Permit .,) n� ,
r
PLUMBING PERMIT
frr CITY OF TIGARD
°" -! 2 , ' COMMUNITY DEVELOPMENT Permit #: PLM2009 -00280
TIGARI 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 10/07/2009
Parcel: 25101 BCO2201
Jurisdiction: Tigard
Site address: 8300 SW HUNZIKER RD
Subdivision: Lot: 0 '
Project: Western Partitions
Project Description: Replace (7) w /c, (5) lays, and (1) urinal. Repalce (1) w/c with urinal. Add (1) 2" floor drain.
Owner: FEES
HUNZIKER ONE LLC Quantity Description Date Amount
956 WEST POINT RD
LAKE OSWEGO, OR 97034 1 ea Floor Drain /Floor Sink/Hub 10/07/2009 $25.02
PHONE: 5 ea Lavatories 10/07/2009 $125.10
2 ea Urinal 10/07/2009 $50.04
7 ea Water Closet 10/07/2009 $175.14
Contractor: 1 12% State Surcharge - 10/07/2009 $45.04
MODERN PLUMBING Plumbing
11120 SW INDUSTRIAL WAY
TUALATIN, OR 97062
PHONE: 503 - 691 -6166
FAX:
Type of Use: COM
Class of Work: ALT Type of Const:
Occupancy Grp: •
Stories:
Total $420.34
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: q l�
r( � ^, , G(/� �� /� 11 t_ / ,� 1F /� jz t Permittee Signature: , _
� Call 50 by 7:00 a.m. for an inspection that business day. ,' J,,
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 FOR OFFICE USE ONLY"
Received �
City of 'Tigard Date By Permit No f i h- n X1 Q
• 13125 SW Hall Blvd., Tig OR 97223 ► fL IN
Plan Review
711 111 Phone: 503.639.4171 Fax: 503.598.1960 Date By .ither 1?erintt No a d e 2ocrtota q,
' Inspection Line: 503.639.4175 Date Ready/By. Rmis:. H See Page 2 for
TI GA Fad Internet: www.ti d -or. ov
g� g Notified/Method: X (t1 Supplemental Information
r ''' ` ':'ii-OF Sf ORS -
a FEE* eSCHEDL?LE :..
❑ New construction - ❑ Demolition For special information use checklist
Description I Qt I Ea. I Total
[51-Addition /alteration/replacement ❑ Other. New 1 - 2 - family dwellings (includes 100 ft. for each utility connection) •
. 'CATEGORY OF,'C-- ONS'TRPCTION , _ SFR (1) bath 249.20
❑ I- and 2- family dwelling IkCammercial/industrial SFR (2) bath 350.00
ID Accessory building • ID Multi-family SFR (3) bath 399.00
Each additional bath/kitchen 45.00
❑ Master builder ❑ Other
Fire g F sprinkler ( sq. ft.) Page 2
_
:. JOB SITE_:.INFORNLATION =t.ND icicAiION Site ut llties
Job site address: 8 30 $ l,J 1-fun u IfG Qom Catch basin or area drain 16.60
City/ State / ZIP: i c u. r d_ 8r2 q
Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: ` Project name: w PS'' yl PA..../ 6 h r,.� Footing drain (no. linear fl : ) Page 2
Manufactured home utilities 110.00
Cross street/directions to job site:
Manholes 16.60
77 4 - 0 - 11'td-s (rLa /p 5c f y Rain drain connector 16.60
Sanitary sewer (no. linear ft.: ) Page 2
Storm sewer (no. linear R: ) Page 2
Subdivision: (Lot no.: Water service (no. linear ft.: ) Page 2
Tax map /parcel no.: a S 1s 1 8 c0 l- a 0) Fixture or hem
w Absorption valve
- +
_ Absaptt 16.60
DESCRIPTION OF - 3t "ORh Backflow presenter Page 2
7D / k/ L s 4 S jet ✓.S Backwater valve 16.60
a „� p Aa L. tl „vJ , � / () ," Clothes washer 16.60
! / f�""�""" t� 1, / 1 Dishwasher 16.60
1 �1�
r `7 l JV Ur at A1 Dr6ilking fountain 16.60
❑ "PROPER'\\ - OWNER' ' -• ` ' ' ❑ TEN+kNT
Ejectors/sump 16.60
Name: Expansion tank 16.60
Address: Fixture /sewer cap 16.60
City/State/ZIP: Floor drain/floor sink/hub I )0 „C • Q a
Phone: ( )
Fax ( ) Garbage disposal 16.60
.
