatory
- Bradley
- Commercial *Note: If the fixture work under this permit results in an
- Service increase of sewer EDUs, a sewer permit will be issued and
Swimming Pool Filter
Washer - Clothes fees assessed for the sewer increase must be paid before the
Water Extractor plumbing permit can be issued. •
Water Closet - Toilet
Urinal
Other Fixtures:
http: / /www. tigard -or. gov /ci ty_hal l/ departments /cd/docs/PLMF- PetmitApedoc