Permit •� CITY OF TIGARD PLUMBING PERMIT
11 11 ' . ` COMMUNITY DEVELO PMENT Permit #: PLM2011 -00302
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718 2439 Date Issued: 10/05/2011
Parcel: 2S112CA06800
Jurisdiction: Tigard
Site address: 15374 SW THURSTON LN
Project: Dana Subdivision: ASHFORD OAKS Lot: 22
Project Description: Laundry and kitchen fixtures
Contractor: PORTLANDS REMODELING SOLUTIONS LLC Owner: DANA, MARC R & KRISTEN L
2606 A ST. 15374 SW THURSTON LN
FOREST GROVE, OR 97116 TIGARD, OR 97224
PHONE 503 - 793 -4338 PHONE.
FAX 503 - 357 -0407
FEES
Quantity Description Date Amount
1 ea Clothes Washer 10/05/2011 $25.02
Specifics: 1 ea Dishwasher 10/05/2011 $25.02
1 ea Garbage Disposal 10/05/2011 $25.02
Type of Use: SF 1 ea Hose Bib 10/05/2011 $25 02
Class of Work: ALT 1 ea Ice Maker 10/05/2011 $12.51
Type of Const: 1 ea Sink 10/05/2011 $25 02
Occupancy Grp: 1 ea Laundry Tray 10/05/2011 $25 02
Stories: 1 12% State Surcharge - 10/05/2011 $19 52
Plumbing
Total $182.15
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 N ation Ce _ . 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 OUN • by c. • 51 - 232.1987 or 1 800 332.2344
Issu d By: J i 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
Building Fixtures FOR OFFICE USE ONLY .
City of Tigard Received Permit No ,
O� � D/ / '��V 36
.0 13125 SW Hall Blvd , Tigard, OR 97223 Date/By. /0��/0/64 ifi1�
Pl
t a : Phone' 503.718 2439 Fax 503 598.1960 D ate/By an Review Other Permit No
Date/By
T I G A R D Inspection Line 503.639.4175 Date Ready/By furls ® See Page 2 for
Internet. www.tigard- or.gov Notified/Method Supplemental Information
TYPE OF WORK , FEE* SCHEDULE
❑ New construction ❑ Demolition For special information use checklist.
_ / Description Qty Ea. I Total
E Addition/alteration/replacement ❑ Other: New 1 - 2 - family dwellings (includes 100 ft for each utility connection)
CATEGORY OF CONSTRUCTION SFR (1) bath 312.70
Ll ►- 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: J 5 -4, y c5 W in u r5 I o 1 . h Catch basin or area drain 18.76
`
{ Drywell, leach line, or trench drain 18 76
City/State/ZIP: 0 Col 0 P. I Footing drain (no linear ft. ) Page 2
Suite/bldg. /apt. no.: Project name: Manufactured home utilities 50.03
Cross street/directions to job site: T 9 ,t4,1 Ave , 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: 1 Lot no.: Fixture or item:
'
Tax map /parcel no.: Backflow preventer 31 27
DESCRIPTION OF WORK Backwater valve 12 51
9 J Clothes washer .1(/ 25 02
Rada In ) , -1 1 G 4 / U (c w kid 9 Sid o 4 --/' ,/ l.( O Dishwasher 1-
Dishwasher 02
(5( it: 4 I yt C 7(R 1) F> .I iuyes ,f) r1 r; rl fl LI tor U Drinking fountain 25 02
/t( / 1L C in P, n - Ejectors/sump - 25 02
❑ PROPERTY OWNER ❑ TENANT Expansion tank 12 51
Name: Fixture /sewer cap 25 02
Floor drain/floor sink/hub 25.02
Address:
Garbage disposal 1 25.02
City /State /ZIP: _ Hose bib .1- 25.02
Phone: ( ) Fax: ( ) Ice maker 12.51
of ❑ 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 12.51
E -mail: Urinal 25.02
Water closet ' 25.02
CONTRACTOR
Water heater 37 52
Business name: ,r4 )4,n pi '5 �elmnOQ l�yt �O1 U 1 r0
5 �' ! h Water piping/DWV 56.29
Address: 7 60, 6 At 0 _I" Other 25 02
City /State /ZIP: FOY 6Yf1Ue O R 9 7 i) 6 Subtotal /6,2 .63
Phone: (so3) 46)3-- 1 Fax: ( ) Minimum permit fee' $72.50
CCB Lic.: 3 -4 Q 02 _ Plumbing Lic. no.6;35 Z Plan review (25% of permit fee) ------'
State surcharge (12% of permit fee) / g.5
Authorized si ature: TOTAL PERMIT FEE i ii
Print name: - / Date: This permit application expires if a permit is not obtained within 180 days
�l/�IOAJ CV�1N ��� � � after it has been accepted as complete.
*Fee methodology set by Tn -County Building Industry Service Board.
I \Budding\Permits\PLMU- PermitApp doc 10/01/09 440- 4616T(10/02 /COM/WEB)
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 - 1s 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 & Ram Drain - 1st 100' 62 54 Valuation: Permit Fee:
$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 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 ",
please indicate work performed by fixture. 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.
Baptistry/Font Please check all that apply.
Bath Tub /Shower ❑ Any new commercial building with water service 2" and
Jacuzzi /Whirlpool greater, except systems designed and stamped by licensed
Car Wash -Each Stall engineer.
-Drive Thru ❑ 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 ❑ Any multipurpose fire sprinkler system.
Drinking Fountain - ❑ Any complex structure as defined in OAR918- 780 -0040.
Eye Wash
Floor Dram/sink - 2" Submit 2 sets of plans with any of the above.
-3"
Isometric or Riser Diagram
Car Wash Drain ❑ Isometric or riser diagram is required for new buildings - Domestic - non - food s
g q g
Disposal - Domestic 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/Lav - Non -food related
- Bradley
- Commercial -food related
- Service
Swimming Pool Filter *Note: If the fixture work under this permit results in an
Washer - Clothes
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
L\Buil ding \Permits\PLMF - PermitApp.doc 02/24/2011 2