Permit CITY OF TIGARD PLUMBING PERMIT
I I a • COMMUNITY DEVELOPMENT Permit #: PLM2012 -00260
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 09/06/2012
Parcel: 2S103CD07600
Jurisdiction: Tigard
Site address: 13700 SW 118TH CT
Project: Stewart Subdivision: CREEKSIDE PARK Lot: 6
Project Description: (1) hot water heater replacement
Contractor: 00)) � Owner: STEWART, WILLIAM R AND LORENA R
13700 SW 118TH CT
TIGARD, OR 97223
PHONE:
PHONE: 503 - 620 -6122
FAX:
FEES
Quantity Description Date Amount
1 ea Water Heater 09/06/2012 $37.52
Specifics: 1 12% State Surcharge - 09/06/2012 $8.70
Plumbing
Type of Use SF 35 ea Minimum Fee Adjustment - 09/06/2012 $34.98
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 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 to OUNC by calling 503.232.1987 or 1
Issued By: `P .1 ` I - 1 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.
Plumbing Permit Application
Building Fixtures
RE
City of Tigard Received P em h No.:
v 13125 SW Hall Blvd., Tigard, OR 97223 S E P 0 6 2012 DateB 4 0//2-- � i 101,)„.DDS
C P hone: 503.718.2439 Fax: 503.598. Plan Review
19 -�/ ryF T p� Date/By: Other Permit No.: 61 T I GA k D
Inspection Line: 503.639.4175 � 1 I j � 1 1 I IL111RL Date Ready Ready/By: See Page 2 for
Internet: www.tigard or.gov II ` DI DIVISION Notified/Method: Supplemental Information
TYPE OF WORK FEE* SCHEDULE
❑ New construction ❑ Demolition For special information use checklist.
Description I Qty. I Ea. I Total
® Addition/alteration/replacement ❑ Other. New 1 2 - family dwellings (includes 100 R. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (1) bath 312.70
® 1- and 2- family dwelling ❑ Commercial/industrial SFR (2) bath 437.78
building SFR (3) bath 500.32
❑ Accessory g ❑ 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: 13700 SW 118 Ct Catch basin or area drain 18.76
City/State /ZIP: Tigard, OR 97223 Drywell, leach line, or trench drain 18.76
Footing drain (no. linear R: __) Page 2
Suite/bldg. /apt. no.: I Project name: Manufactured home utilities 50.03
Cross street/directions to job site: Gaarde Manholes 18.76
3 Right off Gaarde after Right off Highway 99 Rain drain connector 18.76
Sanitary sewer (no. linear R: ) Page 2
Storm sewer (no. linear R: ) 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 Backw valve 12.51
Clothes washer 25.02
hot water heater replacement
Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
® PROPERTY OWNER ❑ TENANT Expansion tank 12.51
Name: Bill and Lorena Stewart Fixture /sewer cap 25.02
Address: 13700 SW 118 CT Floor drain/floor sink/hub 25.02
Garbage disposal 25.02
City/State/ZIP: Tigard, OR 97223 Hose bib 25.02
Phone: (503)620 -6122 Fax: ( ) Ice maker 12.51
® APPLICANT ❑ CONTACT PERSON Interceptor /grease trap 25.02
Business name: Medical gas (value: $ ) Page 2
Contact name: Bill or Lorena Stewart Primer 12.51
Roof drain (commercial) 12.51
Address: 13700 SW 118 Cr Sink/basin/lavatory 25.02
City/State /ZIP: Tigard, OR 97223 Solar units (potable water) 62.54
Phone: (503) 620 -6122 I Fax: : ( ) Tub /shower /shower pan 12.51
E -mail: lorenaandbill @gmail.com Urinal 25.02
CONTRACTOR Water closet 25.02
Water heater 1 37.52
Business name:
Water piping/DWV 56.29
Address: Other. 25.02
City/State /ZIP: Subtotal
Phone: ( ) F ax: ( ) Minimum permit fee: $72.50
Plan review (25% of permit fee)
CCB Lic.: Plumbing Lic. no.:
State surcharge (12% of permit fee)
Authorized signature, 44 `� , TOTAL PERMIT FEE Rt. ?A)
Print name: Lo re/t 1 S fGlNs4 t I Date: 9/62013 This permit application expires ita 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 \Perntts\PLMU- PemntApp.doc 10/01/09 440-4616T(f0/02/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
Q ty. Fee (ea) Total each additional $100.00 or fraction thereof, to
• Other Inspections or Fees 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
Quimby by Fixture Type Plan Review for Plumbing Installations
Fixture Type for Replace/ Plan review is any re required for of the following. Performed: Copped Added Relocate <l g'
Baptistry/Font 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 Thru ❑ 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 ❑ 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"
- 4- Isometric or Riser Diagram
Car Wash Drain
Garbage - Domestic -non -food ❑ Isometric or riser diagram is required for new buildings
Disposal - Domestic -food related that meet the qualifications above.
- Commercial -food related
- Industrial -food related
Ice Mach./Refrig. Drains
Oil Separator (Gas Station) Comments regarding fixture work:
Rec. Vehicle Dump Station
Shower -Gang
-Stall
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 EDNs, 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:
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