Hose 60
-:❑ •1 PPI�IG _� Nf ❑` C bNT _Nei. PERSCIN
. 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
.-- d ^ ___ Sink/basin/lavatory 60
Phone: ( ) ,Fax :: (I r ) f a_i
E -mail:
U U I 7 Tub /shower /shower pan 16.60
Urinal "2.
,' '; r.; C'C)NI'K4CTOR - e
�,_.: : Water closet 7
»
Business name: Modern Plumbing Co. 1.!__ ° t: -- Water heater 16.60 r15 , ti t
Address: 11120 SW Industrial Way Other: '7
. City/State/ZIP: Tualatin, OR 97062 • Subtotal a ro
Minimum permit fee: $72.50
Phone: (503) 691 6166 Fax: (503 ) 691 6771 Residential backflow minimum permit fee: $36.25 3 5 3 0
CCB Lie.: 87906 Plumbing Lie. no.: 34 250PB Plan review (25% of permit fee) 45.
State surcharge (12% of permit fee)
Authorized signatur .
/ I TOTAL PERMIT FEE 1 )
Print name:t, Y )( r (�t�.�y 5 Jr Date: f p I/ 1 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 Boa 2
1�tding \Pettttits\PL� � �� � � C � ���: 34 l< Q.) � 4-• � ZLJ • �/
360• •
Plumbing Permit Application - City of Tigard ()-
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Si Ut i l ities cam- F (en) . :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 lt)0' 46.40
Water Service - tst 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
' 'Flxture;o item . Qty'. 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
Inspection of existing plumbing or each'additronal $100.00 or fraction thereof to
specially requested inspections - per hour 72.50 and including 0.00.
•
Subtotal: $50,001.00 and up $742.00 for the first $50,000.00 and $1.20 for
each additional $I00.00 or fraction thereof.
Fixture Work: .
_� -- Plan_ Review -for Plumbing Insfallatlous,
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 *. ❑ Any new commercial building with water service 2" and
Qaantrt -b (Future) Z� oil. Performed'. greater. except systems designed and stamped by licensed
Fixture Tigre :_ p la ce engineer.
,Pre'ioua Capperi' 4dded Etta ❑ Any new exterior pltunhing site utilities.
Ba , ❑ Medical gas and vacuunrsv.stems for health care facilities.
Bath - Tub/Shower ❑ Any multipurpose fire sprinkler system.
- Jacuzzi/Whirlpool ❑ Any complex structure as defined in OAR918- 780 -0040.
Car Wash -Each Stall
DCive 1ru Submit 2 sets of plans with any of the above.
Cuspidor Water Aspirator
Dishwasher - Commercial
- Domestic 50Inrac et or Riser ia m g r r_ .. - .
Drinking Fountain ❑ Isometric or riser diagram is required for new buildings
Eye Wash that meet the qualifications above.
Floor Drain /sink - 2" l
-3"
4 " Comments regarding fixture work:
Car Wash Drain
Garbage - Domestic
Disposal - Commercial
- Industrial
Ice MachJRefrig. Drains
Oil Separator (Gas Station)
Rec. Vehicle Dump Station
Shower -Gang *Note: If the fixture work under this permit results in an
-Stall increase of sewer EDUs, a sewer permit will be issued and
Sink - Bar /Lavatory ,S .5"- fees assessed for the sewer increase must be paid before the
- Bradley \
Con n,ercial plumbing permit can be issued.
- Service
Swimming Pool Filter
\Washer - Clothes •
Water Extractor
Water Closet - Toilet .... 7 .
Urinal I Z
Other Fixtures: I fl �G1
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i:\ Building \Pennits\PLM - Permit ipp.doc 09/22/06 •