Permit CITY OF TIGARD PLUMBING PERMIT
C • COMMUNITY DEVELOPMENT Permit #: PLM2012 -00264
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 09/12/2012
Parcel: 151260000300
Jurisdiction: Tigard
Site address: 9432 SW WASHINGTON SQUARE RD K02
Project: Hannah Society Subdivision:VASHINGTON SQUARE ESTATES NO. Lot: 108
Project Description: Replace previously existing lay and add (1) 3/4" water meter. No change in EDU's
Contractor: KODIAK PLUMBING Owner: PPR WASHINGTON SQUARE LLC
12030 SE MT SCOTT BLVD BY THOMSON PROPERTY TAX SERVICES
PORTLAND, OR 97266 2235 FARADY AVE, STE 0
CARLSBAD, CA 92008
PHONE: 503 - 756 -4696 PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Lavatories 09/12/2012 $25.02
Specifics: 25 Misc Other Fee 09/12/2012 $25.02
1 12% State Surcharge - 09/12/2012 $8.70
Type of Use: COM Plumbing
Class of Work: ALT 22 ea Minimum Fee Adjustment - 09/12/2012 $22.46
Type of Const: Plumbing
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, o ' • is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility • ification Cen - Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. You may obtain a copy of the rules
or •' ect questions to OUNC • • • 13.232.1987 or 1.800.332.2344.
Is� ued By: ' I Permittee Signature:
t
L
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
RECEIVED 01 I I US U. O
: City of Tigard Receive w /} / 1 / Permit No.: ��10(fQ
Date/Sy: : " 7 " `
q 13125 SW Hall Blvd., Tigard,OR 97223 Plan Review
ll Phone: 503.718.2439 Fax: 503.598.19601 2 ?()12 Date/By: Other Permit No.:
Inspection Line: 503.639.4175 luris: la See Page 2 for
Internet: www.ti
1 1 � It D ard -or. ov CITY OF Date Ready/By: g
g g Notified/Method: Supplemental Information
TYPE 01BVLMING DIVISION 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 ft. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (I) 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 L9CATION Site utilities:
Job site address: WfU t�� A....ki. l...K tt-s� Catch basin or area drain 18.76
City/State /ZIP: Drywell, leach line, or trench drain 18.76
Footing drain (no. linear ft.: ) Page 2
Suite/bldg. /apt. no.: Project name tB 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
P ESCRIPTION OF WORK Backwater valve 12.51
t n '� 1 Clothes washer 25.02
�.'_•t I �%.t� `, . _w _ n d L . , Mzi" W Dishwasher 25.02
' _11 • Drinking fountain 25.02
Ejectors /sump 25.02
ROPERTY OWNER I 0 TENANT Expansion tank 12.51
Name: C .04rx 4 N r o - x - J 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 l 25.02 �6"
City/State /ZIP: Solar units (potable water) 62.54
Phone: ( ) Fax: : ( ) Tub /shower /shower pan 12.51
E -mail: Urinal 25.02
Water closet 25.02
CONTRACTOR
Water heater 37.52
Business name: 6 e g o �/ , , Water piping/DWV 56.29
Address: /,. A %) fl /t 5-e, (.4 vv
`4(i/..i Other: ov r-erL/ t 44 a 25.02 0
City/State/ZIP: /1 Z Subtotal
v �� �� y Fax: ( )
r� Minimum permit fee: $72.50 7A.6-6 Phone: (5:33 CCB Lic.: 7a c / it i/ b 9- Plumbing Lic. no.: No -- T/ / /45 Plan review (25% of permit fee) �-
S J State surcharge (12% of permit fee) Q. 7U
Authorized signature: �� ?� //t / TOTAL PERMIT FEE gr • 2
�t
Print name: Da e: _ This permit application expires if a permit is not obtained within 180 days
_ after i t has been accepted as complete.
'Fee methodology set by Tri-County Building Industry Service Board.
I:\ Building \Pennits\PLMU- PennitApp.doc 10 /01/09 440- 4616T(10 /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
Sewer - 1st 100' 62.54 3,601 to 7,200 $233.20 • •
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 . $25,001.0016 $50,000:00 $379:50 Tor 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
-Tub/Shower ❑ New exterior plumbing site utilities for any complex structure
Bath - er
Tub /Show as defined in OAR918- 780 -0040.
Car Wash zi / Stall
erlpool ❑ Medical gas and vacuum systems for health care facilities.
Drive Stall ❑ Any multipurpose fire sprinkler system.
Cuspidor/Water Aspirator • ❑ Any complex structure as defined in OAR918 -780 -0040.
_ Dishwasher - Commercial -
Domestic Submit 2 sets of plans with any of the above.
Drinking Fountain .
Eye Wash Isometric or Riser Diagram
• Floor Drain/sink - 2" V ❑ Isometric or riser diagram is required for new buildings
3 that meet the qualifications above.
Car . Wash Drain . v .
Garbage - Domestic
Disposal • - Commercial
- Industrial Comments regarding fixture work:
Ice MachiRefrig. 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:
I: \ Building \Permits\PLM- PermitApp.doc 2