Permit •
•
CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit #: PLM2012 -00255
T I GARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 09/05/2012
Parcel: 1S 133AD02200
Jurisdiction: Tigard
Site address: 10730 SW 130TH AVE
Project: Westgate Baptist Church Subdivision: HAWK'S BEARD TOWNHOMES Lot: 62
Project Description: Adding utility sink to 2nd floor
Contractor: SHARPE PLUMBING Owner: WESTGATE BAPTIST CHURCH
PO BOX 23984 12930 SW SCHOLLS FERRY RD
TIGARD, OR 97281 TIGARD, OR 97223
PHONE: 503 - 590 -7050 PHONE: 503 524 -3500
FAX: 503 - 400 -6714
FEES
Quantity Description Date Amount
1 ea Sink 09/05/2012 $25.02
Specifics: 1 12% State Surcharge - 09/05/2012 $8.70
Plumbing
Type of Use COM 47 ea Minimum Fee Adjustment - 09/05/2012 $47.48
Plumbing
Class of Work: ALT
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 • ' .. • . - ter. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. You may obtain a copy of the rules
or • -ct questions to 0 •y c- Ilia . 503.232.1987 or 1.800.332.2344.
I - sued By: I 4, 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.
I
From: Rebecca Sharpe Fax: (503) 400-6714 To: +15035981960 Fax: +15035981860 Page 2 of 4 9/4/2012 4:57
i ���!
Plumbing Permit Application 't
„ ,.. ,
._ , .
Building Fixtures Foil of I� Icl u o
SC, N!_)• ,
City of Tigard
S EP 0 4 2 012 Dy�y 9 4/, III, / 1 Permit N°.: °Li1jo%Z- 7
P SW Hall Blvd., Tigard, OR 97223
Plan Review Other Permit No. O(IZ�a ig7 /
= Phone: : 503.718.2439 Fax: 503.598.1960
Inspection Line: 503.639.1175 CITY OF TIGA.R Date Ready /t3 1 turn: Fa See Page 2 for
, T:IGARD 5' I
Internet: www.tigard ��/� utifcdMethud: Supplemental Information
TYPE OF WORIt°" DI J1S CR I FEE* SCHEDULE
❑ New construction I ❑ Demolition i For special information use checklist
- - - - ._...._.._... ..------- . ____ - - -- - -- -- 1 Description 1 Qty. ; 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 1 312.70
❑ I - and 2- family dwelling OkCommercial/industrial SFR (2) bath 437.78
- - I - --1 SFR (3) bath ( 500.32 j
❑ Accessory building ❑ Multi- family ; Q
Each additional bath/kitchen i 25.02
❑ Master builder ❑ Other. Fire sprinkler ( sq. ft.) I Page 2 5.3
475 Sv, /,30 JOB SITE INFORMATION AND LOCATION Site utilities: t
Job site address: . ' t _ / _ I Catch basin or area drain 18.7(i
City/Slate/ZIP: --r' t -/ n` d O R . Z 23 .
i Drywell leach line, or trench drain 18.76
Fooling drain (nu. linear IL: _._ ) Page 2 I j ( fi n
Suite/bldg. /apt. no.: ' Protect name: (,oty� � 6,075 7--- Manufactured home utilities 50.03 V
Cross street/directions to job site: rn .€6# Manholes 18.76
G Q t 3 _ k- k1 Rain drain connector ..- . 18.76
•J Sanitary sewer (nn. linear ft.: _) Page 2
Stouu sewer (110. linear ft.: ) Page 2
Water service (no. linear ft.: ) Page 2
Subdivision: L Lot no.: Fixture or item:
Tax map/parcel no.: /j!_3 g7/q Do? POD Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51 __
A� d Clothes washer 25.02
�,L 1 1 1 [ cA tI \L - 2 �ct 5 A-a� t-1 Dishwasher 25.02
J Drinking fountain 25.02
Ejectors/sump 25.02
PROPERTY OWNER ❑ TENANT Expansion tank 12.51
Name: Wes c,1 e. 6 -1-. S,>t- C,_ VA \ IA
Fixture/sewer o flo r 25.02
n� - Floor drain/floor sink/hub 25.02
Address:
Z-1 3 0 51J1 n Sc \ c1 S r C((11 O ci Garbage disposal 25.02
City /Stare/ZIP: '1 gafd 1 (3" 17 123 �' Hose bib 25.02
Phone: c50 t Fax - Ice maker
(503) a Z�- 350 ( S Q'� 524 NS( e 12.51 .. 0 APPLICANT PC CONTACT PERSON Interceptor /grease trap 25.02
fit, n (� Medical gas (valve;: S ) Pape 2
Business name:
�_ Re /'fi1 Primer 12.51
Contact name: F c , a Y . \ N `L i-F-r. n l
l� U Roof drain (commercial) 12.51
Address: ‘ i 5w L\ FtrPSt B \V4 Sink/basin/lavatory -- ( 25.02 25 b2
City /State/Z1P: IS,_ l' c i2 c) O 2 Solar units (potable water) 62.54
Phone: (5o'3) 512. -13r/ z Fax:: (' ) Tub/slum - et /slower pan 12.51
E -mail: Urinal 25.02
Water closet 25.02
CONTRACTOR _ _ Water heater 37
� _.. -
Business name: Y70. C P_ pt (A,.Yfw-)., VI C Water piping/DWV - 56.29 -
`J
Address: �6 (�13r`X 2- :21:00-1 J Other: 25.02
City /State/ZIP: cora R RI Z g. i Subtotal 2 5 , O Z
Phone: (503) C� 4 Minimum permit fee: $72.50 72 ,so.
