Permit CITY OF TIGARD PLUMBING PERMIT
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IIII s COMMUNITY DEVELOPMENT Permit #: PLM2012 -00254
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 09/04/2012
Parcel: 2S 112DC01400
Jurisdiction: Tigard
Site address: 15865 SW 74TH AVE 115
Project: Builder Services Group, Inc Subdivision: FANNO CREEK ACRE TRACTS Lot: 4
Project Description: (1) water closet, (1) lavatory and (1) water heater
Contractor: GRIDLINE PLUMBING Owner: JDS LLC
4343 SE 37TH CRITERION CREEKVIEW LLC
PORTLAND, OR 97202 ATTN JAMES A MEYER
PO BOX 6525
BEAVERTON, OR 97007
PHONE: 503 - 771 -8790 PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Lavatories 09/04/2012 $25.02
Specifics: 1 ea Water Closet 09/04/2012 $25.02
1 ea Water Heater 09/04/2012 $37.52
Type of Use: COM 1 12% State Surcharge - 09/04/2012 $10.51
Class of Work: ALT Plumbing
Type of Const:
Occupancy Grp:
•
Stories:
Total $98.07
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 folio e rules .dopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. You may obta a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: Permittee Signature: / i.
Call 503.639.4175 by 7:00 a.m. for the next available in- ? -ct'.. : • .
This permit card shall be kept in a conspicuous place on the job site until comp etion of the project.
Approved plans are required on the job site at the time of each inspection.
Plumbing Permit Application RECEV
City of Tigard SEP 0 4 2012 Received /1I�� r'i Permit a _ r,/
111
Y 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
�I af-- ri'1 �0�'7 Y
C �f l i OF TomD D an Re - ^
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Phone: 503.718.2439 Fax: 503.598.196 Pla R . Other Permit No . f 69
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Inspection Line: 503.639.4175 /� Date B Irk ® 2
I I G n li D Internet: www.tigard- or.gov BUILDING DIVISION Notifie elhod: �� Supplemental See Pa e Information for
TYPE OF WORK FEE* SCHEDULE
❑ New construction ❑ Demolition For special information use checklist
Description I Qty. I Ea. I Total
:. ition/alteration/replacement ❑ Other: New I- 2- family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (I) bath 312.70
❑ 1- and 2- family dwelling ' - . � erciaUindustrial SFR (2) bath 437.78
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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: / i ', !� 444 Catch basin or area drain 18.76
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City /State /ZIP: / 6 / �! Drywell, leach line, or trench drain 18.76
Footing drain (no. linear ft.: ____) Page 2
Suite/bldg. /apt. no.: j / 5 I Project name: 7 ' S Manufactured home utilities 50.03
Cross street/directions to job site: %('0 Ce.S . 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
2) / GdQ / ` G ` OSe 7 Clothes washer 25.02
✓ l,..417 i ` Dishwasher 25.02
/ - Drinking fountain 25.02
f , ()a-.-il Ai. > Ejectors /sump 25.02
❑ PROPERTY OWNER I ❑ TENANT Expansion tank 12.51
Name: Fixture /sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address:
Garbage disposal 25.02
City/State /ZIP: Hose bib 25.02
Phone: ( ) Fax: ( ) Ice maker 12.51
❑ APPLICANT ❑ CONTACT PERSON Interceptor /grease trap 25.02
Business name:
Medical gas (value: $ ) Page 2
Primer 12.51
Contact name:
Roof drain (commercial) 12.51
Address: Sink/basin/lavatory X / 25.02 0 2 .5
City /State /ZIP: Solar units (potable water) 62.54
Phone: ( ) Fax: : ( ) Tub /shower /shower pan 12.51
E -mail: Urinal 25.02
Water closet X 1 25.02 CZ 5/ 02_
CONTRACTOR 4 Water heater f / 37.52 37 .5v.,
Business name: -
D / n r t /1, Water piping/DW V 56.29
Address: 1 1 ' GZ ■ Other: 25.02
City /State /ZIP: t 9 g � 4.-- # 0/2-- 977 Subtotal
Phone: ( ,,,, 7 / -e-a Fax: (J��3 7 7/-/A9''3 _ Minimum permit fee: $72.50
I. Plan review (25% of permit fee)
CCB Lic.: . 71/e/ I ' bing Lic. no.: �� i
State surcharge (12% of permit fee)
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Authorized signature: ` s TOTAL PERMIT FEE ` (/t1 07
w/
Print name: , _ Date: - 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 Board.
I:\ Building \Permits\PLMU- PermitApp.doc 10 /01/09 440- 4616T(I0 /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 - I' 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
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 ", Plan Review for Plumbing Installations
please indicate work performed by fixture. Failure to Plan review is required for any of the following.
accurately report fixtures could result in increased sewer fees * . Please check all that apply.
Quantity by (Fixture) Work Performed ❑ Any new commercial building with water service 2" and
Fixture Type: Replace greater, except systems designed and stamped by licensed
Previous Capped Added Existing engineer.
Baptistry/Font
Bath - Tub /Shower El New exterior plumbing site utilities for any complex structure
Tub /Sh/Whirlpool as defined in OAR918- 780 -0040.
Car Wash Each Stall ❑ Medical gas and vacuum systems for health care facilities.
Drive tall El Any multipurpose fire sprinkler system.
Cuspidor/Water ❑ Any complex structure as defined in OAR918 -780 -0040.
Dishwasher -Commercial Submit 2 sets of plans with any of the above.
- Domestic
Drinking Fountain
Eye Wash Isometric or Riser Diagram
Floor Drain/sink - 2" ❑ Isometric or riser diagram is required for new buildings
- 3 that meet the qualifications above.
-4"
Car Wash Drain
Garbage - Domestic -
Disposal - Commercial
Industrial Comments regarding fixture work:
Ice Mach./Refrig. Drains
Oil Separator (Gas Station)
Rec. Vehicle Dump Station
Shower -Gang
-Stall
Sink - Bar/Lavatory
- Bradley
- Commercial *Note: If the fixture work under this permit results in an
- Service increase of sewer EDUs, a sewer permit will be issued and
Swimming Pool Filter fees assessed for the sewer increase must be paid before the
Washer - Clothes
Water Extractor plumbing permit can be issued.
Water Closet - Toilet
Urinal
Other Fixtures:
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