Permit CITY OF TIGARD PLUMBING PERMIT
1,1 - � '� Permit #: PLM2012 -00242
.. COMMUNITY DEVELOPMENT Date Issued: 08/21/2012
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Parcel: 2S104DB02500
Jurisdiction: Tigard
Site address: 13133 SW ROCKINGHAM DR
Project: Dicken Subdivision: AMESBURY HEIGHTS Lot: 25
Project Description: (1) lay, (1) shower and (1) tub for bath remodel
Contractor: POWER PLUMBING CO Owner: DICKEN, KEVIN R & ANN T
PO BOX 19418 13133 SW ROCKINGHAM DR
PORTLAND, OR 97280 TIGARD, OR 97223
PHONE:
PHONE: 503 - 244 -1900
FAX: 503 - 244 -8825
FEES
Quantity Description Date Amount
1 ea Lavatories 08/21/2012 $25.02
Specifics: 2 ea Tub /Shower /Shower Pan 08/21/2012 $25.02
1 12% State Surcharge - 08/21/2012 $8.70
Type of Use: SF Plumbing
Class of Work: ALT P2 ea Minimum Fee Adjustment - 08/21/2012 $22.46
Plumbing
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 -0090. You may obtain a copy of the rules
or direct questions too by calling 503.232.1987 or 1.800.332.2344. /
Issued By: ,((/ Permittee Signature: 0/17 / G / /0 /
� 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.
AUG/17/2012/FR I 11:40 AM POWER PLUMBING FAX No, 503 244 8825 P. 001
PlumbinE Permit Application
Building Fixtures FOR OFFICE USE ONLY
City of Tigard RECEIVED Received
Datc/BY! CrAdrAng Pcrmit1 -10,...,79
li . 13125 SW Hall Blvd., Tigard, OR 97 g _ 2 0 2012. Plan Review
Phone: 503,7182439 Fax: 503.592MAD Date/By. Other Permit No.:
Inspection Line: 503.639.41'75
TIGARD Date Ready/By: raiti , See Page 2 for
Internet; www.tigard-orgov iii 1 I , ••• ,': a Nonfied/Method: i -.., Su , plerneolal Information
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For , ectal In ormadon use checklist
I2 New construction • Demolition •
Description Ea. Total
i'r■ Addition/alteration/replacement El Other. New I- 2-family dwellin . s (includes 100 ft, for each utili connection)
re;31ilig -1 111ZIFP, ', ; ,. . 7 -.;,• " :; " 4;4'1;41' SFR (1 ) tut 312.70
1F. I- and 2-family dwelling 1:j Commercial/industrial SFR (2) bath grail NEM
SFR (3) bath 500.32
0 Accessory building El Multi-family
Each additional bath/kitchen 25.02
El Master builder 0 Other: Fire sprinkler ( sq. ft) Page 2
■;1. k ' Ix ' .' Site utilities:
I l m
Job site address: 1 3 13 L () 7117( , o Catch basin or area drain 18.76
4 Drywell, leach line, or trench drain 18.76
City/State/ZIP: / AA4 Chf I - ... Footing drain (no. linear ft: 111M Page 2
Suite/bldg./apt no.: Project name: A. f c4s--111111 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
, r ,,„.., ,, ...., Backwater valve 12.51
E'::: „ .-_,,,, 4.) ,. •• ,..-- , ,., 86 .• 1 . „
eti:f ., . ;
, A , li , r• - ■ ' . ' 4 , * • , "■-,-,, n Clothes washer 25.02
r Dishwasher 25.02
Drinking fountain 25-02
Ejectors/rump 25.02
-- .;`-.L'-" , t37-zt - ."-.6 ( ."4. - .siT,.‹..,..1; ,,, e". :, . , 'I, A+ 5 ; - .., , '11% -:*.ra." 4,r. c` 1 "-1411ef';' ' Expansion tank 12.51
:
W 0.tawk.... ..,.tlf.f::*:.•:!,:. ,,: Alnft - ...,‘ •
Fixture/sewer cap 25.02
Name: Aub _ &----
Floor drain/floor sink/hub 25.02
Address: . Garbage disposal 25.02
City/State/ZIP: Hose bib 25.02
Phone: ( ) Fax: ( ) lee maker 12.51
-J P ■--, -: - - -`4,1%,...Z"
[;ti'■,..''rAi ' eqi xtP 3 I.: 0 'ftrri•
Interceptor/grease trap 25.02
: .,1,•;,,snZ-/d3-t - - -,- ;t=:-,izi:::;•".k,:s;.;. , .. „ .::4,st.lit. •,• 221111nI*27.417. A .1,. ....WI. N,.. ., _ ,
Rpm _ pri ,11111.11111 Medical gas (value: $ _ ) Page 2
Business name: tiVOIEM/ , . . ii./ ..AZ. Primer 12.51
Contact name: IY) t 0 11.411// I 1%C. 12.51
... ,....
