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Permit -, CITY OF TIGARD PLUMBING PERMIT - COMMUNITY DEVELOPMENT Permit #: PLM2012 -00011 1 IGAD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 01/17/2012 R, Parcel: 2S104DCO3400 Jurisdiction: Tigard Site address: 13167 SW CLEARVIEW WAY Project: HENIFF Subdivision: BENCHVIEW ESTATES Lot: 34 Project Description: Master bathroom remodel. Contractor: CLASSIC PLUMBING LLC Owner: HENIFF, DAVID E & MELLANIE M 521 S BALINE ST 13167 SW CLEARVIEW WAY NEWBERG, OR 97132 TIGARD, OR 97223 PHONE: 503 - 554 -1605 PHONE. FAX: 503 - 538 -8570 FEES Quantity Description Date Amount 1 ea Fixture /Sewer Cap 01/17/2012 $25.02 Specifics: 2 ea Sink 01/17/2012 $50.04 1 ea Tub /Shower /Shower Pan 01/17/2012 $12.51 Type of Use: SF 1 ea Water Closet 01/17/2012 $25.02 Class of Work: ALT 1 12% State Surcharge - 01/17/2012 $13.51 Type of Const: Plumbing Occupancy Grp: Stories: Total $126.10 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 ma obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. Issued By: ..... AHHIA mo , 411 111111P Permittee Signature: ` 1 Call . • • . 5 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 COS) FoR OFFICE USE ONLY i City of Tigard �� �^ Date /B / / 7 ` Permit No.n f , ��.r.- �\ I ( n 1 3125 SW Hall Blvd., Tigard, OR 9 1. y rr `' �� tt VV 1 Plan R eview . M : Phone: 503.718.2439 Fax: 503.5 �' ": t, ti Other Permit No.: Date/By: Inspection Line: 503.639.4175 �\ T I GA R D � 4� �` ' Date Ready/By: kids: H See Page 2 for ww Internet: w.tigard- or.gov Notified/Method: Trz, Supplemental Information TYPE OF WORK ® I S) ` FEE* SCHEDULE ■ ❑ Dem�1 For special information use checklist ‘, Descri.tion Qt Ea. Total '�.. Addition/alteration/replacement ❑ Oth 11 ft. for each utility connection) CATEGORY OF CONSTRUCTION 1 V ' 1- and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 437.78 bath 500.32 ❑ Accessory building ❑ Multi - family Each additional bath/kitchen 25.02 ❑ Master builder ❑ Other: . JOB SITE INFORMATION AND LOCATION Site utilities: Catch basin or area 18.76 Job site address: \‘...?s\ b (___X .1 � to '1 drain Drywell, leach line, City /State /ZIP: el - 1. - 17 Footing drain (no. linear ft.: _.) Page 2 ' ' • 18.76 Suite/bldg. /apt. no.: N I Project name: Manufactured home utilities 50.03 Cross street/directions to job site: Manholes 18.76 drain Rain 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 Tax map /parcel no.: ' ' A DESCRIPTION ` OOF y` WOORK �`�QJ ,�� Backwater valve 12.51 \`s `�r���o.)� \ ...)h . ` 1 lam',\ `v �i ` ` Dishwasher , 1 Drinking fountain 25.02 % � 9 . A Q � c R . . _ % . \ - - - v 3V J 2 r i l k e d N& 2 L ,v S 25.02 0 PROPERTY OWNER I ❑ TENANT Expansion tank II ®� Fixture/sewer cap Name: �. K._ �Th fit- 1'I•�Y \‘ C ( T ` .. a s 25.02 Address: \�`\Cfk �� kj‘�W W44. .._ disposal 1 City /State /ZIP: \ ,` O� l c it -) Hose bib 25.02 Phone:( ) Fax:( ) Ice maker 12.51 0 APPLICANT 0 CONTACT , PERSON Interceptor/grease trap 25.02 Medical gas (value: $ ) Page 2 Business name: Primer 12.51 Contact name: Roof drain (commercial) 12.5 I Address: I. I 1 (potable City/State/ZIP: • Solar units Phone: ( ) Fax: : ( ) Tub/shower/shower pan V 12.51 /4 51 Urinal E -mail: Water closet 1. 1 1 CONTRACTOR Water heater 37.52 Business name: L \=4• t` \n.J,�� + ••■ C \— LL piping/DWV Address: \ ' , . l ' Mt.. � L . Other: 25.02 City /State /ZIP: 'tom 0I(� t • Z Subtotal o Phone: ( r — l r , i 4 �► Minimum permit fee: $72.50 --- CCB Lic.: \.�1Sko ' A _ Plan review (25% of permit fee) ' State surcharge (12% of permit fee) / , 5 Authorized signature: ` 7 �" l TOTAL PERMIT FEE 01# g 1 1 Print name: ---`� v \ Date: , \ 1 1'� � This permit application expires if a permit is not obtained withi 180 days 1 after it has been accepted as complete. *Fee methodology set by Tri- County Building Industry Service Board. C\ Building\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 - 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 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 . . Plan Review for Plumbing Installations Quantity by Fixture Type Plan review is required for any of the following. Fixture Type for Replace/ Please check all that apply. Work Performed: Capped Added Relocate pp y' ❑ Any new commercial building with water service 2" and Bapti stry/Font Bash Tub /Shower greater, except systems designed and stamped by licensed - Jacuzzi /Whirlpool engineer. Car Wash: Each Stall ❑ New exterior plumbing site utilities for any complex structure Drive Thru as defined in OAR918- 780 -0040. Cuspidor /Water Aspirator ❑ Medical gas.and vacuum systems for health care facilities. Dishwasher: Commercial ❑ Any multipurpose fire sprinkler system. Domestic ❑ Any complex structure as defined in OAR918- 780 -0040. Drinking Fountain Eye Wash Submit 2 sets of plans with any of the above. Floor Drain/sink: - 2" 3 " Isometric or Riser Diagram ❑ Isometric or riser diagram is required for new buildings -Car Wash Drain Garbage - Domestic non -food that meet the qualifications above. Disposal: - Domestic food related - Commercial food related - Industrial food related Ice Mach. /Refrig. Drains Comments regarding fixture work: Oil Separator (Gas Station) Rec. Vehicle Dump Station Shower: -Gang - Stall Sink: - LavBar non -food related - Bradley - Com/Serv/Util food related . . - Service *Note: If the fixture work under this permit results in an Swimming Pool Filter increase of sewer EDUs, a sewer permit will be issued and Washer - Clothes Water Extractor fees assessed for the sewer increase must be paid before the Water Closet- Toilet plumbing permit can be issued. Urinal Other Fixtures: I:\Building\Permits \PLMF - PermitApp.doc 08/04/2011 2