c503) ��D� - 1oS�7 I F c..o� UGO- C� -i
CCB Lie.: 2 9 % 4/ /i // s Plumbing Lie. no.: 7( - 5 1 J PB Plan review (25% of permit fee)
,/ / / // T f State surcharge (12% of permit fee) % ,Q
Authorized signature: ,/ � / , - rr --s"c TOTAL PERMIT FEE 'A y ,'ZV
i T his permit application expires d a permit is not obtained within 180 days
Print name: �[ V P Date: 0 � � o y r 2 after it has been accepted as complete.
"Feu wuticdulugy set by TO-County Building Industry Service Board.
1'130ding \Pennils\PL.MU- rmnitApp.doc l4'01tt19 440.4616T( IO/OYCOM/WES) •
From: Rebecca Sharpe Fax: (503) 400 -6714 To: +15035981960 Fax: +15035981960 Page 3 of 4 9/4/2012 4:57
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 - l" 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 1t 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 $10,000.00 572 50 for the first .55,000.00 and $1.52 for
Other ins ections or Fees Qty. Fee (ea) Total each additional $100.00 or fraction thereof, to
p and including $10,000.00.
Inspection of existing plumbing ur for $10,001.00 to $25,000.00 $148.50 for the first $10,110000 and $1.54 for
which no fee is specifically indicated 90.00Au each additional $100.00 or fraction thereof. to
(ntinintwn charge - 1/2 how) 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 OO)hr $50,001.00 and up $742.00 for the first $50,000.00 and $120 for
(minimum charge - l2 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: t apped Added Relocate Plan review is required for any of the following.
HaptisW — - 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 Thou ❑ New exterior plumbing site utilities for any complex structure
Cus p idor/Water Aspirator as defined in OAR918- 780 -0040.
__.!gip
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.
Eve Wash
Floor Drain /sink -2" Submit 2 sets of plans with any of the above.
-
Isometric o r Riser Diagram
Car Wash Drain • ❑ Isometric or riser diagram ram is required fur new buildings
Garbage - Domestic-non -food 9 g
Disposal -Domestic-food stared that meet the qualifications above.
-Commercial-food related
- Industrial -food related
Ice Mach./Refrig. Drains
Oil Separator (Gas Station) - -- Comments regarding fixture work:
Rec. Vt./tide Dump Station
Shower Clang , l / L , 1 _
-Stall 1
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:
ht1p:/ /www.tigard - or.gov /city L' departments /cd /dors/PLMF- PetmitApedoc
•
From: Rebecca Sharpe Fax: (503) 400 -6714 To: +15035991960 Fax: +15035981960 Page 1 of 4 9/4/2012 4:57
F a X Date: 9/4/2012
Pages including cover sheet: 14
To: +15035981960 From: Rebecca Sharpe
Sharpe Plumbing
PO Box 23335
Tigard
OR 97281
Phone Phone (503) 400 -6714
Fax Number +15035981960 Fax Number (503) 400 -6714
NOTE:
plumbing permit application & credit card authorization
•
Send and receive faxes with RingCentral, www.ringcentral.com RI. Ce '