Permit CITY OF TIGARD PLUMBING PERMIT
114
s COMMUNITY DEVELOPMENT Permit #: PLM2012 -00089
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 04/20/2012
Parcel: 2S102BD00701
Jurisdiction: Tigard
Site address: 12785 SW PACIFIC HWY
Project: Burgerville Subdivision:RTH TIGARDVILLE ADDITION, AMENC Lot: 8
Project Description: Interior plumbing.
Contractor: PORTLAND MECHANICAL CONTRACTORS Owner: BENNETH, CATHERINE MCNICOL
2000 SE HANNA HARVESTER DR 3830 ROBIN CREEK LN
MILWAUKIE, OR 97222 WEST LINN, OR 97068
PHONE: 503 -656 -7400 PHONE:
FAX: 503 - 655 -0620
FEES
Quantity Description Date Amount
1 ea Dishwasher 04 /20/2012 $25.02
Specifics: 12 ea Floor Drain /Floor Sink/Hub 04 /20/2012 $300.24
2 ea Hose Bib 04/20/2012 $50.04
Type of Use: COM 2 ea Ice Maker 04 /20/2012 $25.02
Class of Work: ALT 6 ea Primer 04 /20/2012 $75.06
Type of Const: 8 ea Sink 04/20/2012 $200.16
Occupancy Grp: 1 ea Urinal 04 /20/2012 $25.02
Stories: 3 ea Water Closet 04/20 /2012 $75.06
1 ea Water Heater 04 /20/2012 $37.52
1 12% State Surcharge - 04/20/2012 $97.58
Plumbing
Total $910.72
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 -00 0090. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800 -
Issued By: / Permittee Signa • I a
Call 503.639.4175 by 7:00 a.m. for the next availabl inspectio date.
This permit card shall be kept in a conspicuous place on the job s e until c • • pletion of the project.
Approved plans are required on the job site at the time o each inspection.
Plumbing Permit Application 0S l 11_,. j 1 do , i - r
_
� FOR OFFICE USE ONLY
Building Fixtures ®V I o
c t J�� Received • City of Tigard % ` Date/By: iilE Permit No.: ` • i
II U 13125 SW Hall Blvd., Tigard, 3 Q Plan Review -
0 Phone: 503.639.4171 Fax: 503.598.1 t et G P ` Q D ate /B y: Other Permit No.: .� u
Inspection Line: 503 c � e `��\ ��(� r `�
T I G A R D Q` 0��1 Date Ready/By: Juris: See age 2 for
Internet: www.tigard or.gov �\'' � i Notified/Method: p Supplemental Information
TYPE OF WORK , ) ' FEE* SCHEDULE
❑ New construction ❑ Demolition For special information use checklist
Description 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
❑ 1- 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: 12785 SW Pacific Hwy Catch basin or area drain 18.76
Drywell, leach line, or trench drain 18.76
City /State /ZIP: Tigard OR 97223
Footing drain (no. linear ft.: ) Page 2
Suite/bldg. /apt. no.: I Project name: Burgerville #45 Tigard Manufactured home utilities 50.03
Cross street/directions to job site: 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
Install plumbing systems for build -out.
Dishwasher 1 25.02 25.02
Drinking fountain 25.02
Ejectors /sump 25.02
❑ PROPERTY OWNER I ® TENANT Expansion tank 12.51
Name: Burgerville #45 Fixture /sewer cap 25.02
Floor drain/floor sink/hub 12 25.02 300.24
Address: 12785 SW Pacific Hwy
Garbage disposal 25.02
City /State /ZIP: Tigard OR 97223 Hose bib 2 25.02 50.04
Phone: ( ) Fax: ( ) Ice maker 2 12.51 25.02
® APPLICANT ® CONTACT PERSON Interceptor /grease trap 25.02
Business name: Portland Mechanical Contractors Medical gas (value: $ ) Page 2
Primer 6 12.51 75.06
Contact name: Paul Hettervig
Roof drain (commercial) 12.51
Address: 2000 SE Hanna Harvester Drive Sink/basin/lavatory 8 25.02 200.16
City /State /ZIP: Milwaukie OR 97222 Solar units (potable water) 62.54
Phone: (503) 656 -7400 I Fax: : (503) 655 -0620 Tub /shower /shower pan 12.51
E -mail: paulh @pmc -g.com Urinal 1 25.02 25.02
CONTRACTOR Water closet 3 25.02 75.06
Water heater I 37.52 37.52
Business name: Same as above.
Water P i p In WV 56.29
Address: Other: 25.02
City /State /ZIP: Subtotal 813.14
Phone: ( ) Fax: ( )
Minimum permit fee: $72.50
CCB Lic.: 151807 • ,. ' . robing Lic. no.: 3 -425PB Plan review (25% of permit fee)
State surcharge (12% of permit fee) 97.58
Authorized signs EPPP. L I , I TOTAL PERMIT FEE 910.72
Print name: Paul Hett Date: 4 s , 7 This permit application expires if a permit is not obtained within 180 days
, l after it has been accepted as complete.
*Fee methodology set by Tri -County Building Industry Service Board.
I:\ Building \Permits\PLMU- PermitApp.doc 10/01/09 440-4616T(t0 /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 - In 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 - 1 st 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
P 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 Plan Review for Plumbing Installations
accurately report fixtures could result in increased sewer fees *. 'Plan review is required for any of the following.
Quantity by (Fixture) Work Performed Please check all that apply.
Fixture Type: Replace
Previous Capped Added Existing El Any new commercial building with water service 2" and
Baptistry/Font greater, except systems designed and stamped by licensed
Bath - Tub /Shower engineer.
- Jacuzzi/Whirlpool ❑ New exterior plumbing site utilities for any complex structure
Car Wash -Each Stall as defined in OAR918- 780 -0040.
-Drive Thru ❑ Medical gas and vacuum systems for health care facilities.
Cuspidor/Water Aspirator ❑ Any multipurpose fire sprinkler system.
Dishwasher - Commercial L ❑ Any complex structure as defined in OAR918- 780 -0040.
- Domestic
Drinking Fountain Submit 2 sets of plans with any of the above.
Eye Wash
Floor Drain/sink - 2" I.Q Isometric or Riser Diagram
-3"
❑ Isometric or riser diagram is required for new buildings
Car Wash Drain that meet the qualifications above.
Garbage - Domestic
Disposal - Commercial
- Industrial
Ice Mach./Refrig. Drains Comments regarding fixture work:
Oil Separator (Gas Station)
Rec. Vehicle Dump Station
Shower -Gang
-Stall
Sink - Bar/Lavatory a_
- Bradley
- Commercial
- Service *Note: If the fixture work under this permit results in an
Swimming Pool Filter ❑❑
Washer Clothes increase of sewer EDUs, a sewer permit will be issued and
Water Extractor fees assessed for the sewer increase must be paid before the
WaterCloset - Toilet plumbing permit can be issued.
Urinal
Other Fixtures:
H:\Departments \New Div 71 Mech & Plumbing\Projects \Small Projects - 20000 Series \I 1700 - 11799 Job Folders \1 1 704 -7 -1 2 Burgerville #45
Tigard \City of Tigard - Plumbing Fixture Units.doc