Address:
. IP 4 Sink/II: = lavato WM 25 Mlirra
-ity/Stateg / a a --414D-- . _
-Solar-u t i otable-watcr)
Mail -
Phone: ( 0 ) ti - ' Fax: : (516) ? .4- F2_, giro= howcr pan 12 PAI -
51 Mira
- -"-- 25.02
E-mail:
- ' • ' tr''..t. •1, , ••;•, • I •
- 1... - ??itl s ::i 4 ; 4 ;? ,. .4 - ;. 1 003F4 4 , Vikifint:R4iii. ''; :r.M.' -- )y f• -- ,. -- • 25.02
•...,,,....pi.1,A.•_,E,..v.,,,, - ,s :: ..,: - 1 'SiVe'zle“ ' '14 .... V. .." ' .- water h ea t er 11111 37.52
Business Mme: P Oltoto r 'tiA4V1J9LAJ1 Water pipingIDWV 56.29
•
Address: Other: 1111 25.02
• ,,-V-V- -. 50 D
City/State/ZIP:
Ph. ) Fax: ( )
Minimum permit fee: $72.50
; .
Plan review (25% of permit fee)
CCB Lie.: .512..37 fr A- Plumbing Lic. no.: 34_-156 P6 -
State surcharge (12% of permit fee) ! 10
N.
Authorized signature: TOTAL PERMIT FEE 121U2 1/
Pthn;;mute: i 0-1/4 Date: . 1fla . This permit applicolon expires If a permit is not obtained within 180 days
after it has been accepted as complete.
*Fee methodology set by Th.-Comity Building Industry Service Board.
1:113uildirlitrermitaLNIU-Pen1ti14p 10/01/09 440-40167(I0/02/COM/WEB) . .
AUG /17 /2012 /FRI 11:40 AM POWER PLUMBING FAX No, 503 244 8825 P. 002
Plumbing Permit Application - City of Tigard •
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Su 1 . ression S stems:
., f { I � t+� �1 r '
,) ��� u I r r- .4 �.rw c 1 ��
1 aS=
1.
11.a .. S` .!.., r.. i rb,i. i -a!'._ 42 °_ve c 's: : : w o f jrO y .3 kt� eill Fr J2 -111 i�r JX4 � d ,,,Pall: i ,_ 7-'l 11 :; „ q ` " r .1
Footing drain -1" 100 50.03 0 to Z 000 $121.90
Footing drain -each additional 100' MEM 37.52 _ 2,001 to 3 600 $169.69
3,601 to 7 I t 3.20
Sewer- 1st 100' MIN 62.54 7,201 and er $327.54
Sewer - each additional 100' IMO 37.52
Water Service -1st 100' 62.54
� Medical Gas stems: Water Service - each additional 100' 37.52 �* i ll ryb ' 3 a tY , _ «1 , ' " fi � } F
&
Storm Rain Drain -1st 100' r 1 ��_ l(. �b •- r r �,� . ��w_ l ..: F? j x,ar,.:sai ....: -:,�, aL
_�_ $1.00 to $5,000.00 Minimum fee $ .50
Storm & Rain Drain - each additional 100' 11111111 37.52 $5,001.00 to $10,000.00 $72.50 for the first $5,000.00 and $1.52 for
!r (� 1 `1 s i� i 1 t i X a t D iii., r4 ' 7r ■ 1 . j, _ - ` �� l 1` 'r p " ,/- I t 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 ch: :c -1/2 hour and inciu $25,000.00.
Inspections outside of normal business 90.00/hr 11111 $25,00I.00 to $50,000.00 $379.50 for the first $25.000.00 and $1.45 for
hours minimum char: -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 111. $50,001.00 and up $742.00 for the first $50.000.00 and $1.20 for
minimum ohs :e -1/2 hour each additional $100.00 Or fraction thereof.
Subtotal :
W •..r,-,..m■P.
Commercial Fixture Work:
Are you capping, adding or replacing fixtures? If "yes ", ,
please indicate work performed by fixture. Failure to
accurately re . ort fixtures could result in increased sewer fees*. t
0 ,' J , 'qrf '2r U e r`J,, I .. lab: �i k e... ' •; IF�% sf'�$ a �r R 3 -„4 (�[ {, i T,L1 iT7 t /1 ,,,.0 47 ,
f :ii `.. a ,, ,,s „.,; - ' t" . RSIgiu, i, ,., J , s S _xiti
7 , i � , ; ,• w a ` - k' j'2 ', mad dig Plan review is required• for any of the following -
Baptistry/Font
Please check all that apply.
Bath - Tub/Shower ID 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 Thai ❑ 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 0 Any complex structure as defined in OAR918- 780 -0040.
Eye Wash
Floor Drain/sink - 2" - Submit 2 sets of plans with any of the above.
-3"
- - -- _,.. -- -Car washDrain.. - -'- l rcrl _ _, Cil.t..",i) 1w! Z I t
t3a rbage _ .,-
- Domestic -non -food - - - -�•�� • ��_ -� -� -� -- • - O Isomaric or nse• r�lagais required • for new litul dings -
Disposal -Domestic-food related that meet the • ualxf`lcatious above.
- Commercial -food related
-Industrial-food related
Ice MachiRefrig. Drains
Oil Separator (Gas Station) Comments regarding fixture work:
Rec. Vehicle Dump Station V
Shower -Gang
-Stall
Sink/Lav -Non-food related t
- Bradley -
- Commercial -food related
- Service
Swimming Pool Filter *Note: If the fixture work under this ermit results in an
Washer - Clothes p
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 li1.13 plumbing permit can be issued.
Other Fixtures: /
Imp://www.tigard-or.govicity hall/ deparnnents /cd/docs/PLMF- PermitApadoc